Image Fusion for Computer-assisted Bone Tumor Surgery


The fusion of computed tomography and magnetic resonance images is a software-dependent processing technique that enables one to integrate and analyze preoperative images for planning complex musculoskeletal tumor resections. By integrating various imaging modalities into one imaging data set we may facilitate preoperative image analysis and planning of navigation computer-assisted bone tumor resection and reconstruction. We performed image fusion for computer-assisted tumor surgery in 13 consecutive patients, seven males and six females, with a mean age of 35.8 years (range, 6–80 years). Visual verification of fused images was accurate in all patients. The mean time for image fusion was 30.6 minutes (range, 8–80 minutes). After intraoperative registration, all tumor resections were performed as planned preoperatively under navigation image guidance. Resections achieved after navigation resection planning were validated by postoperative CT or resected specimens in seven patients. Histologic examination of all resected specimens showed tumor-free margins in patients with bone sarcoma. The fusion of computed tomography and magnetic resonance imaging has the potential to enhance computer-assisted bone tumor surgery. The fusion image, when combined with surgical navigation, helps surgeons reproduce a preoperative plan reliably and may offer substantial clinical benefits.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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We thank Eric Wai-kin Ng and Keith Kam-shing Lee (ACAOS-ITAV team, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong), for setup of the navigation system and documentation of operative procedures; Ulrich G. Buehner and Dr. Sarvestani Amir (R&D, Computer Assisted Applications, Stryker Navigation, Freiburg, Germany) for their support with use of the cranial navigation software; and Dr. Paul Unwin and the design team (Stanmore Implants Worldwide Ltd, Centre for Biomedical Engineering, Royal National Orthopaedic Hospital, Middlesex, UK) for the CAD custom tumor prosthesis. We also appreciate the assistance of Prof. Martin C. M. Wong and Man-ho Lee (Department of Rapid Prototyping & Tooling Unit, Hong Kong Polytechnic University) in use of the CAD software.

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Correspondence to Kwok Chuen Wong MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research.

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Wong, K.C., Kumta, S.M., Antonio, G.E. et al. Image Fusion for Computer-assisted Bone Tumor Surgery. Clin Orthop Relat Res 466, 2533–2541 (2008).

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  • Image Fusion
  • Malignant Peripheral Nerve Sheath Tumor
  • Giant Cell Tumor
  • Navigation Software
  • Intralesional Excision