PMC7417346_01
(A) X-ray of pelvic bone showing bone destruction and irregular calcification of the right ilium extending to the sacrum. (B) CT scan showing large soft tissue mass surrounding the right ilium with sunburst calcification. The tumor invades to L5 vertebral cavity. (C) T1 sequence with contrast of MRI showing huge soft tissue mass surrounding the ilium with mixed signals. (D) HE staining of the specimen showing high-grade anaplastic tumor with immature osteoid production.
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F1
Osteosarcoma was suspected and later confirmed with pathology after core needle biopsy (Figure 1D).
PMC7417346_02
(A) X-ray of pelvic bone showing bone destruction and irregular calcification of the right ilium extending to the sacrum. (B) CT scan showing large soft tissue mass surrounding the right ilium with sunburst calcification. The tumor invades to L5 vertebral cavity. (C) T1 sequence with contrast of MRI showing huge soft tissue mass surrounding the ilium with mixed signals. (D) HE staining of the specimen showing high-grade anaplastic tumor with immature osteoid production.
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F1
Osteosarcoma was suspected and later confirmed with pathology after core needle biopsy (Figure 1D).
(A) 3-D model reconstructed with AI-assisted CT/MRI image fusion technique. Note that the tumor size was bigger and margins are better shown in this model comparing with the one with solely CT image data. (B) Image fusion data model showing tumor together with adjacent arteries. (C) Image fusion model showing tumor together with adjacent veins. Note that emboli were shown in purple within the veins. (D) 3-D model reconstructed with enhanced CT image data showing tumor of the right ilium extending to the sacrum. Note that the tumor did not invade L5 vertebra in this model.
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F2
AI-assisted CT/MRI image fusion technique was utilized, and a personalized 3-D pelvic model (Figures 2A-C) showing tumor was constructed together with adjacent structures such as blood vessels, nerves, and L5 vertebra. A normal 3-D pelvic model (Figure 2D) based solely on enhanced CT image data was also constructed as a control.
PMC7417346_03
(A) Gross view of transverse resection of the sacrum and L5 during surgery. (B) Postoperative X-ray of the pelvis showing resection of the right ilium and semi-resection of the sacrum and L5 vertebra.
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F3
The discovery of emboli within the blood vessel which suggested metastasis discouraged any reconstruction surgery and promoted us to choose pelvic amputation in an attempt to get better local disease control (Figures 3A,B).