MRI visible Fe3O4 polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures
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Introduction and hypothesis
To demonstrate mesh magnetic resonance imaging (MRI) visibility in living women, the feasibility of reconstructing the full mesh course in 3D, and to document its spatial relationship to pelvic anatomical structures.
This is a proof of concept study of three patients from a prospective multi-center trial evaluating women with anterior vaginal mesh repair using a MRI-visible Fe3O4 polypropylene implant for pelvic floor reconstruction. High-resolution sagittal T2-weighted (T2w) sequences, transverse T1-weighted (T1w) FLASH 2D, and transverse T1w FLASH 3D sequences were performed to evaluate Fe3O4 polypropylene mesh MRI visibility and overall post-surgical pelvic anatomy 3 months after reconstructive surgery. Full mesh course in addition to important pelvic structures were reconstructed using the 3D Slicer® software program based on T1w and T2w MRI.
Three women with POP-Q grade III cystoceles were successfully treated with a partially absorbable MRI-visible anterior vaginal mesh with six fixation arms and showed no recurrent cystocele at the 3-month follow-up examination. The course of mesh in the pelvis was visible on MRI in all three women. The mesh body and arms could be reconstructed allowing visualization of the full course of the mesh in relationship to important pelvic structures such as the obturator or pudendal vessel nerve bundles in 3D.
The use of MRI-visible Fe3O4 polypropylene meshes in combination with post-surgical 3D reconstruction of the mesh and adjacent structures is feasible suggesting that it might be a useful tool for evaluating mesh complications more precisely and a valuable interactive feedback tool for surgeons and mesh design engineers.
Keywords3D mesh reconstruction Fe3O4 MRI-visible anterior mesh Pelvic floor mesh surgery Pelvic organ prolapse
We thank Dr A. Maleika (Director of the Department of Obstetrics and Gynecology, Hospital Schwetzingen, Germany) for her assistance in patient recruitment for this trial. Dr J. DeLancey and Dr L. Chen acknowledge support from the Office for Research on Women’s Health Special Center of Research Grant at the NIH P50 HD 44406 and R21 HD079908.
Compliance with ethical standards
KAB and FL received speaking honoraria from the company Serag Wiessner (Naila, Germany). FL received speaking honoraria from American Medical Systems, USA, and C.R. BARD, Karlsruhe, Germany. No money from speaking honoraria was used to fund this trial. KAB has received research funding from Serag Wiessner in the past, none of which was used to perform this trial. KAB received a scholarship from the organization Forum urodynamicum e.V. to complete this work. CDA and CS state that they have nothing to disclose.
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