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Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Investigation of Three-dimensional Printing Materials for Printing Aorta Model Replicating Type B Aortic Dissection

Author(s): Chia-An Wu, Andrew Squelch and Zhonghua Sun*

Volume 17, Issue 7, 2021

Published on: 18 February, 2021

Page: [843 - 849] Pages: 7

DOI: 10.2174/1573405617666210218102046

Price: $65

Abstract

Aim: This study aims to determine a printing material that has both elastic property and radiology equivalence close to the real aorta for simulation of endovascular stent-graft repair of aortic dissection.

Background: With the rapid development of Three-Dimensional (3D) printing technology, a patient- specific 3D printed model is able to help surgeons to make a better treatment plan for Type B aortic dissection patients. However, the radiological properties of most 3D printing materials have not been well characterized. This study aims to investigate the appropriate materials for printing human aorta with mechanical and radiological properties similar to the real aortic Computed Tomography (CT) attenuation.

Objective: Quantitative assessment of CT attenuation of different materials used in 3D printed models of aortic dissection for developing patient-specific 3D printed aorta models to simulate type B aortic dissection.

Methods: A 25-mm length of aorta model was segmented from a patient’s image dataset with a diagnosis of type B aortic dissection. Four different elastic commercial 3D printing materials, namely Agilus A40 and A50, Visijet CE-NT A30 and A70 were selected and printed with different hardness. Totally four models were printed out and CT scanned twice on a 192-slice CT scanner using the standard aortic CT angiography protocol, with and without contrast inside the lumen. Five reference points with the Region Of Interest (ROI) of 1.77 mm2 were selected at the aortic wall, and intimal flap and their Hounsfield units (HU) were measured and compared with the CT attenuation of original CT images. The comparison between the patient’s aorta and models was performed through a paired-sample t-test to determine if there is any significant difference.

Results: The mean CT attenuation of the aortic wall of the original CT images was 80.7 HU. Analysis of images without using contrast medium showed that the material of Agilus A50 produced the mean CT attenuation of 82.6 HU, which is similar to that of original CT images. The CT attenuation measured at images acquired with the other three materials was significantly lower than that of the original images (p<0.05). After adding contrast medium, Visijet CE-NT A30 had an average CT attenuation of 90.6 HU, which is close to that of the original images without a statistically significant difference (p>0.05). In contrast, the CT attenuation measured at images acquired with other three materials (Agilus A40, A50 and Visiject CE-NT A70) was 129 HU, 135 HU and 129.6 HU, respectively, which is significantly higher than that of original CT images (p<0.05).

Conclusion: Both Visijet CE-NT and Agilus have tensile strength and elongation close to actual patient’s tissue properties producing similar CT attenuation. Visijet CE-NT A30 is considered the appropriate material for printing aorta to simulate contrast-enhanced CT imaging of type B aortic dissection. Due to the lack of body phantoms in the experiments, further research with the simulation of realistic anatomical body environment should be conducted.

Keywords: Three-dimensional printing, printing materials, type B aortic dissection, cardiovascular disease, model, contrast.

