Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA.
Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY, USA.
Abdom Radiol (NY). 2017 May;42(5):1501-1509. doi: 10.1007/s00261-016-1022-2.
To determine whether patient-specific 3D printed renal tumor models change pre-operative planning decisions made by urological surgeons in preparation for complex renal mass surgical procedures.
From our ongoing IRB approved study on renal neoplasms, ten renal mass cases were retrospectively selected based on Nephrometry Score greater than 5 (range 6-10). A 3D post-contrast fat-suppressed gradient-echo T1-weighted sequence was used to generate 3D printed models. The cases were evaluated by three experienced urologic oncology surgeons in a randomized fashion using (1) imaging data on PACS alone and (2) 3D printed model in addition to the imaging data. A questionnaire regarding surgical approach and planning was administered. The presumed pre-operative approaches with and without the model were compared. Any change between the presumed approaches and the actual surgical intervention was recorded.
There was a change in planned approach with the 3D printed model for all ten cases with the largest impact seen regarding decisions on transperitoneal or retroperitoneal approach and clamping, with changes seen in 30%-50% of cases. Mean parenchymal volume loss for the operated kidney was 21.4%. Volume losses >20% were associated with increased ischemia times and surgeons tended to report a different approach with the use of the 3D model compared to that with imaging alone in these cases. The 3D printed models helped increase confidence regarding the chosen operative procedure in all cases.
Pre-operative physical 3D models created from MRI data may influence surgical planning for complex kidney cancer.
确定特定于患者的 3D 打印肾肿瘤模型是否会改变泌尿外科医生为复杂肾肿瘤手术准备而制定的术前计划决策。
从我们正在进行的肾脏肿瘤 IRB 批准的研究中，回顾性选择了 10 个肾肿块病例，这些病例的肾肿瘤评分大于 5（范围为 6-10）。使用 3D 后对比脂肪抑制梯度回波 T1 加权序列生成 3D 打印模型。这三个经验丰富的泌尿外科肿瘤医生以随机的方式评估这些病例，使用（1）仅在 PACS 上的成像数据和（2）除了成像数据之外的 3D 打印模型。管理了有关手术方法和计划的问卷。比较了有和没有模型的假定术前方法。记录了假定方法与实际手术干预之间的任何变化。
在所有 10 个病例中，使用 3D 打印模型改变了计划的方法，在腹膜后或腹膜后入路和夹闭方面的决策影响最大，有 30％-50％的病例发生了变化。手术肾脏的平均实质体积损失为 21.4％。体积损失> 20％与缺血时间增加有关，并且在这些病例中，与仅使用成像相比，使用 3D 模型的外科医生倾向于报告不同的方法。3D 打印模型有助于在所有病例中增加对所选手术程序的信心。
术前从 MRI 数据创建的物理 3D 模型可能会影响复杂肾癌的手术计划。
