CINEMRI to help cure painful abdominal adhesions

CINEMA - Implementation and validation of CineMRI for detection and image-guided surgery of painful abdominal adhesions

Top Sector Life Sciences & Health (LSH) supports innovative research and development in a public-private partnership (PPP) of Radboudumc and Watson Medical B.V. that aims to enable curation of abdominal pain due to adhesions by imaging-guided personalised treatment. 

Pain caused by adhesions after abdominal surgery occurs in the Netherlands up to 30,000 times a year. Adhesions cause about 15,000 of these cases for chronic pain. At this moment the only effective remedy for pain caused by adhesions is by operating again to release the adhesions. In many cases, such reoperations result in harmful outcomes. Frequently no adhesion is found, or too many adhesions at risky locations causing complications. Recently an imaging method was discovered that can detect the presence and location of an adhesion, but this is not clinically available. 

CineMRI is a new imaging technique that can find adhesions without surgery. CineMRI can prevent many of those unnecessary and harmful operations, and it allows targeted surgery. How does it work? During an MRI, abdominal muscles are tightened in various ways, and a 'film' is made. The MRI film then shows whether tissues move along a membrane or not. The lack of that movement predicts an adhesion. CineMRI reading is very labor-intensive and requires much expertise. Radboudumc demonstrated that novel, Shearogram technology can help reading this type of CineMRI. A Shearogram is the output of a computer algorithm that calculates shift (shear) along manually drawn anatomical structures. 

The experimental research development aimed to enhance and transform the laboratory prototype into a clinical tool. The collaborative partners then investigated in multiple centers whether this tool can prevent unnecessary surgeries, the feedback was used to further improve the tool such that it is ready to be certified and usable for clinical use.

Results

Radboudumc and Watson Medical further developed Shearogram technology to allow robust clinical use. A commercial prototype was built and successfully clinically validated in a hospital. The new visceral slide parameter now reproducibly quantifies sliding motion and allows clinicians to probe the abdominal region for various adhesion levels. A laborious manual segmentation was transformed into a simple routine by a new semi-automatic contouring algorithm. The clinical validation led to insights that triggered successful new grant applications to fully exploit the potential of the CineMRI using Artificial Intelligence.

Summary
Abdominal pain after surgery occurs in the Netherlands up to 30,000 times a year and the subsequent surgery is often ineffective. This project explored the implementation of a novel MRI technique (CineMRI) with assistive tools to provide patient specific diagnosis of presence and location of adhesions.
Technology Readiness Level (TRL)
6 - 7
Time period
2 years
Partners