Technical report: 3D printing of the brain for use as a visual-aid tool to communicate MR imaging features of hypoxic ischaemic injury at term with non-physicians

Abstract

3D printing has been used in several medical applications. There are no reports however of 3D printing of the brain in children for demonstrating pathology to non-medical professionals such as lawyers. We printed 3D models of the paediatric brain from volumetric MRI in cases of severe and moderate hypoxic ischaemic injury as well as a normal age matched control, as follows: MRI DICOM data was converted to NifTI (Neuroimaging Informatics Technology Initiative) format; segmentation of the brain into CSF, grey, and white matter was performed; the segmented data was converted to STL format and printed on a commercially available scanner. The characteristic volume loss and surface features of hypoxic ischaemic injury are visible in these models, which could be of value in the communication of the nature and severity of such an insult in a court setting as they can be handled and viewed from up close.

Keywords: Hypoxic ischeamic injury; MR imaging features; Technical report.

Fig. 1

3D printed models of the brains of age matched children. On the left, a child severely affected by partial-prolonged hypoxic ischaemic injury [GREEN brain]; in the middle, a child with mild/moderate hypoxic ischaemic injury predominantly affecting the parasagittal and anterior watershed zones [GREY brain]; on the left a healthy brain [YELLOW brain]. When printed at scale and placed side-by-side, the extent of volume loss due to atrophy is far more apparent than when viewing axial images on an MRI because they allow appreciation of scale

Fig. 2

a, b Severe partial-prolonged hypoxic ischaemic injury to the brain with MR imaging at the age of 4 years and accompanying 3D print. a Coronal T1 weighted MRI at the level of the 3rd ventricle in a child with changes of severe term partial-prolonged hypoxic ischaemic injury, demonstrating marked widening of the interhemispheric fissure (curved arrow) with severe bilateral, symmetric volume loss in the anterior watershed distribution as well as perisylvian regions (dashed arrow). b 3D printed model of the brain shown in Fig. 3a demonstrating the pronounced interhemispheric and sulcal widening due to the volume loss (curved arrow) and severe bilateral, symmetric shrinkage of the brain along the peri-Sylvian and peri-Rolandic regions (dashed arrows)

Fig. 3

a, b Moderate/mild partial-prolonged hypoxic ischaemic injury to the brain with MR imaging at the age of 4 years and accompanying 3D print. a Coronal T1 weighted MRI at the level of the third ventricle demonstrates relatively mild changes of term partial-prolonged hypoxic ischaemic injury. Note widening of the interhemispheric fissure (curved arrow) and of the parasagittal sulci (dashed arrow) with ulegyria (arrowhead). b 3D printed model of the brain shown in Fig. 4a (mild changes of term partial-prolonged hypoxic ischaemic injury). There is moderate widening of the interhemispheric fissure (curved arrow). Note also prominent widening of the superior frontal sulcus corresponding to a parasagittal and anterior watershed continuum of volume loss (dashed arrow). Ulegyria is seen anteriorly (small black arrows)

Fig. 4

a, b Control patient with ‘normal’ MR imaging at the age of 4 years and accompanying 3D print. a Coronal T1 weighted MRI at the level of the 3rd ventricle in a healthy child age-matched with those in Figs. 3 and 4. The interhemispheric fissure is narrow (curved arrow) and the hemispheres and gyri are closely apposed (dashed arrow). b 3D printed model of the brain. The interhemispheric fissure is narrow (curved arrow) and the hemispheres and gyri are closely apposed (dashed arrows)