{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:25:23Z","timestamp":1787149523913,"version":"build-2736575974"},"reference-count":16,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Imaging"],"abstract":"<jats:p>Patients with implanted cardiac devices are a rapidly growing imaging population, and electrocardiogram-gated cardiac computed tomography (CT) is increasingly used to characterize device geometry, multi-device relationships, and dynamic behavior across the cardiac cycle. Cinematic rendering (CR) is a photorealistic three-dimensional (3D) visualization technique for cardiac CT whose established contribution in this population is communicative: it conveys 3D device geometry and material distinctions within a single rendered volume. We describe a demonstrative case series extending CR across the cardiac cycle\u2014time-resolved \u201c4D cine\u201d CR\u2014to depict dynamic device behavior and time-resolved multi-device interaction in a single volume; this is an illustrative technical experience rather than a systematic evaluation of diagnostic performance. Illustrative examples include an EVOQUE transcatheter tricuspid valve rendered together with concurrent surgical mitral and transcatheter aortic valves, a left atrial appendage occlusion device, a normally positioned Impella catheter, and a HeartMate 3 left ventricular assist device (LVAD). Across cases, 4D cine CR feasibility scaled inversely with metallic burden\u2014the aggregate volume and radiodensity of metallic device components within the scan field\u2014with renderings informative for low-metal nitinol and catheter devices but substantially degraded by streak artifact in high-metal LVAD housings. This relationship was observed qualitatively in a small selected series and is offered as an initial observation rather than an established characteristic of the technique. We discuss current limitations and emerging directions such as photon-counting detector CT, metal artifact reduction, and artificial-intelligence-assisted post-processing that may extend 4D cine CR in this population.<\/jats:p>","DOI":"10.3390\/jimaging12080390","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T13:14:01Z","timestamp":1787145241000},"page":"390","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Four-Dimensional Cine Cinematic Rendering of Structural Heart and Mechanical Circulatory Support Devices: An Illustrative Technical Experience"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1387-9703","authenticated-orcid":false,"given":"Amy","family":"Avakian","sequence":"first","affiliation":[{"name":"Southern Hills Hospital and Medical Center, Las Vegas, NV 89148, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6113-8335","authenticated-orcid":false,"given":"Muhammad","family":"Umair","sequence":"additional","affiliation":[{"name":"Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA"},{"name":"Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1056\/NEJMoa1900486","article-title":"A Fully Magnetically Levitated Left Ventricular Assist Device\u2014Final Report","volume":"380","author":"Mehra","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","article-title":"Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients","volume":"380","author":"Mack","year":"2019","journal-title":"N. Engl. J. 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Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jcct.2017.11.013","article-title":"Cinematic Rendering of Cardiac CT Volumetric Data: Principles and Initial Observations","volume":"12","author":"Rowe","year":"2018","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.jcct.2019.09.019","article-title":"Black-Blood Cinematic Rendering: A New Method for Cardiac CT Intraluminal Visualization","volume":"14","author":"Rowe","year":"2020","journal-title":"J. Cardiovasc. Comput. 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Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1148\/radiol.211780","article-title":"Coronary CT Angiography with Photon-Counting CT: First-In-Human Results","volume":"303","author":"Boccalini","year":"2022","journal-title":"Radiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1097\/RCT.0000000000001381","article-title":"Augmented Reality with Cinematic-Rendered 3-Dimensional Images from Volumetric Computed Tomography Data","volume":"47","author":"Rowe","year":"2023","journal-title":"J. Comput. Assist. 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