Graphical Abstract
[1]
Witowski J, Sitkowski M, Zuzak T, et al. From ideas to long-term studies: 3D printing clinical trials review. Int J Cars 2018; 13(9): 1473-8.
[http://dx.doi.org/10.1007/s11548-018-1793-8] [PMID: 29790077]
[2]
Sun Z. Insights into 3D printing in medical applications. Quant Imaging Med Surg 2019; 9(1): 1-5.
[http://dx.doi.org/10.21037/qims.2019.01.03] [PMID: 30788241]
[3]
Langridge B, Momin S, Coumbe B, Woin E, Griffin M, Butler P. Systematic review of the use of 3-dimensional printing in surgical teaching and assessment. J Surg Educ 2018; 75(1): 209-21.
[http://dx.doi.org/10.1016/j.jsurg.2017.06.033] [PMID: 28729190]
[4]
Lau IWW, Liu D, Xu L, Fan Z, Sun Z. Clinical value of patient-specific three-dimensional printing of congenital heart disease: Quantitative and qualitative assessments. PLoS One 2018; 13(3): e0194333.
[http://dx.doi.org/10.1371/journal.pone.0194333] [PMID: 29561912]
[5]
Sun Z, Liu D. A systematic review of clinical value of three-dimensional printing in renal disease. Quant Imaging Med Surg 2018; 8(3): 311-25.
[http://dx.doi.org/10.21037/qims.2018.03.09] [PMID: 29774184]
[6]
Ryan JR, Almefty KK, Nakaji P, Frakes DH. Cerebral aneurysm clipping surgery simulation using patient-specific 3D printing and silicone casting. World Neurosurg 2016; 88: 175-81.
[http://dx.doi.org/10.1016/j.wneu.2015.12.102] [PMID: 26805698]
[7]
Yi X, Ding C, Xu H, Huang T, Kang D, Wang D. Three-dimensional printed models in anatomy education of the ventricular system: A randomized controlled study. World Neurosurg 2019; 125: e891-901.
[http://dx.doi.org/10.1016/j.wneu.2019.01.204] [PMID: 30743037]
[8]
Yang Y, Liu X, Xia Y, et al. Impact of spatial characteristics in the left stenotic coronary artery on the hemodynamics and visualization of 3D replica models. Sci Rep 2017; 7(1): 15452.
[http://dx.doi.org/10.1038/s41598-017-15620-1] [PMID: 29133915]
[9]
Kim WK, Kim T, Lee S, et al. 3D-printing based open repair of extensive thoracoabdominal aorta in severe scoliosis. Semin Thorac Cardiovasc Surg 2019; 31(1): 61-3.
[http://dx.doi.org/10.1053/j.semtcvs.2018.09.017] [PMID: 30273648]
[10]
Huang J, Li G, Wang W, Wu K, Le T. 3D printing guiding stent graft fenestration: A novel technique for fenestration in endovascular aneurysm repair. Vascular 2017; 25(4): 442-6.
[http://dx.doi.org/10.1177/1708538116682913] [PMID: 27928064]
[11]
Tong YH, Yu T, Zhou MJ, et al. Use of 3D printing to guide creation of fenestrations in physician-modified stent-grafts for treatment of thoracoabdominal aortic disease. J Endovasc Ther 2020; 27(3): 385-93.
[http://dx.doi.org/10.1177/1526602820917960] [PMID: 32517556]
[12]
Sebastià C, Pallisa E, Quiroga S, Alvarez-Castells A, Dominguez R, Evangelista A. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics 1999; 19(1): 45-60.
[http://dx.doi.org/10.1148/radiographics.19.1.g99ja0945] [PMID: 9925391]
[13]
Tien M, Ku A, Martinez-Acero N, Zvara J, Sun EC, Cheung AT. The penn classification predicts hospital mortality in acute stanford yype A and type B aortic dissections. J Cardiothorac Vasc Anesth 2020; 34(4): 867-73.
[http://dx.doi.org/10.1053/j.jvca.2019.08.036] [PMID: 31558394]
[14]
Tran TP, Khoynezhad A. Current management of type B aortic dissection. Vasc Health Risk Manag 2009; 5(1): 53-63.
[PMID: 19436678]
[15]
Apostolakis E, Baikoussis NG, Georgiopoulos M. Acute type-B aortic dissection: The treatment strategy. Hellenic J Cardiol 2010; 51(4): 338-47.
[PMID: 20650832]
[16]
Qin YL, Wang F, Li TX, et al. Endovascular repair compared with medical management of patients with uncomplicated type B acute aortic dissection. J Am Coll Cardiol 2016; 67(24): 2835-42.
[http://dx.doi.org/10.1016/j.jacc.2016.03.578] [PMID: 27311522]
[17]
Kamman AV, Brunkwall J, Verhoeven EL, Heijmen RH, Trimarchi S. Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database. J Vasc Surg 2017; 65(4): 964-971.e3.
[http://dx.doi.org/10.1016/j.jvs.2016.09.033] [PMID: 27876516]
[18]
Li FR, Wu X, Yuan J, Wang J, Mao C, Wu X. Comparison of thoracic endovascular aortic repair, open surgery and best medical treatment for type B aortic dissection: A meta-analysis. Int J Cardiol 2018; 250: 240-6.
[http://dx.doi.org/10.1016/j.ijcard.2017.10.050] [PMID: 29066151]
[19]
