Three-dimensional visualization and virtual simulation of resections in pediatric solid tumors.
OBJECTIVE
Three-dimensional visualization of solid tumors is possible because of high-resolution computed tomography and magnetic resonance imaging scans. However, additional preoperative information is often desirable in complex malignancies. For the first time, the authors present a model of preoperative 3-dimensional visualization and virtual resections in pediatric solid tumors.


METHODS
Image analysis of various pediatric tumors was performed using the research software HepaVision2 (MeVis, Bremen). Organs, tumors, and the vascular system were extracted from multislice computed tomography scans. After hierarchical analysis of the vascular system, territories supplied or drained by the major vascular branches were calculated. Results were explored and virtual resections of organs were carried out using the research software InterventionPlanner (MeVis, Bremen). Data were correlated to intraoperative findings.


RESULTS
Four hepatic malignancies, 4 renal tumors, and 3 other neoplasms were analyzed. The technique of 3-dimensional visualization was feasible for all investigated children (mean age 5 years and 9 months). Spatial relations between physiological and pathological structures were identified, and anatomical structures (vessels, tumor tissue, and organ parenchyma) were determined using colorimetric encoding. Virtual simulations of tumor resection were used successfully for planning of surgical procedures in the hepatic and renal tumors.


CONCLUSIONS
The technique of 3-dimensional tumor visualization and virtual simulation of tumor resections provides the basis for a successful planning of complex tumor resections in children. The efficiency of these techniques should be further analyzed in series with higher numbers and differentiations of tumors.
Fuchs
Jörg
J
Department of Pediatric Surgery, University Children's Hospital, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany. joerg.fuchs@med.uni-tuebingen.de
Warmann
Steven W
SW
Szavay
Philipp
P
Kirschner
Hans J
HJ
Schäfer
Jürgen F
JF
Hennemuth
Anja
A
Scheel-Walter
Hans G
HG
Bourquain
Holger
H
Peitgen
Heinz O
HO
D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D010347:Patient Care Planning; D012984:Software; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface