3D printed models from MRI scans can effectively demonstrate the surface structure of the brain. Previous workflows focus on adult brains as a basis for prints. Our database of pediatric MRI brains who had perinatal hypoxic ischemic injury and presented late for imaging, with pathology causing cortical surface irregularities and parenchymal cysts. Difficulties arise in accurate depiction of the cortex on 3D print models in these pathologic brains. We aim to demonstrate effective workflows to accurately and efficiently print 3D models of especially pathologic pediatric MRI brains. Also, to critically and empirically test and refine the various steps involved in producing 3D print models which include segmentation of the MRI volume into tissue classes, generation of a surface model from this volume, preparation and final print of a 3D model. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Chacko Anith, Andronikou Savvas, Shearn Andrew, Thai Ngoc Jade

Keywords: 3D Printing, Hypoxic Ischaemic Injury, 3D Models

Effective text-based communication, through radiologist reports, of imaging findings in term Hypoxic Ischemic Injury (HII) to family members, non-radiologist colleagues and members of the legal profession can be extremely challenging. Utilization of 3D printed models, where the actual findings of the brain can be communicated via tactile perception and rotating/grasping the models is a potential solution which has not been tested in practice. We aimed to determine the sensitivity and specificity of different groups, comprising trained radiologists, non-radiologist physicians and non-physicians, in the detection of gross disease of the cerebral cortex from 3D printed brain models derived from MRI scans of children. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Venkatakrishna Shyam Sunder, Chacko Anith, Schoeman Sean, Andronikou Savvas

Keywords: Magnetic Resonance Imaging, 3D Printing, Hypoxic Ischemic Injury

To assess the utility and adaptability of some widely used automated segmentation methods when applied to abnormal pediatric magnetic resonance imaging (MRI) brain scans. Segmentation is an essential component of the workflow when building 3D anatomical models of abnormal pediatric brains to demonstrate surface pathology. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Schoeman Sean, Venkatakrishna Shyam Sunder, Chacko Anith, Andronikou Savvas

Keywords: Segmentation, 3D Printing, MRI Brain

Hypoxic ischemic injury (HII) is a leading cause of neonatal encephalopathy and resultant cerebral palsy. Most studies focus on early magnetic resonance imaging (MRI) findings and patterns of injury, with few studies evaluating patterns in delayed MRI of patients with cerebral palsy. We aim to categorise the delayed imaging MRI findings and distribution of abnormalities in a large cohort of children with cerebral palsy and obtained for medicolegal purposes to determine the causes of cerebral palsy, and to map the frequency of anatomic involvement in those with hypoxic ischemic injury. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Chacko Anith, Andronikou Savvas, Goncalves Fabricio, Vedajallam Schadie, Thai Ngoc Jade

Keywords: hypoxic ischaemic injury, HII, Patterns of hypoxic ischemic injury

The inter-arterial watershed zone in neonates is a geographic area without discernible anatomic boundaries, is difficult to demarcate and usually not featured in atlases. Schematics currently used to depict the areas are not based on any prior anatomic mapping, as compared to adults. Magnetic resonance imaging (MRI) of neonates in the acute to subacute phase with suspected hypoxic ischaemic injury can demonstrate signal abnormality and restricted diffusion in the cortical and subcortical parenchyma of the watershed regions, although this can often be subtle. In contrast, in the chronic stage of evolution of partial prolonged hypoxic-ischaemic injury, atrophy and ulegyria can make the watershed zone more conspicuous as a region. Our aim is to use images extracted from a large medicolegal database (approximately 2000 cases), of delayed MRI scans in children with cerebral palsy, to demonstrate the watershed region. To achieve this, we have selected cases diagnosed on imaging as having sustained a pattern of term, partial-prolonged hypoxic-ischaemic injury affecting the hemispheric cortex, based on the presence of bilateral, symmetric atrophy with ulegyria. From these we have identified those patients demonstrating injury along the entire watershed continuum as well as those demonstrating selective anterior or posterior watershed predominant injury for demonstration. Recognition of this zone is essential for diagnosing partial-prolonged hypoxic-ischaemic injury sustained in term neonates, which also has implications for potential compensation in litigation. The set of images presented in this pictorial review provides a template for identifying the cortical watershed distribution when there is milder regional (anterior, parasagittal, peri-Sylvian and posterior) watershed injury and for more severe injury where multiple regions are injured in combination or as a continuum. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Chacko Anith, Andronikou Savvas, Goncalves Fabricio, Mian Ali, Vedajallam Schadie, Thai Ngoc Jade

Keywords: Cortical Ischemic Patterns, Watershed Zone, Hypoxic Ischemic Injury