Cinematic Rendering of Gastrointestinal Stromal Tumours: A Review of Current Possibilities and Future Developments

Abstract

Gastrointestinal stromal tumors (GISTs) are defined as CD117-positive primary, spindled or epithelioid, mesenchymal tumors of the gastrointestinal tract, omentum, or mesentery. While computed tomography (CT) is the recommended imaging modality for GISTs, overlap in imaging features between GISTs and other gastrointestinal tumors often make radiological diagnosis and subsequent selection of the optimal therapeutic approach challenging. Cinematic rendering is a novel CT post-processing technique that generates highly photorealistic anatomic images based on a unique lighting model. The global lighting model produces high degrees of surface detail and shadowing effects that generate depth in the final three-dimensional display. Early studies have shown that cinematic rendering produces high-quality images with enhanced detail by comparison with other three-dimensional visualization techniques. Cinematic rendering shows promise in improving the visualization of enhancement patterns and internal architecture of abdominal lesions, local tumor extension, and global disease burden, which may be helpful for lesion characterization and pretreatment planning. This article discusses and illustrates the application of cinematic rendering in the evaluation of GISTs and the unique benefit of using cinematic rendering in the workup of GIST with a specific emphasis on tumor characterization and preoperative planning.

The SmARTR pipeline: a modular workflow for the cinematic rendering of 3D scientific imaging data

“…These algorithms can reproduce effects such as indirect lighting, light reflection/refraction from curved surfaces (caustics), blurry reflections, and soft shadows, dramatically enhancing the realism of generated 3D volumes 65,[71][72][73][74][75] . Referred to as cinematic or photorealistic rendering 74,76 , these DVR techniques-largely implemented through commercial platforms usually bundled with expensive imaging hardware-are gaining momentum in the human medical field to support diagnostics, surgery, and anatomy teaching 73,[77][78][79][80][81][82][83][84] , while revitalizing the connection between science and impactful anatomical illustrations. In contrast to this dynamic landscape, the potential impact of cinematic rendering remains largely unexplored across most biological fields, yet…”

Utilization of Cinematic Rendering for Evaluation of Gastrointestinal Stromal Tumours (GIST)

“…Cinematic rendering can more easily detect if there is bleeding from a small bowel tumour. It also provides increased information to differentiate GIST form other gastrointestinal tumours, especially at the ampulla and in the pelvis where anatomical detail is limited on conventional CT. 5 The use of cinematic rendering in GIST is particularly useful as this technique provides exquisite mucosal detail which increases sensitivity for assessment of gastrointestinal mucosal fold changes. 5 Lastly, the ability to produce vascular mapping of a GIST with cinematic rendering allows localization of the feeding vessel in a preoperative setting.…”

“…It also provides increased information to differentiate GIST form other gastrointestinal tumours, especially at the ampulla and in the pelvis where anatomical detail is limited on conventional CT. 5 The use of cinematic rendering in GIST is particularly useful as this technique provides exquisite mucosal detail which increases sensitivity for assessment of gastrointestinal mucosal fold changes. 5 Lastly, the ability to produce vascular mapping of a GIST with cinematic rendering allows localization of the feeding vessel in a preoperative setting. Many of the features described are also used to risk stratify GISTs from very low to high risk for recurrence; the added value of cinematic rendering for assessment of GIST may provide a future role for imaging estimation of risk.…”