Applications of Cinematic Rendering in the Diagnoses of Compressive Complications of Saphenous Venous Graft Pseudoaneurysms: A Pictorial Essay

Pseudoaneurysms arising from the saphenous venous graft (SVGs) are an uncommon complication of the coronary artery bypass graft (CABG). Although angiography is the gold standard, computed tomography angiography (CTA) of the coronary arteries is the most efficient modality to diagnose these cases and their associated complications. Among numerous possible complications of SVG pseudoaneurysms, local mass effect on the cardiac chambers, adjacent pulmonary vasculature or coronary arteries/bypass grafts have been described. Cinematic rendering, an advanced post-processing technique can be valuable for problem solving in complex cases. In this pictorial essay, we report 3 CT cases of SVG pseudoaneurysms that demonstrate a range of CT imaging appearances of SVG pseudoaneurysms and related complications. Additionally, we will emphasize the applications of cinematic rendering in visualization of complex post-surgical cardiovascular pathology. This manuscript is designed as a pictorial essay of 3 complex cases given the relative uncommon nature of this pathology and the availability of cinematic rendering as an advanced post-processing modality. We demonstrated 3 imaging examples of utilization of cinematic rendering (CR) to demonstrate complex anatomical details of the mass-effect and compression related complications associated with SVG pseudoaneurysms. A side-by-side comparison with conventional volume rendering (VR) is also performed in 1 case for perspective and to show improved comparative visual appeal of the CR given better depth perception and more natural appearing illumination. The technical differences of the 2 techniques are also briefly discussed.