Volume Rendering-Based Phrenic Nerve/Pericardiophrenic Bundle Identification Using Cardiac Computed Tomography

Daisetsu Aoyama; Mark Rimmer; Yuichiro Miyazaki; Yu Izawa; Tatsuya Nishii; Kalyanam Shivkumar; Shumpei Mori

doi:10.1016/j.jaccas.2025.104947

Volume Rendering-Based Phrenic Nerve/Pericardiophrenic Bundle Identification Using Cardiac Computed Tomography

JACC Case Rep. 2025 Sep 10;30(27):104947. doi: 10.1016/j.jaccas.2025.104947.

Authors

Daisetsu Aoyama¹, Mark Rimmer¹, Yuichiro Miyazaki¹, Yu Izawa², Tatsuya Nishii³, Kalyanam Shivkumar⁴, Shumpei Mori⁵

Affiliations

¹ Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California-Los Angeles (UCLA), Los Angeles, California, USA.
² Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
³ Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
⁴ Department of Medicine, Radiology & Bioengineering, UCLA, Los Angeles, California, USA.
⁵ Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California-Los Angeles (UCLA), Los Angeles, California, USA. Electronic address: smori@mednet.ucla.edu.

Abstract

Anatomy: Phrenic nerves descend anterior to the pulmonary hila, sandwiched between the pericardium and parietal pleura, thus running extrinsically to the heart and lungs.

Pathology: Phrenic nerve injury during catheter ablation or diaphragmatic stimulation during cardiac resynchronization therapy.

Imaging correlation: Conventional approach of preprocedural identification of the phrenic nerve includes slice-by-slice detection of the pericardiophrenic bundle using axial images. However, it is time-consuming with substantial uncertainty and difficulty in precise structural tracing in each axial plane. Three-dimensional visualization using a volume rendering technique has a distinct advantage for detecting fine structures and their anatomical course.

Treatment: Preprocedural identification of the 3-dimensional course of the phrenic nerve in relation to surrounding structures is useful in avoiding iatrogenic injury of the phrenic nerve or predicting diaphragmatic stimulation.

Take-home message: Volume rendering reconstruction offers fast and easy 3-dimensional identification of the phrenic nerve and is even feasible without a contrast material.

Keywords: anatomy; computed tomography; phrenic nerve; volume rendering.