Innovative multi-modality segmentation and 3d fusion in the management of giant abdominopelvic chondrosarcoma

Innovative multi-modality segmentation and 3d fusion in the management of giant abdominopelvic chondrosarcoma

Lokesh Goyal , Lalit Maini, Sumit Arora, Lovenish Bains, Sunil Jha, Abhay Meena
Maulana Azad Medical College, New Delhi, India; IIT Delhi, New Delhi, India; Lok Nayak Hospital, New Delhi, India

Tumors arising from the pelvis pose challenges for treating orthopaedic surgeons owing to their complex anatomical location and proximity to the vital organs. Meticulous preoperative planning is important in safe surgical excision of giant abdominopelvic chondrosarcoma as intraoperative assessment is generally difficult due to its complex three-dimensional spread.

We present a case of a 35-years-old female who had giant abdominopelvic chondrosarcoma and underwent type-I pelvic resection using virtual planning on MIMIC and 3-Matic (Materialise, Belgium). Three-dimensional virtual models of the pelvis, great vessels, and tumor were segmented from MRI, NCCT, and CT angiography and fused. It revealed the tumour relationship with neurovascular and urogenital structures. A patient-specific 3D-printed jig was created for tumour resection intraoperatively. Safe surgical excision with wide margins was achieved successfully in the case and she was asymptomatic when last followed up at 12 months.

The multi-modality fusion of medical image segmentation has a significant impact on the clinical practice of musculoskeletal oncology. A bone tumor fused model can be obtained by MR-CT registration after obtaining segmentation in both MR and CT. In this way, a high-resolution 3D model including tumor, pelvic bones, and vital organs can be obtained for subsequent surgical planning.