Tong Y, Qin Y, Yu T, et al. 3D printing to guide the application of modified pre-fenestrated stent grafts to treat aortic arch disease. Ann Vasc Surg 2020; 66: 152-9.
[http://dx.doi.org/10.1016/j.avsg.2019.12.030] [PMID: 31917223]
[20]
Lei Y, Chen X, Li Z, et al. A new process for customized patient-specific aortic stent graft using 3D printing technique. Med Eng Phys 2020; 77(77): 80-7.
[http://dx.doi.org/10.1016/j.medengphy.2019.12.002] [PMID: 31937437]
[21]
Sun Z, Squelch A. Patient-specific 3D printed models of aortic aneurysm and aortic dissection. J Med Imaging Health Inform 2017; 7(4): 886-9.
[http://dx.doi.org/10.1166/jmihi.2017.2093]
[22]
Ho D, Squelch A, Sun Z. Modelling of aortic aneurysm and aortic dissection through 3D printing. J Med Radiat Sci 2017; 64(1): 10-7.
[http://dx.doi.org/10.1002/jmrs.212] [PMID: 28134482]
[23]
Ratinam R, Quayle M, Crock J, Lazarus M, Fogg Q, McMenamin P. Challenges in creating dissectible anatomical 3D prints for surgical teaching. J Anat 2019; 234(4): 419-37.
[http://dx.doi.org/10.1111/joa.12934] [PMID: 30710355]
[24]
Riedle H, Mukai B, Molz P, Franke J. Determination of the mechanical properties of aortic tissue for 3D printed surgical models. 2018 11th Biomedical Engineering International Conference (BMEiCON) 2018, IEEE. 1-5.
[25]
Shearn AIU, Yeong M, Richard M, et al. Use of 3D Models in the surgical decision-making process in a case of double-outlet right ventricle with multiple ventricular septal defects. Front Pediatr 2019; 7: 330.
[http://dx.doi.org/10.3389/fped.2019.00330] [PMID: 31482075]
[26]
Hussein N, Kasdi R, Coles JG, Yoo SJ. Use of 3-dimensionally printed heart models in the planning and simulation of surgery in patients with Raghib syndrome (coronary sinus defect with left superior vena cava). JTCVS Techniques 2020; 2: 135-8.
[http://dx.doi.org/10.1016/j.xjtc.2020.01.023]
[27]
Bieniosek MF, Lee BJ, Levin CS. Technical Note: Characterization of custom 3D printed multimodality imaging phantoms. Med Phys 2015; 42(10): 5913-8.
[http://dx.doi.org/10.1118/1.4930803] [PMID: 26429265]
[28]
Solomon J, Ba A, Bochud F, Samei E. Comparison of low-contrast detectability between two CT reconstruction algorithms using voxel-based 3D printed textured phantoms. Med Phys 2016; 43(12): 6497-506.
[http://dx.doi.org/10.1118/1.4967478] [PMID: 27908164]
[29]
Stratasys Ltd Agilus30 Material Data Sheet.. https://www.stratasys.com/materials/search/agilus30
[30]
[31]
Knollmann FD, Lacomis JM, Ocak I, Gleason T. The role of aortic wall CT attenuation measurements for the diagnosis of acute aortic syndromes. Eur J Radiol 2013; 82(12): 2392-8.
[http://dx.doi.org/10.1016/j.ejrad.2013.09.007] [PMID: 24120225]
[32]
Craft DF, Kry SF, Balter P, Salehpour M, Woodward W, Howell RM. Material matters: Analysis of density uncertainty in 3D printing and its consequences for radiation oncology. Med Phys 2018; 45(4): 1614-21.
[http://dx.doi.org/10.1002/mp.12839] [PMID: 29493803]
[33]
Sun Z. Use of three-dimensional printing in the development of optimal cardiac CT scanning protocols. Curr Med Imaging 2020; 16(8): 967-77.
[http://dx.doi.org/10.2174/1573405616666200124124140] [PMID: 32107994]
[34]
Sun Z, Jansen S. Personalized 3D printed coronary models in coronary stenting. Quant Imaging Med Surg 2019; 9(8): 1356-67.
[http://dx.doi.org/10.21037/qims.2019.06.21] [PMID: 31559165]
[35]
Aldosari S, Jansen S, Sun Z. Patient-specific 3D printed pulmonary artery model with simulation of peripheral pulmonary embolism for developing optimal computed tomography pulmonary angiography protocols. Quant Imaging Med Surg 2019; 9(1): 75-85.
[http://dx.doi.org/10.21037/qims.2018.10.13] [PMID: 30788248]
[36]
Aldosari S, Jansen S, Sun Z. Optimization of computed tomography pulmonary angiography protocols using 3D printed model with simulation of pulmonary embolism. Quant Imaging Med Surg 2019; 9(1): 53-62.
[http://dx.doi.org/10.21037/qims.2018.09.15] [PMID: 30788246]
[37]
Sun Z, Ng CKC, Squelch A. Synchrotron radiation computed tomography assessment of calcified plaques and coronary stenosis with different slice thicknesses and beam energies on 3D printed coronary models. Quant Imaging Med Surg 2019; 9(1): 6-22.
[http://dx.doi.org/10.21037/qims.2018.09.11] [PMID: 30788242]

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