Construction and clinical application of three-dimensional visualization platform in diagnosis and treatment of primary liver cancer

Objective To investigate the construction and clinical application of three-dimensional visualization platform in diagnosis and treatment of primary liver cancer. Methods Fifty-six patients with liver cancer diagnosed and treated in Zhujiang Hospital of Southern Medical University between January 2012 and December 2014 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 56 patients, 49 were males and 7 were females with the average age of (47±7) years old. The 256-slice spiral CT scan was performed on the patients to collect plain scan data and thin-layer CT data of arterial phase, portal venous phase and hepatic venous phase. The data were imported into the Medical Image Three-dimensional Visualization System (MI-3DVS) to perform image segmentation and three-dimensional visualization analysis of the liver, tumor tissues, portal venous system, hepatic venous system, hepatic arterial system and organs around the liver. The individualized liver segmentation, classification of the vascular and middle lobe tumor was performed and individualized volume was calculated. The surgical planning was formulated through simulating multiple surgery and the rational surgical procedure was selected. For patients undergoing complex hepatectomy, three-dimensional liver model was printed. Results The construction of three-dimensional visualization model of all 56 patients was completed, which could clearly display the anatomical morphology of each vascular system, the location and size of tumor, and perform individual liver segmentation as well as vascular, middle lobe tumor classification. According to individualized volume calculation, the median total liver volume was 1 215 (1 025-1 856) ml, the liver tumor volume was 368 (25-653) ml and the virtual removal liver volume was 478 (125-854) ml. All the 56 patients received radical resection of tumor. The actual operation was in accordant with the preoperative surgical plan. The 3D printing model of 11 patients undergoing complex hepatectomy was exactly the same with that observed during the operation. The operations of all patients were completed successfully and no death was observed during the perioperative period. Six patients developed pleural effusion and one developed bile leakage on the liver cutting surface after operation. These patients were cured after symptomatic treatments. Conclusion Three-dimensional visualization platform for diagnosis and treatment of primary liver cancer can realize the precise preoperative diagnosis and intraoperative manipulation, thus enhances the success rate of surgery. Key words: Carcinoma, hepatocellular; Imaging, three-dimensional; Diagnosis; Therapeutics