Three-dimensional imaging of liver masses: Preliminary experience

Three-demensional (3-D) imaging has had limited application in the abdomen and has not been evaluated previously as an aid for planning resections of liver tumors. We manually reconstructed 3-D images of the liver in ten patients with liver masses. A manual 3-D reconstruction technique was used as a feasibility test for furture automated reconstruction. The mass and the liver were displayed separately and then combined. Subsequently, the axial computed tomography (CT) and 3-D images were reviewed independently by two surgeons. In all cases for surgeon A and in eight cases for surgeon B, 3-D images allowed a better understanding of the location of the liver mass. In five cases for surgeon A and in four cases for surgeon B, 3-D display produced changes in the preoperative planning of the resection. Both surgeons preferred the coronal plane for reconstruction. Large, central liver masses were more evaluable on 3-D display, compared with 2-D CT. A significant drawback of the technique was the inability to reconstruct more than two structures at a time, thereby not allowing the depiction of other landmarks in the combined image (i.e., inferior vena cava, gallbladder, and falciform ligament). Other drawbacks were lack of real-time rotation and a time-consuming reconstruction process. We conclude that 3-D imaging applied to preoperative planning of liver tumor resection has valuable potential. Further research using multiple, independent object reconstruction and automatic thresholding is needed.