Assessing the Feasibility and Utility of Patient-Specific 3D Advanced Visualization Modeling in Cerebrovascular Disease: Retrospective Analysis and Prospective Survey Pilot Study

Abstract

Background: The prevalence, clinical burden, and health care costs (>US $100 billion) associated with cerebrovascular disease (CVD) will increase significantly as the US population grows and ages over the next 25 years. Existing 2D imaging modalities have inherent limitations in visualizing complex CVD, which may be mitigated with the use of patient-specific 3D advanced visualization (AV) technologies. There remain gaps in knowledge, however, regarding how and with what impact these technologies are being used in CVD.

Objective: The aim of this study was to characterize the clinical attributes and reported utility associated with the use of 3D AV modeling in CVDs, specifically intracerebral arteriovenous malformations.

Methods: This pilot study employs a combination of retrospective analysis and prospective surveys to describe the utilization and utility of patient-specific AV models at a single high-volume certified comprehensive stroke center.

Results: From July 2017 to February 2023, 25 AV models were created for 4 different clinicians. The average patient age was 37.4 years; 44% (11/25) of the patients were African Americans, 52% (13/25) were on public insurance, and 56% (14/25) were associated with a neurovascular procedure. In this study, 18 clinicians with diverse experience responded to AV model surveys, with a 92.2% (166/180) completion rate. There was an average reported utility of 8.0 on a 0-10 scale, with higher scores reflecting increased utility. Compared to 2D viewing, AV models allowed staff to appreciate novel abnormal anatomy, and therefore, they would have changed their therapeutic approach in 45% (23/51) of the cases.

Conclusions: AV models were used in complex CVDs associated with young, publicly insured individuals requiring resource-intensive interventions. There was strong and diverse clinician engagement with overall report of substantial utility of AV models. Staff clinicians frequently reported novel anatomical and therapeutic insights based on AV models compared to traditional 2D viewing. This study establishes the infrastructure for future larger randomized studies that can be repeated for CVDs or other disease states and incorporate assessments of other AV modalities such as 3D printing and medical extended reality.

Keywords: 3D modeling; 3D printing; advanced visualization; artery; augmented reality; brain; cerebral; cerebrovascular; cerebrovascular disease; intracerebral arteriovenous malformations; medical extended reality; medical simulation; stroke; survey; usability; vein; vessel; virtual reality.

Figure 1

Ochsner BioDesign Digital Request and Fabrication Process. An electronic medical record–based order request is placed by a clinician. Source imaging DICOM (Digital Imaging and Communications in Medicine) datasets are accessed via a secure enterprise PACS (Picture Archiving and Communications System). Biomedical engineers utilize computer-aided design applications to transform DICOM datasets into 3D file types. These 3D files are then either visualized using a web-based browser or extended reality modalities such as virtual or augmented reality. These 3D files can be further processed to produce physical models using 3D printing. DICOM: Digital Imaging and Communications in Medicine; EMR: electronic medical record.

Figure 2

(A) Spetzler-Martin Grading scoring approach and (B) dot plot of Spetzler-Martin Grading scores, showing the distributions for values 1 (6/25, 24%), 2 (8/25, 32%), 3 (5/25, 20%), 4 (5/25, 20%), and 5 (1/25, 4%). SMG: Spetzler-Martin Grading.

Figure 3

Boxplots for complexity, utility, and improvement derived from 3D model based on expertise: advanced practice provider (n=5), staff (n=6), and trainee (n=7). APP: advanced practice provider.

Figure 4

Boxplots for complexity, utility, and improvement derived from 3D model based on the number of arteriovenous malformations evaluated: low (0-10, n=6), intermediate (11-100, n=9), and high (>101, n=3). AVM: arteriovenous malformation.

Figure 5

Boxplot of utility across self-reported experience. The Kruskal Wallis H test demonstrated a statistical difference between the low and high experience groups (P=.03). The analysis reveals that the median utility scores for low (n=6), intermediate (n=9), and high (n=3) categories of self-reported experience are 7.45, 8.00, and 9.00, respectively.