| As we all known, Female pelvis is a very complex three-dimensional anatomical structure, its internal organizational structure of many, not only the urinary, reproductive, and digestive system, including three multiple tissues and organs, but also blood vessels, nerves, and pelvic muscle and other tissue components, spatial relations are complicated, which is closely related to women and Obstetrics slender tortuous pelvic vessels, distribution density, grading rich, complex and so the direction of blood flow has been difficult anatomy and clinical research. In recent years, with the vascular interventional therapy, vaginal surgery, laparoscopic techniques in the diagnosis and treatment of gynecological and obstetrical diseases in the widely used and people of allogeneic transplantation of the uterus [1], people's understanding of female pelvic vascular network With higher demand [1-3]. Present on the vascular network of female pelvic mainly from the autopsy, and digital subtraction angiography (Digital subtraction angiography, DSA) technology, but because of the difficulties to obtain specimens, more valuable, and with a "destroy" the nature of the research methods, we can not get a lot of anatomy to describe the data and follow-up study, DSA technology is the study of female pelvic blood vessels more practical means, since November 1980 has been made public DSA technology, DSA technology is widely used in clinical and scientific research and teaching, With the technology can clearly show the wealth of pelvic arterial branches at all levels, major blood vessels and is also involved in the preoperative evaluation of gynecologic standards, but the high cost of the technology, with trauma, clinical operations complex, not as a clinical routine examination [4], in short, our preliminary study of female pelvic vascular means there are certain limitations, limiting our further study of female pelvic blood vessels. With the number of people in recent years, technology development and application, Some scholars use digital data sets were frozen milling female pelvic vessels on a preliminary study in 2004, such as Switzerland, M. BAJKA [5] number of women who first used the U.S. data set on female pelvic anatomy built digital three-dimensional model discussed, but due to data shortcomings, not in the data set before data acquisition using the effective labeling method, and its failure to successfully build a pelvic vascular network.2005 domestic single-Jin Lu, etc. [6] The number of Chinese women who constructed the data set the number of female pelvic three-dimensional model (pelvis, major blood vessels, uterus, etc.), the construction of pelvic arterial vascular network includes the abdominal aorta, iliac artery, external iliac artery and iliac artery of the trunk. In 2007 the re-use of the data set further to the pelvic arteries were separate building networks, digital models of the vascular network, including external iliac artery, internal iliac artery and some of the primary branches, but the display of the vascular network fuzzy boundaries, shape due to the rules. There are presently number of women who reported only 4 cases of data sets, these data have a color, thin and intuitive advantages, but also have difficulty in collecting, rebuilding difficult and complex procedures, and other subjective factors, major shortcomings, while These data can only provide common pelvic vascular anatomy, personalized features can not be achieved, however, the data set is the number of female pelvic vascular three-dimensional model provides a way, we can use the technology as much as possible a single body of data " information ", but also to retain as much as possible the information it contains. However, due to the body when the number of people collecting data sets, although perfusion and blood vessels for systemic treatment, but because of the infusion material viscosity, flow and perfusion pressure and perfusion restriction sites, resulting in perfusion can not reach all of the mesh material blood vessels, which is not conducive to follow-up of small blood vessels in the identification, segmentation and reconstruction, and therefore can not make the uterine vascular network of the hollow organs of the digital. Although uterine artery vascular network in the current cast specimens reports, but no digital three-dimensional model of the temporary data collection reports. In order to meet women's needs for basic research of pelvic blood vessels, uterine vascular network of the three data collection becomes necessary. With the era of progress and scientific and technological progress, the frozen body of milling although follow-up data sets provide a benchmark for clinical research or in-kind basis, but due to the acquisition of the long period of data collection, process complex can not adapt to the needs of the clinical diagnosis and treatment of medical records. With the clinical application of multi-source helical CT continues to increase. CTA (Computed tomographic angiography, computed tomography angiography) has become a kind of advanced vascular disease with diagnostic methods, CTA is in the bolus dynamic scan and three-dimensional image reconstruction technique developed on the basis of angiography. The basic principle is:use the spiral scan, intravenous bolus injection of contrast agent enhancement within the vessels in the interest peak