Application Research Of Three-dimensional Visualization In The Diagnosis And Therapy Of Ovarian Tumor

BACKGROUNGOvarian Tumor is the common neoplasm in the female genital,Ovarian malignant tumor is one of the most common three malignancies of female's reproductive system,Ovarian structure is complex,though its small.A variety of tumors can occur,furthermore it don't has symptoms in the early days.The traditional approach has two ways,laparotomy or waiting.The consequences of this behavior is delay treatment or over-treatment.It is difficult to make definite diagnosis in the early days.The development of modem science and technology more and more reflects inter-disciplinary intersection and penetration.Digital Medical Research,which integrates medicine,biomechanics,mechanics,electronics,automatic control,mathematical analysis and the like is developing rapidly,bringing about rapid change on modem medical diagnosis and therapeutic.In recent years,with the development of image diagnostic apparatus,the application of computer virtual reality technology in medicine has developed rapidly.The computer provides objective,accurate,intuitive and scientific methods for surgery simulation,surgery navigator,surgery orientation and surgery planning through using the image information to reconstruct the three-dimensional images.National Library of Medicine was established the retrieval system of human mor-phology in 1989,which started epoch of research of Visible human.Then,it had pro-gress in succession in European countries and Japan,Korea,Singapore,and also on.Meanwhile,some programs had been proposed including embryonic plan,virtual cell visual plan,the human brain plan,Harvard University's whole brain plan,visible mouse plan,Harvard University virtual surgery,and other famous project plan.In China,a conference was held in the fragrant hills,which entitled "China digital virtual human science and technology problems" in 2001.In the same year the program,which named"digital virtual human and some key techniques",was included in the national high technology development program(863 program).Since then the study of digital virtual human has developed rapidly.In 2002,Third Military Medical University completed the data collection of Chinese visible human.The following year,the data set of Virtual Chinese Human Female was successfully established in Southern Medical University.Digital Medical Research of basic research and applied research has been in the ascendant.The digital medical research center of Fudan university had completed the reconstruction of CT images.The digital medical engineering research center of Zhejiang university structured the soft tissue visco-elastic model in the study of soft deformation.Fang Chi-hua completed the liver virtual surgery simulation system for surgeons in Southern Medical University.At present the digital human body has been widely used in the brain,lung and kidney and the liver and other organs.The female pelvic cavity is an important region with a great mang viscera.There are consanguineous affinities in urinary system,genitalia system and digestive system in female pelvic cavity.It is very useful in clinical diagnosis and treatment of diseases in the female pelvic cavity to recognize the complicated distribution and extensity of the anatomical structures in the female pelvic cavity through thin sectional antomy and three-dimensional visualization.This study is to investigate the application of 3D reconstruction of pelvic blood vessels,uterus,bladder,ovarian tumor,which based on the data of 64-slice spiral CT,in ovarian tumor diagnosis.Chapter 1 A study on the optimal scanning time using 64-slice spiral CT in the venous phase of female pelvic angiographyObjective:To study the optimal scanning time using 64-slice spiral CT in the venous phase of female pelvic computed tomography angiography(CTA).Method:Different scanning time were adopted in pelvic CTA by using Smart Prep,compared with each other optimal scanning time was chosen.30 cases of Subjects,who didn't have pelvic lesions,were randomly divided into 3 groups(A,B,C),each group of 10 cases.The patient was lying down in supine position.The scanning parameter was set as following:120 KV and 250 mAs with 0.625 mm×64 multi-detector combination,5 mm-thick reconstruction layer,5 mm layer intervals.thread pitch 0.984 and 0.5s for one rotation of the tube.Forearm vein using automatic high pressure injector to do bolus injection of nonionic diodone ultravist with the dosage of 90ml at a rate of 4.5ml/s.Arterial phase scan Was performed when the CT value of the abdominal aortas reached above 200Hu,by using Smart Prep technique.There were three scanning time of Venous phase 65-70 s,85-90 s,105-110 s.Comparing different CT attenuation value of vena iliaca and uterine in the level of fourth sacral vertebra through statistical processing.Results:Iliac inside vein and uterus strengthen significantly when Venous phase of scanning time was selected 85-90 s,meanwhile bladder and bowel high-contrast,Venous phase of scanning time selecting 85-90 s was preferred.Conclusion:The scanning parameter was set as following:120 KV and 250 mAs with 0.625 mm×64 multi-detector combination,5 mm-thick reconstruction layer,5 mm layer intervals.thread pitch 0.984 and 0.5s for one rotation of the tube.Forearm vein using automatic high pressure injector to do bolus injection of nonionic diodone ultravist with the dosage of 90ml at a rate of 4.5ml/s.Arterial phase scan Was performed when the CT value of the abdominal aortas reached above 200Hu,by using Smart Prep technique,The scanning time of Venous phase 85-90 s.Chapter 2 Application research of three-dimensional visualization in the diagnosis and therapy of ovarian tumorObjective:Establishment of digitalized 3D reconstruction of The female pelvic cavity.We perform 3D reconstruction of urinary system,genitalia system and digestive system in female pelvic cavity,to establish digitized anatomy of female pelvic cavity by using the abdomen medical image-3D visualization system(MI-3DVS)respectively,We apply 3D reconstruction and simulation techniques to the clinical diagnosis,classification and surgical treatment,then to