3D Magnetic Resonance Imaging–based Printed Models of Prostate before and after focal therapy
3D Magnetic Resonance Imaging–based Printed Models of Prostate before and after focal therapy
M Martins Favre, S Regusci, S Martinerie, GA De Boccard, G Mayor, G Wirth, CH Rochat
To demonstrate that the use of three-dimensional (3D)-printed prostate models in minimal invasive focal therapy is useful to explain the therapy to patients and to help the surgeon in the planification and in the survey.
The model was based on a 67-year-old patient with intermediate-risk prostate cancer (Gleason 3+4). The Patient-specific 3D resin models were printed based on preoperative multiparametric magnetic resonance imaging (mpMRI) to provide an exact 3D impression of significant tumor lesions. Focal Laser Therapy was planned based on the MRI and the software Dynacad. The 36-region Prostate Imaging Reporting and Data System (PI-RADS) v2.0 scheme was used to compare the MRI/3D print. We use a T2 vista axial 1mm slice sequences DICOM to segment the prostate, the tumor, and the necrose vacuolization. The different anatomic structures (bladder, seminal vesicle, tumor and urethra) were modeled and segmented with the software Mimics Medical 23.0 form Materialise (https://www.materialise.com/en/medical/mimics-innovation-suite/23). The material used was a photosensible resine polymerized with a UV laser. The printing cycle were prepared with the software Preform from Formlabs . The orientation of the model and the position in the support is important in order to obtain the same geometrie from the original.
Pre therapeutic MRI with a lesion mesured 6 x 8 x 10mm localised on right anteromedial lobe demonstratring restrction in diffusion sequence with a hypersignal in B2000 and hyposignal in ADC. The transperineal biopsy realised with target MRI/US software demonstrated a Gleason 3+3
MRI control 10 days after laser transperineal guided by target MRI/US software demontrating a vacuolisation zone (necrosis) covering the tumoral lesion with security margins
MRI sagittal view after laser treatment with vacuolisation zone in the anterior part of right lobe
Three 3D models prototype was printed in order to demonstrate the evolution of the treatment. All these three prototype based on MRI. First prototype demonstrates the prostate with the suspicious lesion targeted. Then the second prototype was the 10 days control after focal therapy with the vacuolization zone of necrosis and the third prototype is the control 1 year after focal therapy. Localization of the index lesion was correctly displayed by MRI and the 3D model. In addition, a significant correlation of the width, length, and volume of the tumor and prostate gland, derived from the printed model was also concordant.
3D analysis based on the MRI images in 1mm segmentation
3D analysis based on the MRI images in 1mm segmentation
First 3D prototype with tumor identification
The use of three-dimensional (3D)-printed prostate models based on preoperative magnetic resonance imaging (MRI) may improve the comprehension of the patient in the focal therapy with an individual planification of the treatment, providing better orientation guide to help urologist and radiologist. Therefore, 3D models may play an increasingly important role in providing guidance for orientation for preservation of the nerves and the exact localization of the lesion.
Second 3d prototype control 10 days after focal therapy with necrosis vacuolisation zone
Pratical use of the 3D models to explain focal therapy.