period, the volume of a breath-hold fast continuous scanning, and display three-dimensional reconstruction of vascular structures of the image. With this technique, we can quickly and accurately capture the physiological state of the patient CT data sets of pelvic vessels, use of the data set, reconstructing female pelvic vascular digital three-dimensional visualization model, used clinically to guide the diagnosis and treatment of patients, before us has become a problem. [3,7-9] previous experiments, we are perfused through the traditional materials, CPVC (Chlorinated poly vinyl chloride, CPVC) improvement of vascular casting technology with the CT scan reconstruction of thin organic combination, and In animal experiments on the basis of further success [7] constructed normal human uterine artery vascular network of digital three-dimensional model [8-9]. And on the uterine vascular network of veins weak, yet levels of vascular anatomy of the uterine vein network clear digital model was constructed successfully. In summary, we intend to study in the early, based on the successful construction of normal human uterine venous vascular network and the use of CT scanning technology to build thin uterine vein in the body of female three-dimensional model of the digital network method and meaning. This study divided into three parts:part I:Construction of 3D Digital model of pig normal uterus vein vasucular network[Purpose]By vascular casting techniques, CT scanning thin build, pig normal uterine vein vascular network digital three-dimensional model, so as to explore the use of different infusion materials, different pressures, the bilateral uterine vein, intravenous infusion of building bilateral pig urogenital normal uterine vein vascular network in digital three-dimensional model of the feasibility of uterine arteriovenous perfusion similarities and differences, the normal human uterine vein in vitro model construction of digital networks to provide technical guidance and theoretical support. [Methods]Genitourinary system for pig normal specimens (uterus and double annex, vagina, bladder and urethra),12 cases were randomly divided into A, B, C, D, E, F group, n= 2 cases. Reference to previous experimental research group in the formulation and CPVC filler denture materials reported in the literature of self-curing formula [to self-curing denture water as the solvent, the solute self-curing denture powder, lead oxide added CT contrast agent (8:100), and number of red or blue color ads] configuration fillers, underwent bilateral uterine infusion, intravenous infusion of bilateral urogenital. Perfusion in each group are as follows:(1):A group of self-curing denture with 0.75:1 material, perfusion pressure is the volume compression ratio 9ml/20ml;(2):B group with 1.25:1 self-curing denture materials, perfusion pressure is the volume compression ratio 9ml/20ml;(3):C group were 1.75:1 self-curing denture materials, perfusion pressure is the volume compression ratio 9ml/20ml;(4):F group of self-curing denture with 1.25:1 material, the side of the perfusion pressure for the volume compression ratio 12ml/20ml, the other side of the perfusion pressure for the volume compression ratio 9ml/20ml;(5):D group were 20% of a vinyl chloride infusion, perfusion pressure is the volume compression ratio 9ml/20ml;(6):E group were 30% of a vinyl chloride infusion, perfusion pressure is the volume compression ratio 9ml/20ml;Perfusion immediately after the thin line of 64-slice spiral CT scan and reconstruction. CT comes with software to the maximum intensity projection (Maximum intebsity projection, MIP), volume rendering technique (Volume rendering, VR) to complete three-dimensional reconstruction, and finally placed in 37% of the samples in concentrated hydrochloric acid corrosion vascular cast specimens obtained. Comparison of different nature, different proportions of different building materials vascular perfusion pressure cast specimens, CT reconstruction of digital three-dimensional model characteristics.[Results]In this study,12 cases of pigs used in the normal urogenital specimens are complete uterine vein, bilateral urogenital venous infusion, after the form of concentrated hydrochloric acid corrosion are full, structural integrity of the vascular network of the pig uterine vein cast specimens, CT scan reconstruction models show the pig uterine vein forms a complete vascular network, blood vessel anatomy level of clarity, the same kind of vascular cast specimens with high consistency.6 group by comparing cast specimens, CT reconstruction model, we draw the following conclusions:(1), uterine vein, urogenital venous perfusion can successfully build the structural integrity of the vascular network of the pig uterine vein digital three-dimensional model.(2) The proportion of self-curing denture material, a vinyl chloride filler constructed at different pressures pig uterine vein cast specimens form a complete vascular network, blood vessels full, bright color, clearly shows the uterine vein, ovarian vein and vein of the urogenital course, distribution and venous return area.