Accuracy and feasibility in building a personalized 3D printed femoral pseudoaneurysm model for endovascular training

Abstract

Background: The use of three-dimensional(3D) printing is broadly across many medical specialties. It is an innovative, and rapidly growing technology to produce custom anatomical models and medical conditions models for medical teaching, surgical planning, and patient education. This study aimed to evaluate the accuracy and feasibility of 3D printing in creating a superficial femoral artery pseudoaneurysm model based on CT scans for endovascular training.

Methods: A case of a left superficial femoral artery pseudoaneurysm was selected, and the 3D model was created using DICOM files imported into Materialise Mimics 22.0 and Materialise 3-Matic software, then printed using vat polymerization technology. Two 3D-printed models were created, and a series of comparisons were conducted between the 3D segmented images from CT scans and these two 3D-printed models. Ten comparisons involving internal diameters and angles of the specific anatomical location were measured.

Results: The study found that the absolute mean difference in diameter between the 3D segmented images and the 3D printed models was 0.179±0.145 mm and 0.216±0.143mm, respectively, with no significant difference between the two sets of models. Additionally, the absolute mean difference in angle was 0.99±0.65° and 1.00±0.91°, respectively, and the absolute mean difference in angle between the two sets of data was not significant. Bland-Altman analysis confirmed a high correlation in dimension measurements between the 3D-printed models and segmented images. Furthermore, the accuracy of a 3D-printed femoral pseudoaneurysm model was further tested through the simulation of a superficial femoral artery pseudoaneurysm coiling procedure using the Philips Azurion7 in the angiography room.

Conclusions: 3D printing is a reliable technique for producing a high accuracy 3D anatomical model that closely resemble a patient's anatomy based on CT images. Additionally, 3D printing is a feasible and viable option for use in endovascular training and medical education. In general, 3D printing is an encouraging technology with diverse possibilities in medicine, including surgical planning, medical education, and medical device advancement.

Fig 1. Pelvic Computed Tomography images(CT).

The raw data of the pelvic CT with contrast (A) stored in the DICOM format was acquired to create the 3D model. (B) Then, the DICOM files are imported into Materialise Mimics 22.0 software where relevant arterial anatomy is segmented. (yellow) (C)Next the segmented model is exported to Materialise 3-Matic to create mesh representations of the individual parts or volumes to be printed.

Fig 2. Two superficial femoral artery pseudoaneurysm 3D printed models.

Fig 3

Ten specific anatomical location for measurement of (A) diameters and (B) angle to assess the accuracy of the segmented models and the two printed 3D models.

Fig 4

The measurement of the diameter at anatomical location 6 for (A) 3D model 1 and (B) 3D model 2. It also displays the measurement of the angle at anatomical location 8 for (C) 3D model 1 and anatomical location 3 for (D) 3D model 2.

Fig 5. Bland-Altman analysis of three-dimensional (3D) printed model measurement accuracy.

Graph A and B show the diameter measurements agreement between segmented model (.stl format data derived from CT data) and 3D printed model 1 (A) and 3D printed model 2 (B) at ten specific anatomical locations. Values are expressed in mm. Graph C and D show the angle measurements agreement between segmented model (STL format data derived from CT data) and 3D printed model 1 (C) and 3D printed model 2 (D) at ten specific anatomical locations. Values are expressed in degree(°). Central red line represents mean bias of difference. Yellow dotted lines represent upper and lower limits of agreement (LOA) ± 1.96 standard deviation.

Fig 6

(A) Digital subtraction angiography (DSA) performed by injection of contrast into the 3D-printed model, revealing a pseudoaneurysm which resembles the real case. (B) Coil embolization of the pseudoaneurysm sac performed under fluoroscopic guidance by Philips Azurion7 in the angiography room.