Four-Dimensional Cinematic Rendering of a Presumed Aortic Valve Papillary Fibroelastoma on Coronary CT Angiography

Four-dimensional cinematic rendering represents a convergence of physically based volumetric visualization and time-resolved cardiac imaging, enabling simultaneous assessment of structure and motion within a continuous spatial context. Its application to valvular pathology remains limited. We present a technical implementation of four-dimensional cinematic rendering applied to retrospectively electrocardiographically gated coronary computed tomography angiography for characterization of a presumed aortic valve papillary fibroelastoma. This approach enabled direct visualization of lesion morphology, stalk attachment, and dynamic mobility while preserving spatial relationships to valve cusps and the coronary ostium. In contrast to conventional two-dimensional and static three-dimensional techniques, four-dimensional cinematic rendering provided continuous spatial and temporal coherence, reducing interpretive fragmentation across imaging planes. Used as an adjunct to conventional cross-sectional interpretation, this method allows anatomical detail and functional behavior to be assessed concurrently, with potential implications for risk stratification and procedural planning in valvular disease.