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Year 2019 Vol. 27 No 3


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Samara State Medical University, Samara,
The Russian Federation

Objective. To design a patient-specific preoperational 3D model of the neck anatomical formations based on MRI study to facilitate the search and removal of parathyroid adenoma in patients with tertiary hyperparathyroidism (THPT).
Methods. Preoperative 3D modeling was done for 7 patients with tertiary hyperparathyroidism. All patients were on the program renal dialysis because of the terminal stage of chronic renal insufficiency. For obtaining the personified 3D model the results MRI and special software were used. Data in DICOM format were loaded in software; at the same time, individual series of MRI studies were recorded and brought to a single coordinate system, they were segmented the selection on the images of borders of anatomical structures, and three-dimensional polygonal models of the anatomical structures of the anterior surface of the neck and pathological sites adenomas of the parathyroid glands were designed.
Results. With the use of preoperation 3D modeling the obtained models of the anatomical formations of neck allowed revealing and removing parathyroid adenomas rapidly, with the smallest time interval. The operation time on the average comprised 6015 the minutes (Mσ). The operation effectiveness was proved by the results of laboratory investigations and clinical picture on the whole. In the postoperative period, during the following day after operation the median of ionized calcium decreased to 0.88 mmol/L (decrease by 0.32 mmol/L or on 26.7%, with r=0.00001), the median of parathyroid hormone to 98.2 pg/ml (decrease on 2048.8 pg/ml 95.4% with r=0.00001); the median of phosphorus to 1.28 mmol/L (it was lowered on 0.33 mmol/L 20.5%). The pains in the bones and the joints were clinically stopped in patients.
Conclusions. The suggested method is a reliable technique of the preoperative topical diagnosis of the pathological changes of the parathyroid glands. Its use leads to the decrease of operation time and reduces the need for traumatic and time-consuming neck exploration, necessary to find 4 and more adenomas), thus reducing the risk of post-surgery complications. The given method can be used for objective visualization of parathyroid adenomas during the operation and serve as the effectiveness criterion of surgical treatment adequacy.

Keywords: 3D model, magnetic resonance imaging, tertiary hyperparathyroidism, diagnostics, surgical treatment
p. 307-317 of the original issue
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Address for correspondence:
443099, The Russian Federation,
Samara, Chapayevskaya Str., 89,
Samara State Medical University,
Department of Surgical Diseases 1.
Tel. +7 903 334-22-59,
Igor V. Makarov
Information about the authors:
Makarov Igor V., MD, Professor, Head of the Department of Surgical Diseases 1, Dean of the Pediatric Faculty, Samara State Medical University, Samara, Russian Federation.
Zhirov Vladimir V., PhD, Head of the Center for Educational Information Technologies, Programming Engineer of the Augmented Reality Technology Laboratory of the Virtual Technologies Department of the Center for Breakthrough Research IT in Medicine, Samara State Medical University, Samara, Russian Federation.
Kolsanov Alexander V., MD, Professor of RAMS, Head of the Department of Operative Surgery, Clinical Anatomy with the Course of Innovative Technologies, Samara State Medical University, Samara, Russian Federation.
Galkin Rudolf A., MD, Professor of the Department of Surgical Diseases 1, Samara State Medical University, Samara, Russian Federation.
Sidorov Aleksandr Yu., PhD, Associate Professor of the Department of Surgical Diseases 1, Samara State Medical University, Samara, Russian Federation.
Khokhlova Darya O., Clinical Intern of the Department of Surgical Diseases 1, Samara State Medical University, Samara, Russian Federation.
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