MRI Surveillance of Plastic Material Surgical Meshes: Experimental Model - Interim Results

Adrian Carabineanu,Octavian Cretu,Ramona Gadea,Cristina Saracin,Raluca Ceausu,Dan Navolan,Daniel Malita,Dan Costachescu,Adelina Mocanu,Alexandru Blidisel

doi:10.37358/mp.21.3.5520

Abstract

The number of surgical procedures for abdominal wall defects is increasing, often requiring the insertion of plastic material meshes. Surveillance of patients with inserted plastic meshes requires an accurate determination of the position of the mesh. However, this is a difficult task, depending on the kind of mesh, magnetic resonance imaging (MRI) protocol or consistence of the surrounding tissue (fat, muscle, aponeurosis). The aim of our research was to develop an experimental model to test the ability of MRI to identify the exact position of surgical plastic meshes: polypropylene or polyester. To simulate the placement of a mesh in human body we developed a model built up from two pieces of tissue with dimensions of 40 cm x 20 cm, harvested from a pig with a weight of 120 kg. The meshes were situated for MRI evaluation between the two pieces: abdominal pig muscle respectively suprajacent abdominal pig wall subcutaneous fat, approximately 2 cm high. Five surgical meshes were scanned through six MRI sequences, in view of establishing an optimal MRI scanning protocol and best visible meshes. The MRI scans were evaluated by 5 radiologists with different degrees of training. Our results showed that the experimental model developed by us can be successfully used to test the ability of MRI to visualize different kind of plastic meshes. Also, our experiment has revealed that T1fl2D sequence is the best in highlighting meshes from surrounding tissue, and the best visualized Mesh was number 4, made of polyester. In conclusion, based on our experimental model, we should select a plastic mesh or MRI protocol which will allow an optimal post implantation monitoring. Modern technology of material�s fabrication can help to better identify the mesh itself using MRI scanning.

Highlights

Surgical repair of abdominal wall weakness or defects represents a common procedure which could be done with native tissue or synthetical meshes
After a systematic analysis of literature we found there are a significant number of case reports but a very few experimental studies, or in vivo studies, regarding the visualization of the surgical meshes with the help of magnetic resonance imaging (MRI) scanning
A median value was calculated from the 60 visualization scores obtained by each of the five physicians on evaluating of each mesh in all the six different MRI sequences

Summary

Introduction

Surgical repair of abdominal wall weakness or defects represents a common procedure which could be done with native tissue or synthetical meshes. The experience of surgeons, the strength and perfusion of affected tissues, particularities of patients or type of available meshes play a role in choosing one or the other of the repair options [1, 2]. If the patient's native tissue has been compromised, meshes are most often necessary to supplement tissue strength. Up to 75-80% of cases which require hernia surgery benefit from a plastic material mesh. The diversity of plastic meshes for surgical repair has stirred the interest of surgeons and radiologists in studying features of meshes: composition, structure, price, risk of infection, inflammatory response of surrounding tissue and imagistic monitoring of implanted meshes. Advantages and disadvantages of these plastic meshes ought to be recognized and understood before choosing procedure and materials

Objectives

Methods

Results