Abdominal aortic aneurysms (AAA) are a localized dilation of the artery wall. This will eventually weaken the wall and potentially rupture, which is a life threatening, possibly fatal event.

This 72 year-old patient presented with a large, infrarenal AAA. The treament of the aneurysm with an endovascular stent was the result evaluation of the patient's overall health and the morphology of the aortic aneurysm. The stent deployed included bilateral iliac components. A follow-up scan was performed in order to assess the stent's patency and overall status of the patient's abdominal aorta. The patient will have subsequent follow-up CT evaluations as needed to rule out potential issues such as stent leakage or movement of the stent.

The use of 3D volume rendering and maximum intensity projection (MIP) on the Visage CS, simplifies and accelerates the process of visualizing the diagnostically relevant, contrast enhanced anatomy. In addition, the use of enhanced tools such as automatic bone removal and vessel analysis, including vessel tracing and curved plane reformation, results in facilitating a rapid diagnosis and treatment.

Most cerebral aneuysms are diagnosed after the aneurysm leaks or ruptures which is usually confirmed by CT angiography. CT Angiography (CTA), however, can be an excellent screening tool which may reveal an unruptured aneurysm.

Using the CTA data, the Visage CS can demonstrate the cerebral aneurysm using 3D visualization. The use of 3D volume rendering, maximum intensity projection (MIP) and a variety of segmentation tools, enables the user to quickly visualize and evaluate the aneurysm and surrounding anatomy while isolating vascular structures.

In addition to powerful, easy to use, visulaization tools, the Visage CS can easily share this information, as a completely interactive session on the server for others to view and manipulate. This will enable surgeons and interventional specialist with surgery and procedure planning, even from remote locations, such as the operating room.

A 76 year-old patient was found with serious stroke symptoms and brought to the hospital late at night. A CT perfusion scan was performed in the emergency department and analyzed using the brain perfusion analysis available in the Neuro package of Visage CS.

Signs for a cerebrovascular accident are clearly visible in the functional maps showing mean-transit-time and time-to-peak. The on-call neurologist could do this diagnosis directly from home using the wide-area-network capabilities of the thin client.

Linked side-by-side viewing is very helpful in follow-up studies as this case of lung cancer. MIP display of thick slices reveals nodules and lesions in the lung very well.

In this case, the lung nodules showed significant growth over time which was documented using the workflow optimized lesion analysis tool available with the Oncology option of Visage CS.

A 31 year-old man with right M1 aneurysm and right ECA/ICA bypass had a routine follow-up on bypass status. A Head CT/CTA was performed according to standard CTA aneurysm protocol, 3D reconstructed views were obtained in multiple standardized planes.

The right ECA/ICA bypass is stable and patent. There is no evidence of acute hemorrhage. There is retrograde filling of the residual aneurysm sac, the left vertebral artery is dominant. The brain parenchyma appears stable without evidence of acute infarction.

A 63-year-old male patient scheduled for resection of a tumor in the left liver lobe was presented to clarify the tumor entity and to plan the expected resection plane.

MR imaging was performed with a 1.5 Tesla, 32-channel, whole body MR scanner (Magnetom Avanto, Siemens Medical Solutions, Germany; max. gradient strength 45 mT/m, min. rise time 200 µsec) using a dedicated phased-array surface coil. 10 ml of the liver-specific contrast agent Gd-EOB-DTPA (Primovist, Bayer-Schering Pharma, Germany) was applied intravenously and images were acquired during the dynamic phases (arterial, portal phase) and during the liver-specific phase 20 min. after contrast injection.

MR imaging revealed a large lobulated, partially necrotic tumor in segments 4a and b, retracting the liver surface and infiltrating the gallbladder and the right colonic flexur. In addition a local peritoneal spread close to the liver segment 5 infiltrating the more proximal ascending colon was observed. The tumor showed an inhomogeneous, peripherally and centrally accentuated contrast enhancement in the portal phase and a wash-out during later phases. Coronal images and curved MPR allowed a better appreciation of the colonic infiltration and a precise localization of the lower tumor nodules to extrahepatic peritoneal rather than intrahepatic.

