title: MRI visible Fe3O4polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures.
abstract: OBJECTIVE
  To demonstrate mesh magnetic resonance imaging (MRI) visibility in living women, the feasibility of reconstructing the full mesh course in 3D, and to document its spatial relationship to pelvic anatomical structures.
  
  
  METHODS
  This is a proof of concept study of three patients from a prospective multi-center trial evaluating women with anterior vaginal mesh repair using a MRI-visible Fe3O4polypropylene implant for pelvic floor reconstruction. High-resolution sagittal T2-weighted (T2w) sequences, transverse T1-weighted (T1w) FLASH 2D, and transverse T1w FLASH 3D sequences were performed to evaluate Fe3O4polypropylene mesh MRI visibility and overall post-surgical pelvic anatomy 3 months after reconstructive surgery. Full mesh course in addition to important pelvic structures were reconstructed using the 3D Slicer® software program based on T1w and T2w MRI.
  
  
  RESULTS
  Three women with POP-Q grade III cystoceles were successfully treated with a partially absorbable MRI-visible anterior vaginal mesh with six fixation arms and showed no recurrent cystocele at the 3-month follow-up examination. The course of mesh in the pelvis was visible on MRI in all three women. The mesh body and arms could be reconstructed allowing visualization of the full course of the mesh in relationship to important pelvic structures such as the obturator or pudendal vessel nerve bundles in 3D.
  
  
  CONCLUSIONS
  The use of MRI-visible Fe3O4polypropylene meshes in combination with post-surgical 3D reconstruction of the mesh and adjacent structures is feasible suggesting that it might be a useful tool for evaluating mesh complications more precisely and a valuable interactive feedback tool for surgeons and mesh design engineers.
authors.affiliation: Pelvic Floor Research Group, Biomedical Engineering Department, University of Michigan, 2350 Hayward Street, Ann Arbor, MI, 48103, USA.
authors.forename: Luyun
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, St Marienkrankenhaus Ludwigshafen, Academic Teaching Hospital of the Faculty of Medicine Mannheim of the University Medical School Heidelberg, Salzburgerstrasse 15, 67067, Ludwigshafen am Rhein, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Lenz
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Céline D
authors.initials: CD
authors.lastname: Alt
authors.affiliation: Medical School, Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Sohn
authors.affiliation: Obstetrics and Gynecology Department, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, 48103, USA.
authors.forename: John O
authors.initials: JO
authors.lastname: De Lancey
authors.affiliation: Medical School, Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. kerstin.brocker@med.uni-heidelberg.de.
authors.forename: Kerstin A
authors.initials: KA
authors.lastname: Brocker
mesh_terms: D000368:Aged; D052858:Cystocele / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D052203:Ferrosoferric Oxide; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010384:Pelvic Bones / Q000000981:diagnostic imaging*; D017773:Pelvic Floor / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000294:innervation; D011126:Polypropylenes; D011184:Postoperative Period; D000075082:Proof of Concept Study; D011446:Prospective Studies; D013526:Surgical Mesh; D014621:Vagina / Q000000981:diagnostic imaging / Q000601:surgery
chemical_list: D011126:Polypropylenes; D052203:Ferrosoferric Oxide
keywords: 3D mesh reconstruction; Fe3O4; MRI-visible anterior mesh; Pelvic floor mesh surgery; Pelvic organ prolapse