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Personalized 3D-Printed Transparent Liver Model Using the Hepatobiliary Phase MRI

Usefulness in the Lesion-by-Lesion Imaging-Pathologic Matching of Focal Liver Lesions—Preliminary Results

Joo, Ijin, MD*,†; Kim, Jung Hoon, MD*,†,‡; Park, Sang Joon, PhD*; Lee, Kyoungbun, MD§; Yi, Nam-Joon, MD; Han, Joon Koo, MD*,†,‡

doi: 10.1097/RLI.0000000000000521
Original Articles

Purpose The aim of this study was to investigate the usefulness of a personalized, 3-dimensional (3D)–printed, transparent liver model with focal liver lesions (FLLs) for lesion-by-lesion imaging-pathologic matching.

Materials and Methods This preliminary, prospective study was approved by our institutional review board, and written informed consent was obtained. Twenty patients (male-to-female ratio, 13:7; mean age, 56 years) with multiple FLLs, including at least one presumed malignant, or an indeterminate lesion 10 mm or less on the preoperative gadoxetic acid–enhanced magnetic resonance imaging (MRI), were included. After digital segmentation of hepatobiliary phase MRI, a transparent, 3D-printed liver model with colored anatomical structures and FLLs was produced. During the gross examination of the liver specimen, the per-lesion detection rates were compared between those without (routine protocol) and those with the aid of the 3D-printed liver model.

Results Among 98 MRI-detected FLLs (11.5 ± 12.5 mm), the per-lesion detection rate on gross examination using the 3D-printed liver model was 99.0% (97/98), which was significantly higher than that obtained on routine examination (82.7% [81/98]; P < 0.001). In the subgroup analysis, according to the tumor size, 23.9% (16/67) of FLLs 10 mm or less were additionally detected using the liver model, whereas none were additionally detected in greater than 10 mm. The additionally detected 16 FLLs in 12 patients included histologic diagnoses of viable metastases, pathologic complete response of metastases, hepatocellular carcinomas, focal nodular hyperplasia–like nodules, and hemangiomas.

Conclusions A personalized, 3D-printed liver model with FLLs may improve the lesion-by-lesion imaging-pathologic matching for small FLLs, thus leading to accurate pathologic tumor staging and obtaining a reliable reference for imaging-detected FLLs.

From the *Department of Radiology, Seoul National University Hospital;

Department of Radiology, Seoul National University College of Medicine;

Institute of Radiation Medicine, Seoul National University Medical Research Center; Departments of

§Pathology, and

Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

Received for publication July 13, 2018; and accepted for publication, after revision, September 1, 2018.

Conflicts of interest and sources of funding: This research was supported by grant number 03-2016-0160 from the SNUH Research Fund. Institutional review board approval was obtained (number 1505–109-676).

The authors report no conflicts of interest.

Correspondence to: Jung Hoon Kim, MD, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. E-mail: jhkim2008@gmail.com.

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