Imaging findings lead to the first differential diagnosis of an cholangiocellular carcinoma (CCC, bile duct adenocarcinoma), which was confirmed pathologically.

Damage to the heart muscle (myocardium) can be the result of problems such as myocardial infarction or cardiomyopathy, which impairs the heart's ability to eject blood. Using a retrospectively gated, multi-phase CT scan of the heart allows for rapid analysis of the heart's ability to eject blood from the left ventricle.

The Visage CS provides for rapid, semi-automated analysis of the left ventricle, from anywhere in the enterprise, using the CT data. LV Analysis will automatically segment the left ventricle, in every phase, resulting in calculation of ejection fraction (EF); stroke volume; end diastolic and end systolic volumes and cardiac output.

Results are displayed including numeric values and a 16 segment circumferential polar plot (bull's eye) representing such values as regional volume and wall motion. The bull's eye will aid in detection of myocardial ischemia and effected region of the myocardium. Finally, the resulting LV segmentation can be represented in volume rendered 3D and 4D cine views. The segmentation and findings can be saved as a session which can be accessed by other clinicians for further interaction and evaluation.

A 22-year-old patient was admitted to the hospital with a benign cystic tumor in the left lateral skull base that affected the mechanical stability of the temporomandibular joint. The whole lesion was visualized on 3D volume-rendered images of the skull. A patient-specific ceramic implant was designed and manufactured on the basis of these images. The outline of the implant was used as input for an intraoperative navigation system. Small titanium marker screws were inserted in the perimeter of the TMJ under local anesthetic. These marker screws were used to register the virtual model of the implant outline with the current position of the patient during surgery. The outline was transferred to the patient's skull, providing guidance for the surgical removal of the cystic tumor and surrounding bone. The implant was then inserted and secured to the skull using standard osteosynthesis plates.

A second CT scan was performed postoperatively. Some advanced visualization functions were used for this imaging assessment.

A follow-up study for a 32 year-old woman with lung cancer was scheduled during radio therapy in order to assess the therapeutic effectiveness of this treatment on the patient.

Viewing the current and prior exams side-by-side in fused mode showing PET and CT superimposed revealed that the main tumor in the upper left lung was considerably reduced in size. Unfortunately, several metastases had formed in spine and abdomen. Using a combined PET/CT scan these lesions could be identifed well and their growth could be docuented using the lesion workflow provided in the oncology option of Visage CS.

A 88-year-old lady suffering from tachyarrhythmia absoluta presented with central abdominal pain and vomiting since more than 10 h. The abdomen was tenderness in the lower half. Blood tests showed beneath a mild leucozytosis and elevated lactate. Plain x-ray of the abdomen revealed one single dilated small bowel loop in the upper abdomen. Under suspicion of a bowel ischemia, the patient was referred for contrast enhanced CT.

Coronal reformation shows the radial distribution of distended, fluid-filled small-bowel loops (so called 'spoke wheel sign') with a hyperdense thickened wall due to venous congestion. As one can load two datasets at one time in the visage 3D thin client viewer and link them, a real 3D side-by-side PR comparison is feasible. This shows that the hyperdensity of the bowel wall shows no change and is therefore not reflecting contrast enhancement but hemorrhagic infarction of the bowel wall.

A 50-year-old male patient with primary adrenal cancer initially presented one year ago for whole-body tumor staging. A survey of his tumor load was now requested while receiving dedicated therapy. Whole-body MR imaging was performed for whole-body tumor staging.

MR imaging was performed with a 1.5 Tesla, 32-channel, whole body MR scanner (Magnetom Avanto, Siemens Medical Solutions, Germany; max. gradient strength 45 mT/m, min. rise time 200 µsec) using five dedicated phased-array surface coils for the head, neck, thorax, abdomen, pelvis, and the lower extremity. A total of 600 images were acquired in one examination, hence 1200 images in both examinations had to be analyzed simultaneously.