Reconstruction of fetal and infant anatomy using rapid prototyping of post-mortem MR images

Silvia Schievano, Neil J Sebire, Nicola J Robertson, Andrew M Taylor, Sudhin Thayyil, Silvia Schievano, Neil J Sebire, Nicola J Robertson, Andrew M Taylor, Sudhin Thayyil

Abstract

OBJECTIVES: The recent decline in autopsy rates and lack of human anatomical material donated for research and training has resulted in issues for medical training in the United Kingdom. This study aims to examine the feasibility of making accurate three-dimensional (3D) models of the human body and visceral organs using post-mortem magnetic resonance (MR) imaging and rapid prototyping. METHODS: We performed post-mortem MR imaging using a 3D T2-weighted sequence in 11 fetuses and infants, before autopsy, using either a 1.5-T or 9.4-T MR scanner. Internal organs were reconstructed in silico and 3D models were created by rapid prototyping. RESULTS: The median gestation of fetuses was 20 (range 19-30) weeks and the median age of infants was 12 (range 8-16) weeks. Models created by rapid prototyping accurately depicted structural abnormalities and allowed clear visualisation of 3D relationships. CONCLUSIONS: Accurate 3D modelling of anatomical features from post-mortem imaging in fetuses and infants is feasible. These models could have a large number of medical applications, including improved parental counselling, invaluable teaching resources and significant medico-legal applications to demonstrate disease or injury, without the need to show actual autopsy photographs.

Figures

Fig. 1
Fig. 1
Rapid prototyping of brain from high-field (9.4-T) MR images of a 16-week fetus. a External appearance of the brain. Note the smooth brain without sulci and gyri. b The brain cut open in the axial plane. G germinal matrix, C cerebrospinal fluid inside the lateral ventricles. Black arrows show the choroid plexus and bleeding into choroid plexus and ventricular cavity. c Corresponding 9.4-T MR images in the axial plane. The rapid prototyping model has been scaled to twice the original size. Conventional autopsy was difficult in this case due to autolysis of the brain and dimensions
Fig. 2
Fig. 2
a External rapid prototyping of a 30-week fetus with sacrococcygeal teratoma. b Posterior and d anterior view after opening the body model. c Post-mortem MR image in the coronal plane. Teratoma is occupying most of the abdomen, displacing the intestines and other visceral organs. H heart, S spleen, A adrenals, I intestine, LK left kidney, RK right kidney, L liver
Fig. 3
Fig. 3
a–c Fractured skull and underling parenchymal bleed in the brain of an infant. d Corresponding post-mortem MR image in the sagittal plane. Black arrows indicate the bleed. These findings were confirmed at autopsy. This model was built by combining and registering CT images, which provided the 3D skull structure, with MR data that were used to reconstruct the bleed volumes and positions
Fig. 4
Fig. 4
External body rapid prototyping of (a) a 19-week fetus with a large exompholos, (b) an 18-week fetus terminated for a large myelemenigocele and exompholos (pentalogy of Cantrell) and (c) a 20-week fetus with short limb skeletal dysplasia

References

    1. Royal College of Paediatrics and Child Health (2002) The future of paediatric pathology services.
    1. Report of a census of organs and tissues retained by pathology services in England. Conducted in 2000 by the Chief Medical Officer.
    1. Shortage of human cadavers for medical training.
    1. Brookes JA, Hall-Craggs MA, Sams VR, Lees WRC. Non-invasive perinatal necropsy by magnetic resonance imaging. Lancet. 1996;348:1139–1141. doi: 10.1016/S0140-6736(96)02287-8.
    1. Cohen M, Whitby EH. The use of magnetic resonance in the hospital and coronial pediatric postmortem examination. Forensic Sci Med. 2007;3:289–296. doi: 10.1007/s12024-007-9017-5.
    1. Griffiths PD, Paley MN, Whitby EH. Post-mortem MRI as an adjunct to fetal or neonatal autopsy. Lancet. 2005;365:1271–1273. doi: 10.1016/S0140-6736(05)74816-9.
    1. Thayyil S, Cleary JO, Sebire NJ, Scott RJ, Chong K, Gunny R, Owens CM, Olsen OE, Offiah AC, Parks HG, Chitty LS, Price AN, Yousry TA, Robertson NJ, Lythgoe MF, Taylor AM. Post-mortem examination of human fetuses: a comparison of whole-body high-field MRI at 9.4 T with conventional MRI and invasive autopsy. Lancet. 2009;374:467–475. doi: 10.1016/S0140-6736(09)60913-2.
    1. Thayyil S, Schievano S, Robertson NJ, Jones R, Chitty LS, Sebire NJ, Taylor AM. A semi-automated method for non-invasive internal organ weight estimation by post-mortem magnetic resonance imaging in fetuses, newborns and children. Eur J Radiol. 2009;72(2):321–326. doi: 10.1016/j.ejrad.2008.07.013.
    1. Schievano S, Migliavacca F, Coats L, Khambadkone S, Carminati M, Wilson N, Deanfield JE, Bonhoeffer P, Taylor AM. Percutaneous pulmonary valve implantation based on rapid prototyping of right ventricular outflow tract and pulmonary trunk from MR data. Radiology. 2007;242:490–497. doi: 10.1148/radiol.2422051994.
    1. Armillotta A, Bonhoeffer P, Dubini G, Ferragina S, Migliavacca F, Sala G, Schievano S. Use of rapid prototyping models in the planning of percutaneous pulmonary valved stent implantation. Proc Inst Mech Eng H. 2007;221(4):407–416. doi: 10.1243/09544119JEIM83.
    1. Hayat T, Jiang S, Allsop J, Hajnal J, Rutherford M. Quantification of human fetal brain development in utero using multislice snapshot MRI with 3D volume reconstruction. Ultrasound Obstet Gynecol. 2008;31:597–609. doi: 10.1002/uog.5338.
    1. Christensen AM, Humphries SM, Goh KYC, Swift D. Advanced “tactile” medical imaging for separation surgeries of conjoined twins. Childs Nerv Syst. 2004;20:547–553. doi: 10.1007/s00381-004-0982-7.
    1. Body display ‘may threaten donations’.

Source: PubMed

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