(3) pressure in the show pig uterine vein branches of the richness of vascular network in place to play a more important role, the greater the pressure, we get the pig uterine vein branches of the more extensive vascular network, the pressure becomes smaller, pig uterine veins Network anatomy of the relative level of clarity, this is very different from the same artery, of which the pressure of the volume compression ratio 9ml/20ml uterine blood volume in the study has certain advantages, the volume compression ratio 12ml/20ml uterine vein vascular anatomy in the study level has some advantages.(4) different concentrations, the ratio of the infusion materials also affected pig uterine vein vascular network forms, for forming a vinyl chloride is volatile, the higher the concentration, the resulting vascular network anatomy of pig uterine vein levels of the more clear, the lower the concentration of to get the pig uterine vein richer vascular network. This conclusion for the chemical reaction forming the self-curing denture materials are also more accurate.(5) using vascular casting techniques, CT scan reconstruction obtained by thin vascular network in digital form three-dimensional models show basically the same vascular network, with a good consistency, comparability.[Conclusion]Pig uterine vein pressure in the vascular network shows an abundance of support play a role, which is our network of arteries early studies did not recognize one of the factors, we use different pressures, different concentrations, different ratios, different types of perfusion materials, the vascular casting technique and combination of imaging, through bilateral uterine vein, bilateral urogenital intravenous infusion, can successfully build a complete vascular network of the pig uterine vein vascular cast model and the digital three-dimensional physical model, which is Next construct the normal uterine vein network digital three-dimensional model provides a good technical support, theoretical guidance and practical experience.PartⅡ:Construction of human normal uterine vein network digital three-dimensional model[Purpose]Vascular cast technique of combining, CT scan reconstruction of medical thin interactive software Mimics 10.01 (Materialise company, Belgium), using different concentrations of vinyl chloride, self-curing denture materials in different proportions of different perfusion pressure in normal uterine constructed venous vascular network of digital three-dimensional model of the feasibility of different pressures on the constructed normal uterine vein in vitro model of vascular network, and the use of digital three-dimensional model to start exploration.[Methods]Access to freshly isolated normal adult female uterus, vagina and two sets of Annex 5, were randomly divided into A (1 case), B (1 case), C (1 case), D (1 case), E (1 cases) respectively formula by filler filler has been prepared, study selected 1.25:1,1.75:1 the self-curing denture materials [to self-curing denture water as the solvent, the solute self-curing denture powder, lead oxide added CT contrast agent (8:100), and a number of blue or red color ad] and 20%,30%,40% of a vinyl chloride were prepared, respectively, intravenous infusion or by bilateral uterine ovarian vein uterine vein combined with different pressure perfusion. Perfusion in each group are as follows:(1):A group of over 20% by using vinyl chloride infusion, perfusion pressure is the volume compression ratio 9ml/20ml;(2):B group with 30% of a vinyl chloride infusion, perfusion pressure is the volume compression ratio 9ml/20ml;(3):C group were 40% of a vinyl chloride infusion, perfusion pressure is the volume compression ratio 9ml/20ml;(4):D Group 1.25:1 self-curing denture materials, perfusion pressure is the volume compression ratio 9ml/20ml;(5):E group were 1.75:1 self-curing denture material, the side of the perfusion pressure for the volume compression ratio 12ml/20ml, the other side of the perfusion pressure for the volume compression ratio 9ml/20ml; Perfusion were performed before and after the CT/MR scan, the data will be collected Dicom3.0 software comes with complete use of CT MIP method, VR technology reconstruction, while the use of Medical Mimics-line interactive software digital three-dimensional model. Finally, after infusion into the concentration of hydrochloric acid corrosion of the specimens obtained after intravenous human normal uterine vascular cast specimens. Comparative analysis of a different nature, in different proportions or different concentrations of infusion material at different perfusion pressures build vascular cast specimens, CT reconstruction model and Mimics reconstruction model of the vascular network in digital three-dimensional model of the similarities and differences, use of interactive software Mimics of access to digitized model related to measurement and study of ways to further use of the three models.[Results]In this study, samples were done in 5 cases of bilateral uterine vein uterine vein or ovarian vein catheterization combined, the two formulations of the perfusion CT scan line when the material has also been satisfactory imaging data clearly shows the uterine vein, which line also had the line of vinyl chloride perfusion MR scans, to achieve satisfactory blood MR images of the 5 specimens after corrosion, get a complete web cast specimens of uterine vein, the use of imaging data, we the successful completion of medical imaging image acquisition, CT with interactive software comes with software and medical Mimics, we get the same specimen of two other digital three-dimensional model, which built three models form a complete vascular network, blood vessels full, clear, while the three form model and can be different studies. Comparative analysis of different forms of the same sample model, we draw the following conclusions. (1) the proportion of self-curing denture with different materials, different concentrations of a vinyl chloride, various perfusion pressures could build a more complete success of normal human uterine vein network digital three-dimensional model.