A 48-year-old male patient presented with a 6-year history of a gradually enlarging soft-tissue mass anterior to the left knee. One month before presentation, the mass developed ulceration with serous discharge. Physical examination revealed a 15-cm subcutaneous mass with superficial ulceration. Laboratory testing showed mildly elevated levels of neuron-specific enolase, ferritin, and CA15-3. Contrast-enhanced CT of the knee demonstrated osteolytic destruction of the proximal tibia accompanied by a large, heterogeneous soft-tissue mass with central liquefaction necrosis (Figure, A). For preoperative planning, cinematic rendering (Syngo.via VB60; Siemens Healthineers) was performed using the arterial phase CT dataset. The three-dimensional reconstruction vividly depicted the extent of osseus destruction and the associated soft-tissue mass. Importantly, it clearly delineated tumor neovascularity, showing multiple feeding vessels originating from branches of the femoral, popliteal, posterior tibial, and peroneal arteries (Figure, B, C; Movie). US-guided biopsy of the mass confirmed the diagnosis of primary leiomyosarcoma of bone. The patient subsequently underwent wide surgical resection.
Figure 1:
Images show primary tibial leiomyosarcoma in a 48-year-old male patient. (A) Contrast-enhanced CT image shows osteolytic destruction of the proximal tibia (black arrow) with a large, heterogeneously enhancing soft-tissue mass and central necrosis (white arrows). (B, C) Cinematic rendering three-dimensional reconstructions demonstrate the osteolytic lesion (white arrow) and extensive tumor neovascularity. Feeding vessels (black arrows) arise from branches of the femoral, popliteal, and tibial arteries, providing a detailed vascular road map.
Movie:
Rotating three-dimensional cinematic rendering model of the lesion, highlighting the bone destruction, soft tissue mass, and complex tumor vasculature.
Primary leiomyosarcoma of bone is exceptionally rare, accounting for less than 0.1% of all primary bone tumors (1,2). In this patient, the internal heterogeneity and liquefaction necrosis observed at CT are common findings, whereas intralesional calcification is relatively uncommon. This case highlights the added value of cinematic rendering over conventional imaging for surgical planning in complex bone and soft-tissue malignancies. By providing realistic three-dimensional visualization, cinematic rendering facilitates clearer depiction of tumor anatomy and vascularity (3), thereby supporting preoperative planning. In particular, the detailed visualization of vascular structures allows the surgical team to better anticipate intraoperative challenges, such as localization and control of major feeding vessels, and to optimize the surgical approach to achieve complete resection (4). Although large-scale studies directly comparing cinematic rendering with conventional imaging in terms of operative time, blood loss, and related outcomes are lacking, its potential for enhancing anatomic understanding, education, and multidisciplinary discussion has been recognized (5).
Supplemental Files
Acknowledgments
Acknowledgment
The authors thank Siemens Healthineers engineer Xi Zhao for his support in rendering film technology.
Footnotes
Funding: Authors declared no funding for this work.
Keywords: Extremities, Knee, CT-Angiography
Disclosures of conflicts of interest
Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplemental materials.
References
- 1. Siegel RL , Miller KD , Fuchs HE , et al . Cancer statistics, 2022 . CA Cancer J Clin 2022. ; 72 ( 1 ): 7 – 33 . [DOI] [PubMed] [Google Scholar]
- 2. Georgeanu VA , Pletosu RI , Vlădescu TC , et al . Primary bone leiomyosarcoma of distal femur: case report and literature review . Rom J Morphol Embryol 2022. ; 63 ( 3 ): 569 – 574 . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Huellner MW , Engel K , Essig H , et al . Cinematic Rendering of Bone SPECT/CT . Clin Nucl Med 2026. ; 51 ( 1 ): 46 – 47 . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Necker FN , Cholok DJ , Shaheen MS , et al . Holographic Deep Inferior Epigastric Perforator Exploration in Mixed Reality using Real-Time Cinematic Rendering . Aesthetic Plast Surg 2026. ; 50 ( 1 ): 183 – 186 . [DOI] [PubMed] [Google Scholar]
- 5. Böttcher B , van Assen M , Fari R , et al . 3D cinematic reconstructions of cardiovascular CT presented in augmented reality: subjective assessment of clinical feasibility and potential use cases . Eur Radiol Exp 2025. ; 9 ( 1 ): 27 . [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.