Abstract

The authors have continued their research on three-dimensional computed tomography (3D-CT) reconstruction. The patient was a 75-year-old male with hypertension and an abdominal aortic aneurysm (AAA). Data from plain and contrast-enhanced abdominal CT were analyzed for reconstruction. The size of the AAA had increased from 40 mm to 45 mm over 1 year, and a detailed evaluation of the AAA was conducted using 3D-CT reconstruction with Synapse Vincent. The AAA was shown to be fusiform with surface irregularities and a posterior bulge. Renal cysts were observed in the lower pole of the right kidney and the upper pole of the left kidney.

Abdominal Aortic AneurysmArtificial IntelligenceReconstructionSynapse VincentThree-Dimensional Computed Tomography

Abbreviations: AAA: Abdominal Aortic Aneurysm; AI: Artificial Intelligence; CT: Computed Tomography; 3D-CT: Three-Dimensional Computed Tomography; ILT: Intraluminal Thrombus

Introduction

In recent years, diagnostic radiology has seen remarkable advancements. Alongside the widespread adoption of artificial intelligence (AI), image reconstruction technologies have evolved [1]. The authors have utilized AI apparatus to generate detailed reconstructed images and have published clinical reports [2]. Notably, Synapse Vincent has been applied to various diseases and disorders [3].

In clinical practice, patients are referred to emergency care facilities or specialized departments depending on the urgency and circumstances. The availability of reconstructed images can significantly aid decision-making [4]. We recently encountered a noteworthy case involving an abdominal aortic aneurysm (AAA) showing signs of enlargement, in which three-dimensional imaging data were used to generate reconstructions. This article outlines general information relevant to this context.

Case Presentation

History and Physical Examination

The patient was a 75-year-old male. He had been taking amlodipine for hypertension for 9 years. He was formerly a civil servant until the age of 65 and is currently retired. An abdominal aortic aneurysm (AAA) had previously been identified, and he had been undergoing annual CT scans for monitoring.

A CT scan performed in September 2025 revealed the following findings: bilateral ureteral calculi, a right renal calculus, and left-sided hydronephrosis. A fusiform abdominal aortic aneurysm with a diameter of 40 mm was observed. An old compression fracture of the 12th thoracic vertebra was also noted.

The patient visited for annual AAA follow-up in September 2026. Vital signs showed a blood pressure of 131/78 mmHg, pulse of 52/min, SpO₂ of 97%, and temperature of 36.5°C. Extensive plain and contrast-enhanced CT scans were performed, covering the area from the chest to the lower extremities, and detailed images were generated using reconstruction.

Results

The AAA increased from 40 mm to 45 mm over 1 year (Fig-1). For reconstruction, the coronal view revealed the AAA and bilateral renal cysts (Fig-2a). No remarkable atherosclerotic changes were observed in the vasculature; no obvious abnormalities, such as stenosis, were detected in the cervical, thoracic, abdominal, or lower extremity vessels (Fig-2b).

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The surface of the AAA appeared irregular, and renal cysts were observed in the lower pole of the right kidney and the upper pole of the left kidney (Fig-3a). A lateral view of the area clarified the details of the AAA morphology: it was fusiform with surface irregularities and exhibited a posterior bulge (Fig-3b).

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Calcification was observed at several sites on the right posterior aspect of the aortic arch and thoracic aorta (Fig-4a). There was somewhat less calcification on the left side of the same aortic segments (Fig-4b). A frontal view of the extensive region spanning from the thorax to the lower limbs allowed for a detailed assessment of the aorta and bilateral renal cysts (Fig-5a). A left-sided view revealed the posterior aorta, the anterior and posterior branching of vessels from the aorta, and the anterior and posterior course of the femoral arteries (Fig-5b).

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Discussion

The patient had hypertension, which may contribute to the development of arteriosclerosis and AAA over time. The size of the AAA increased from 40 mm to 45 mm over 1 year. Contrast-enhanced CT showed no evidence of dissection within the AAA lumen. Reconstructed images provided detailed information regarding the AAA, calcification, and renal cysts.