(2) the use of different perfusion pressures, different proportions of self-curing denture construction materials of normal human uterine veins form a complete network cast specimens, clearly shows that bilateral uterine vein, ovarian vein from the trunk to the terminal small vein branch:①the use of self-curing denture 1.75:1 material, the use of the volume compression ratio of the pressure built 12ml/20ml uterine vein vascular network clearly shows the cast uterine vein, ovarian vein trunk and its important tributaries, anatomical level of clarity, can be used to take the line of vascular anatomy.②The 1.75:1 and 1.25:1 in self-curing denture materials, the use of the volume compression ratio of the pressure built 9ml/20ml uterine vein vascular network clearly shows the cast specimens further bilateral uterine vein, ovarian vein anastomosis and small tributaries.③Using the same pressure (volume compression ratio of 9ml/20ml), concentrations were 20%,30%,40% vinyl chloride infusion materials had been cast specimens with the use of intravenous infusion materials are self-curing denture materials venous vascular network cast specimens in the display similar degree of vascular density, which indicates that the arterial is significantly different:the form of cast specimens in addition to intravenous infusion with the physical nature of the material, but also extremely close relationship with the perfusion pressure.④We uterine infusion or by intravenous infusion combined ovarian, uterine vein have been a complete vascular network, indicating the existence of uterine vein anastomosis with the ovarian veins, ovarian vein blood through the anastomosis between the two, into the iliac vein reflux.⑤very rich in uterine vein blood, and uterine artery similar to single courses, the different shape of a spiral, uterine vein throughout the whole layer of the uterus, significantly more than the number of arterial venous volume, venous blood volume was significantly more than the artery, the outer uterine vein Traveling superficial position than the uterine artery. More uterine vein anastomosis between, the main ligament in the level of the uterus, there is relatively thick vein diameter, the existence of the level in the broad ligament, vein is relatively rare, but by the bow on both sides of the uterus as uterine vein combined with intravenous, in which several ovarian vein to collect blood and the upper part of the broad ligament to form a larger plexiform uterine venous plexus, and out of shape at the location of ovarian suspensory ligament ovarian 2-3 thick venous plexus and vaginal venous plexus phase transport, Synthesis of 1-2 from the bottom bundle branch uterine vein, artery accompanied with the same name, about in the cervix, mouth plane, into the iliac vein or its tributaries. On both sides of the vaginal venous plexus located in the vagina, and uterus, bladder and rectum venous plexus phase transport, each side leads to a vaginal vein, into the iliac vein or other branches of.⑥the uterine vein throughout the uterus full-thickness characteristics, so get the vein cast specimens and the subsequent reconstruction of venous digital three-dimensional model can approximately represent the entire uterus shape for the building of the uterus digital three-dimensional model provides reference and basis for, and uterine digital three-dimensional preliminary studies provide a platform for the model.(3) by CT scanning technology and the thin layer of normal human Mimics software build uterine vein network digital three-dimensional model not only has similar characteristics of uterine vein cast specimens, but also can take advantage of digital three-dimensional model, the model is arbitrary the rotation angle of observation, and the associated measurement of physical constants, giving new physics of the model characteristics and the use of new methods and new ways of academic exchange:for example, thresholding function using Mimics can be a rough classification of vascular reconstruction, showing veins of different diameters, with software provided by the division of functions from coronal, sagittal and horizontal plane of observation of the uterine venous blood in different situations and can complete the relevant diameter measurement, and blood volume measurements.(4) using vascular casting techniques, CT scanning technology and medicine thin Mimics software build interactive software of normal human uterine vein network digital three-dimensional models show consistent form of the vascular network, with good comparability, vascular casting type specimen of the latter two provide the basis for the former uses the latter two is a useful addition to the continuation of the former use and to develop new uses, and both also have their own characteristics and a certain degree of complementarity.