Hepatocellular Carcinoma (HCC) is an intrinsic primary liver tumour in dogs with a median age at presentation of nine years old with HCC estimated to be responsible for over 50% of all hepatic tumours in dogs.
A thorough appreciation of hepatic anatomy and its spatial complexity is a pre-requisite for veterinary surgical oncologists when assessing liver tumour respectability. It is achieved through multiple educational resource methods. Successful treatment of liver cancer, including surgical intervention, requires a precise topographic understanding of the liver's multi-lobular structure. This includes an appreciation of the spatial arrangement and complexity of the hepatic vessels along with the proximity of adjacent structures within the cranial abdomen. However, the anatomical branching of the hepatic artery, vein and portal vein can differ significantly between patients in terms of number, course, and liver regions they supply or drain. The veterinary surgeon must therefore determine where the hepatic blood supply feeds or drains before surgery, assess the tumour heterogeneity and local environment, to help guide surgical resection.
The nature of current Computed Tomography (CT) imaging technology limits what can be perceived anatomically and spatially, and so identifying the exact spatial position of the HCC in relation to normal anatomical structures can be challenging. This can restrict the surgeon's spatial ability and mental reconstruction in defining the best surgical approach to the liver tumour.
In human medicine, surgical techniques and pre-operative management using 3D technology prove effective in clinical practice; however, the potential of 3D technology in veterinary oncology is in its infancy. This research consists of a pilot study testing the feasibility of using historical canine CT scans to create interactive 3D models of the canine liver with and without HCC.
Segmentation using a 'slice addition' technique of normal and abnormal canine CT scans resulted in the volumetric generation of 3D hepatic and tumour models. One healthy canine liver and two abnormal canine livers of patients with HCC were further sculpted and textured using 3D sculpting and modelling software to create photorealistic hepatic and HCC models. The models were integrated into a game engine to create an interactive user interface.
The final application allows veterinary surgeons and students to visualise the features and spatial complexity of the liver in 3D, both normal and with HCC. Featured interactions allow the deployment of HCC tumours into the modelled liver, giving the veterinarian the chance to show the dog’s owner the location, size, and severity of the HCC affecting their dog.
Finally, an evaluation process was undertaken by twelve expert and trainee veterinary surgeons and oncologists, with highly favourable responses to both content and face validity of all 3D hepatic and HCC models. It emphasises the usefulness of and the ability to interact with 3D models to provide essential context, enhance visual accuracy and perceptual learning, support prognosis, and improve client-to-vet-communication.