explore the clinical value of this techniques for reasonable selection of surgical operation.Methods:Research objects:sixty-five patients with histopathologically proved ovarian tumors were tested with 64-slice helical CT(64-MSCT)angiography.and the CT data was reconstructed with MI-3DVS from Dec 2010 to Oct 2011.The dates were analyzed restrospectively.The 3D findings were adopted in diagnosis and the results was compared with the pathological finding.Of all the 65 cases,30 cases were benign tumor and 25 malignant ones and 10 borderline tumors..Instrument and equipment:64-slice spiral CT machine(Holland PHILIPS);The Mxview workstation accompanied with 64-slice spiral CT machine;FreeForm Modeling System(USA,SensAble Technologies);Force feedback system PHANTOM(PHANTOM Desktop);ACDSee Photo manager 12.0(ACD System Ltd.);medical image-3D visualization system(MI-3DVS)developed and set up by ourselves.Methods for 3D reconstruction:The patient Was lying down in supine position and scanned from bilateral renal upper pole to belowing 3cm of greater trochanter.The scanning parameter Was set as following:120 KV and 250 mAs with 0.625 mm ×64 multi-detector combination,5 mm-thickreconstruction layer,5 mm layer intervals,thread pitch 0.984 and 0.5s for one rotation of the tube.The patients were fasted at least 6 to 8 hours before examination.As negative vesical contrast reagent,1000 ml clean water Was taken orally by patients.Forearm vein using automatic high pressure injector to do bolus injection of nonionic diodone ultravist with the dosage of 90ml at rate of 4.5ml/s.Arterial phase scan Was performed when the CT value of the abdominal aortas reached above 200Hu,by using Smart Prep technique.The scanning time of Venous phase 85-90 s.After the scan,the image data Was transmitted to Mxview workstation.and all the three phase(plain scan phase,arterial phase and venous phase)data was burned intodisc for storage.The data format is in DICOM(Digital Imaging and Communications in Medicine)3.0 which can be transformed to BMP format through DICOM viewer.In MI-3DVS,the sequential segmentation of female pelvic cavity were performed using self-adaptive region growing algorithm to get the data with Stereo Lithography(STL)format of abdominal aorta,uterus,bladder.Finally,the reconstructed STLmodels were imported into FreeForm Modeling System for smoothing and retouching to get the smooth and life like 3D images of female pelvic cavity.The video and the multi-angle video recordings were recorded for 3D observation of the anatomic structure of female pelvic cavity.The reconstructed STL models were imported into FreeForm Modeling System for smoothing and denoising to get the smooth,life like 3D models.At the same time,the 3D anatomic relationships were observed.Using Mxview workstation,65 patients' CT scan data,who were with ovarian tumors,restructured by multi-planar reformation(MPR)and curved planar reformation(CPR).Analysing Ovarian vascular pedicle sign in different ovarian tumorvascular types were divided in three types.The tumor vessels of type ?,which was surrounded,shape as arc or short strip,internal tumor had not seen the vascular distribution.Except for peripheral vascular outside,the type.? vessels of the tumor inside were sparse,vascular branch were simple and straight.Type ? vessels of the tumor inside were tortuous irregular and branches of complex,the tumor vessels surrounding were also be found.Results:1.Digital pelvic anatomy construction which based on the 64 row a spiral CTWe successfully generated various 3D anatomical models,including pelvis,uterus,bladder,common iliac artery,internal and external iliac arteries,uterine artery,tumor supplying vessels and tumor vessel networks.These 3D models were imported into FreeForm Modeling System to smooth,match processes to reconstitute 3D digital model containing pelvis,pelvic arterial networks,uterus,bladder and tumor.This model vividly showed spatial positions of uterus,bladder,and pelvic vessels,and individually or grouped exhibited various organ systems.After transparentizing,uterine membrane and tumor vascular networks can be clearly visualized.This reconstituted digital model provides an excellent way to clinical diagnosis of ovarian tumor2.The relationship between Ovarian vascular pedicle sign and Ovarian tumorpropertiesovarian vascular pedicle sign as a way of differentiating ovarian from subserosal uterine lesions on single-detector helical CT.This study analysis of 65 patients ovarian vascular pedicle display situation:(1)In 30 benign ovarian tumor,25 cases were enhancement,5 were not enhancement,and its positive rate was 83%.(2)In 25 malignance ovarian tumor,23cases were enhancement,2 were not enhancement,and its positive rate was 92%.(3)In 10 borderline ovarian tumor,9 cases were enhancement,1 were not enhancement,and its positive rate was 90%.The positive rate of ovarian vascular pedicle sign was 87.7%.there were no difference between benign,borderline and malignant tumor.3.Application research of three-dimensional visualization in the ovarian tumor vascular typeThere was significant difference of vascular types in different kinds of tumor(?2=43.93,v=2,P=0.00),The benigh tumors were mainly type ?,and the malignant tumors were mainly type ? or?,the borderline tumors were shown in any type.The Medical Image three-dimensional Visualization System of Abdomen(MI-3DVS)may provide the vascular distribution.Conclusion:1.By utilizing data of 64-slice spiral CT,and MI-3DVS system,we successfully generate 3D virtual model containing most of women pelvic organs.This model provides a novel means to diagnose various pelvic diseases.2.3D model,derived from live-human dataset,vividly represented the spatial relationship of pelvic vessels,pelvis,uterus,tumors and truly accomplished virtual human anatomy and visualization for diagnosis.3.The positive rate of ovarian vascular pedicle sign was 87.7%.there were no difference between benign,borderline and malignant tumor.4.By using 3D reconstructed virtual model of pelvic arterial networks and organs,we can easily determine best surgical regimen for each patient and make a personalized treatment,which could maximize the effect of therapy.