[Conclusion]Using vascular casting techniques, CT scanning technology and thin Mimics software, through a simple intravenous infusion or bilateral uterine ovarian of uterine intravenous infusion combined, can successfully build a complete human normal uterine vein network digital three-dimensional model. Vascular casting techniques, CT scanning thin joint medical interactive software Mimics software, in the study of normal human uterine venous network fine anatomical structure of different characteristics, is a study of normal human uterine venous vascular network of the more practical method, because the characteristics of uterine venous vascular network, to a certain extent, representative of the uterine shape, reconstruction of the uterine vein network also represents a large extent, the entire uterus digital three-dimensional model for study uterus Digital Reference.Part III:Clinical Research:uterine vein in digital three-dimensional model of network construction [Purpose]Based on animal experiments, experimental body of clinical research results and progress of Task Force to explore the medical use of CTA raw data with software build interactive software Mimics women in the uterine vein network digital three-dimensional model, combining the experimental body cast specimens of the uterine vein In the uterine vein reconstruction results were analyzed to investigate the use of CTA data and interactive software Mimics medical women in the uterine vein reconstruction of vascular network in digital three-dimensional model of the feasibility, technical points and clinical significance.[Methods]Pre-existing data on women scholars use CTA pelvic arteries were useful to explore, but most scholars believe that the use of CTA for reconstruction of female pelvic veins is not feasible, this study in the research process, mainly from the following two aspects:①Comparison Interactive software to medical Mimics get different results of the CT scan reconstruction parameters, data collection interval, the best scanning parameters and time intervals can be more satisfied with the reconstruction of the CTA data uterine vein;②scholars also used for the previous method of Mimics expand exploration, uterine vein vascular network in the reconstruction process, we will deal with the logical relations between binary mathematical calculation-the introduction of Boolean operators and anti-reconstruction operator interaction with the software computing the mask covers the combination of completion of the preparatory work, we use CTA technology for cervical cancer in 1 case the original two-dimensional tomography image Dicom 3.0 data set, the patient specific information is:49 years old, the results of gynecological examination in our hospital: Married vulva production type; vaginal smooth, the upper baptized; abnormal cervical morphology, was stove-like, touch-positive blood, the uterus before the bit about the size of 7×6×5cm, nature, the activities can be, no tenderness; bilateral annex no time was significantly faster package. Anal investigation:into the anal smooth, rectal smooth, palpable cervical 5×4×3 cm about the size of the sacral ligament of the right main nodular thickening, almost pelvic wall, the left main nodular thickening of the sacral ligament, below the basin wall. No bloody finger out. Ultrasound examination showed in our hospital:the cervix increases, thickness 3.5cm, shape disorders, the size of 5.6×3.5cm see such a heterogeneous echo area, boundary less clear, the cervical canal disappeared. Seen in the right ovary of a size 4.3×3.2cm the liquid dark areas, border clearance, the sound can be transparent. Respectively by Mimics 10.01 software pelvis, pelvic arterial network, the more bulky pelvic vein uterine vein network and network for digital three-dimensional reconstruction and renewal registration of digital convergence model, the model using the corresponding interactive software The vessel diameter, vascular capacity were measured, and the digital model for multi-angle, multi-plane of observation, compared to isolated human normal uterine vein vascular network of digital three-dimensional model, combined with reconstruction of the physiological state of the pelvis, pelvic arterial network and the pelvic relatively thick vein network, initially reveal the physiological state of uterine vein of form, course, tributaries and drainage areas and the initial number of gynecological and obstetrical diseases anatomical explanation.[Results]Through comparative analysis, we have come to the right vein reconstruction scan parameters:tube voltage 120kV, tube current 320mA, slice thickness 5mm, spacing 5mm. Angiography via the right cubital vein first to 4.0ml/s (A tube) flow rate with high-pressure syringe injection of contrast medium binoculars 85ml (Ultravist, 370mgI/ml), then 4.0ml/s (B tube) to recover normal saline 20ml. Abdominal aortic bifurcation in the region of interest on the margin level (region of interest, ROI) CT value of the dynamic monitoring, set within the CT value reached when the ROI is automatically triggered scan acquisition 100Hu arterial phase data.50s and then repeat the scan interval venous phase data acquisition. Finally, the demolition of the image as thin as 1.0mm thick engraved plate preservation. The above into the software Mimics, combined with mathematical logic operation to complete venous vascular network of digital three-dimensional reconstruction, based on previous animal studies, cadaver experiment provides experience, a number of specific quantitative data, we