Regarding the incidence of AAA, approximately 2-12% of people older than 65 years are estimated to have AAA worldwide, and the mortality rate exceeds 60% in cases of rupture. Recently, tricaprin, a medium-chain triglyceride composed of three capric acids, has been used as a dietary treatment for neurological and metabolic disorders [5]. It may promote reverse remodeling of AAA in a rat model. A new trial, the First-in-Human Abdominal Aortic Aneurysms Trial with Tricaprin (F-HAAAT), has been reported, in which tricaprin may provide clinical benefits for small AAA. Its protocol includes a 52-week period, providing oral tricaprin (1.5-3.0 g/day) daily for patients with small AAA measuring 30-45 mm in diameter.

This case involved AAA associated with calcification of the aorta in the arch, chest, abdomen, and femoral arteries. According to recent reports, vascular calcification has increasingly been recognized as a clinical marker of atherosclerosis and vascular disease. CT scanning contributes to the clinical evaluation of vascular calcification associated with calcific foci in the abdominal aorta, mesenteric, renal, celiac, and aortoiliac arteries [6]. AAA is associated with a higher risk of fatal rupture, leading to severe outcomes. Evaluation of the intraluminal thrombus (ILT) structure may contribute to exploring its potential role in wall weakening and aneurysm progression [7].

Some limitations may exist in this report. The patient was diagnosed with an enlarged AAA and bilateral renal cysts using reconstructed images. Currently, he does not have an urgent severe risk related to AAA or other arteriosclerotic conditions. However, he should continue to be followed for his general clinical progress.

In summary, a 75-year-old male showed AAA and other findings. With the current information obtained from reconstruction, we will continue to pay close attention to future clinical changes. It is expected that this article may serve as a useful reference for the radiological evaluation of AAA from the perspective of reconstruction techniques.

Conflict of Interest

The authors have read and approved the final version of the manuscript. The authors declare no conflicts of interest.

Funding

There was no funding received for this study.

References

1. 1

   Amano T, Idegami D, Yoneoka Y, Murakami A, Tanaka Y, Yamanaka H, Takahashi A, Tsuji S. 3D Reconstruction and Holographic XR Navigation in Robot-Assisted Sacrocolpopexy: A Report of Two Cases. J Obstet Gynaecol Res. 2026;52(8):e70421.

2. 2

   Ogura K, Bando H, Yamashita H, Kato Y, Kato Y. A Case with Hepatic Hemangioma, Duplicated and Horseshoe Kidney Detected by The Reconstruction of Three-Dimensional Computed Tomography (3D-CT). Asp Biomed Clin Case Rep. 2025 Dec 28;8(3):301-305.

3. 3

   Muro S, Ibara T, Sugiyama Y, Nimura A, Akita K. Evaluating accuracy in artificial intelligence-powered serial segmentation for sectional images applied to morphological studies with three-dimensional reconstruction. Microscopy (Oxf). 2025 Mar 31;74(2):107-16. [PMID: 39948740]

   PMID 39948740
4. 4

   Ogura K, Bando H, Kato Y, Yamashita H, Kato Y. A Case with the Abscess in the Sigmoid Colon/Mesocolon by Three-Dimensional Computed Tomography (3D-CT) and Reconstruction Method. Int J Case Rep Clin Image. 2025;7(3):251.

5. 5

   Kamba T, Yanagawa M, Shimamura K, Yamaguchi S, Shirakura K, Okamura S, Nishimura Y, Yamada T, Sakata Y, Tomiyama N, Miyagawa S, Hirano KI, Zaima N. First-in-Human Abdominal Aortic Aneurysms Trial with Tricaprin (F-HAAAT): Study Design and Protocol. CJC Open. 2025 Feb;7(2):221-30. [PMID: 40060213]

   PMID 40060213
6. 6

   Huang W, Bian Y, Zhu Z, Deng X, Luo S. Abdominal vascular calcification at CT: opportunistic quantification and imaging-based risk stratification. Abdom Radiol (NY). 2026 Aug 20. Online ahead of print. [PMID: 42622827]

   PMID 42622827
7. 7

   Léonet J, de Masi-Jacquier M, Lepidi H, Vicente J, Deplano V. Morphology-mechanics coupling in intraluminal thrombus from abdominal aortic aneurysm visualized by synchrotron imaging. Acta Biomater. 2026 Aug;220:148-160. [PMID: 42457007]

   PMID 42457007