Holographic three-dimensional reconstruction of prostate apex region and its clinical application
Wang lei1, Gao Pengfei1, Li Mengshen2, Li Xiaojian1, Zhao Zichen1, Zhu Gang3, Li Ningchen1,*, Na Yanqun1
1Wujieping Urology Center; 2Department of Medical Imaging, Peking University Shougang Hospital, Beijing 100144; 3Department of Urology, Beijing United Family Hospital and Clinics, Beijing 100015
Abstract：Objective： To explore the feasibility and clinical value of holographic modeling of prostate apex region. Methods： The clinical data of 13 patients with holographic modeling and laparoscopic radical prostatectomy in Peking University Shougang Hospital from January to December 2021 were analyzed retrospectively. The age was （71.0 ± 4.7） years old, and the median value of PSA was 17.4 （ 6.19,159.6） μg/L. DICOM data from patients’ multi parameter MRI were obtained before operation. The fine morphology of prostate apex and the external urethral sphincter complex were segmented and reconstructed under real-time comparison of coronal, sagittal and axial MRI images. The total length and exposed length of the sphincter complex were measured, and the shape of the prostate apex was divided into type 1 sharp shape, type 2 anterior lip protrusion shape, type 3 posterior lip protrusion shape and type 4 round blunt shape. The exposed length of the external sphincter complex ≤11.5mm or the exposed proportion ≤60% was defined as the high risk of urinary control. Those with tumor lesions in apex region were defined as high risk of tumor control, and those with type 1 apex or apex capsule invasion were defined as extremely high risk of apex tumor control. The risks of urinary control and apex tumor control were evaluated by holographic images before operation, and personalized apex treatment strategies were formulated. The operations were guided by holographic image - endoscopic image fusion system during operation. Results： All the 13 cases were successfully completed, with an average operation time of （177±43） min, 7 patients had pathological stages of T3a-T4. The total length of the sphincter complex revealed by the hologram was （17.1±3.5） mm, the exposed length was （12.2±2.6） mm, and the exposed proportion was （72.4±12.8）%. There were 2 cases, 2 cases, 4 cases and 5 cases with apex morphology of type 1-4, respectively. A total of 6 patients with high risk of urinary control and 7 patients with low risk of urinary control were evaluated by holographic images before operation. The recovery rates of urinary control in 6 months after operation were 1/6 （16.7%） and 6/7 cases （85.7%）, respectively, and 5/6 （83.3%） and 7/7 cases （100%） in 12 months. According to the preoperative evaluation, the tumor control of the apex was low-risk in 3 cases, high-risk in 8 cases and extremely high-risk in 2 cases. The positive rates of the incisional margin of the apex confirmed by pathology were 0/3 （0%）, 3/8 （37.5%） and 2/2 （100%）, respectively. Conclusion： Holographic fine reconstruction of prostate apex region is helpful to predict the risk of urinary control and tumor control, and it is helpful for the individualized treatment of the apex region during surgery.
汪磊, 高鹏飞, 李梦参, 李晓建, 赵子臣, 朱刚, 李宁忱, 那彦群. 前列腺尖部区域全息影像三维重构的应用分析[J]. 微创泌尿外科杂志, 2022, 11(5): 321-326.
Wang lei, Gao Pengfei, Li Mengshen, Li Xiaojian, Zhao Zichen, Zhu Gang, Li Ningchen, Na Yanqun. Holographic three-dimensional reconstruction of prostate apex region and its clinical application. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(5): 321-326.
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