E1693. 3D and Cinematic Rendering of Abdominopelvic Pathology in the Peripartum Period
Authors
Naveen Ghuman;
Johns Hopkins Hospital
Elliot Fishman;
Johns Hopkins Hospital
Erin Gomez;
Johns Hopkins Hospital
Background
While ultrasound is the first-line imaging modality for evaluation of pelvic pathology in the peripartum period, certain clinical conditions may warrant evaluation with CT imaging of the abdomen and pelvis, particularly if maternal or fetal health is at risk. When CT is indicated, advanced visualization methods such as 3D and cinematic rendering may aid in characterization of findings, guiding diagnosis and treatment.
Educational Goals / Teaching Points
Review indications for abdominopelvic CT in the peripartum period. Discuss the advantages of advanced visualization techniques including 3D and cinematic rendering, an evolving post-processing technique which can maximize diagnostic utility of the examination by providing photorealistic datasets that can be manipulated at the workstation. Highlight imaging findings present in a number of urgent and emergent clinical entities occurring in the peripartum period which may be better visualized by advanced imaging techniques.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will discuss indications for CT of the chest, abdomen, and pelvis during pregnancy, including consideration of fetal radiation dose and ALARA principles. This most commonly includes evaluation of acute trauma, post-procedural complications and/or peripartum hemorrhage. We will review general concepts and technique related to the creation of cinematic renderings from CT datasets. Advantages of 3D and cinematic rendering will be discussed, including improved anatomic detail with photorealistic lighting, precise vascular mapping and delineation of spatial relationships between pelvic structures. The normal appearance of the gravid uterus and placenta on standard CT and 3D and cinematic renderings will be reviewed. Clinical entities occurring in the context of pregnancy and/or the peripartum period which may be better visualized with advanced imaging techniques will be discussed, with identification of key imaging features via the use of image-rich case vignettes, including ectopic pregnancy (both tubal and intra-abdominal), placenta accreta spectrum (with a focus on placenta percreta), postpartum complications, uterine dehiscence following cesarean section, postpartum hemorrhage, cervical and vaginal laceration, vascular anomalies, pseudoaneurysms, vascular malformations, complications of collagen vascular disease, gynecologic malignancy.
Conclusion
Certain clinical conditions such as acute vascular pathology or post-procedural complications may warrant evaluation with abdominopelvic CT in the peripartum period, particularly if maternal or fetal health is at risk. Cinematic and 3D renderings of CT data may serve as a helpful adjunct technique, permitting detailed visualization and manipulation of anatomic structures during post-processing. The ability to perform precise vascular mapping and delineate spatial relationships between anatomic structures in the pelvis provides opportunities for more detailed operative and interventional planning and thus improved patient care.