are more successful in building the women in the uterine venous vascular network, the model clearly shows that uterine vein, bilateral ovarian vein, and reconstruction of the pelvis, pelvic arterial network registration fusion, the physiological state of the branch vein anatomy course and the drainage area to become more clear, vivid true reproduction of uterine vein, ovarian vein with the pelvis, pelvic arteries, the anatomic relationship between pelvic veins, can accurately measure the physiological state of the blood volume of uterine venous vascular network. Preliminary results with reference to the body, we know that uterine vein uterine vascular network throughout the whole floor, on the whole a very good representation of the uterus, in the physiological state of the uterine vein reconstruction of vascular network of digital three-dimensional model outlines a good physiological state of the the form of the human uterus, uterine size and uterine body axis with the angle of the vagina. Palace but also for calculating blood volume, vaginal blood volume provides a model.[Conclusion]First, scholars of early technology and the use of CTA for vascular medicine interactive software Mimics done some research, but the main object of study for the arterial system, venous system for the research, most scholars believe that the characteristics of the CTA and the Mimics software technical nature, these two kinds of technology can not be completed in venous digital three-dimensional modeling, and our study confirmed that the combination of the two technologies, the basic premise of non-destructive health of patients, according to certain scan parameters, scan conditions and the expansion of Mimics software functions can be achieved venous vascular network reconstruction of digital three-dimensional model, even under physiological conditions to build the uterine vein network, as it involves multiple disciplines, cross-content, the work to the professional training of personnel to complete. The results also have certain defects, reconstruction can fully represent the physical state of the situation? The model results provided by colleagues in the real physiological conditions the difference between the number of blood volume? As no specific control object, temporarily can not solve the above problem. Second, at home and abroad have not yet seen in the uterine vein network digital three-dimensional model construction reports, the uterine vein of research is also extremely rare application of the subject vessel is currently more advanced research methods and professional software Mimics physiological state reconstruction uterine vein network, pelvic veins coarse mesh to fill gaps in the research field, for the subsequent large-volume three-dimensional reconstruction of the uterine vein to provide evidence and references, but also for uterine venous vascular network, Fine veins of pelvic anatomy research platforms, making it possible to collect large samples of data. Uterine vein body experiments we know that throughout the whole layer of the uterus, which in the physiological state of the uterine vein reconstruction of the experimental data has also been confirmed in the uterine venous vascular network, as more than the superposition of dense network structure, which to predict uterine vein blood volume may be in a certain period of expansion exponentially, the format of uterine artery anatomy that curved upward in the uterus within the broad ligament, the uterine wall is also curved to go to their branch line. But when the pregnant uterus to expand, all the bending disappears. And uterine artery spiral different uterine vein there is no obvious spiral walk the line, and walk the line than the artery superficial, due to venous vascular network characteristics, living on the reconstruction of the uterine vein vascular network is also better represent the physiological state of the uterus shape, with interactive software Mimics can see the physiological state similar to the structure of the uterine cavity, and show the shape and the front position with the pelvis, uterus, peripheral vascular relationship. Third, the vascular network of the uterine vein in obstetrics and gynecology clinic also has some significance:①for the diagnosis of benign diseases of obstetrics and gynecology, the treatment provides a digital three-dimensional model of reference, both experimental and clinical research bodies have confirmed that uterine vein compared with the ovarian veins traffic, with the technology and software, we successfully constructed the physiological state of ovarian veins three-dimensional model of the digital network, which for the pelvic venous congestion syndrome diagnosis and treatment of reference, and there may be anatomical diagnosis of ovarian varicose veins morphological basis, the uterine vein reflects the general physiological state of a normal uterus cava, uterine fibroids, uterine gland disease, obstetrics and gynecology and other benign diseases of placenta accreta morphological changes in the diagnosis of vascular reference;②reconstruction of the uterus venous vascular network but also for gynecological malignant disease diagnosis and treatment of the corresponding anatomical reference, the integration pelvis, pelvic arteries and the pelvic arteries, uterine vein clearly sho... |
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