| Research backgroundFemale pelvic arterial system is a large and complex system, and has been the difficulty and keystone in anatomical and gynecologic&obstetric researches due to dense internal iliac arteries, complex origins, tortuosity, polytropy and small arteries. Pelvic arteries are different for different individuals, some individuals even have obvious differences, thus it is difficult to form a unified and fixed standard, as a result, knowledge about the pelvic arterial system needs to be improved to individualized and3D concept.At present, main pelvic artery research methods include color doppler ultrasonography, digital subtraction angiography (DSA), magnetic resonance angiography (MRA) and computed tomography angiography (CTA). Color doppler ultrasonography is non-invasive, economic and convenient, but can not continuously display3D pelvic vessel images, and the imaging quality is greatly influenced by the skills of examiners. DSA has been deemed a "gold standard" for arterial research. However, DSA is an invasive examination and complex in operation, and2D images obtained by DSA can’t be evaluated for overlapping and other reasons, thus significantly restricting its application to morphological study of pelvic arteries, and DSA is only used for subjects to be subject to clinical selective arterial embolization. MRA is radiation-free, and has higher resolution for soft tissues. In recent years, some scholars have performed beneficial research on the construction of pelvic arterial vascular networks based on MRA. In2008, Naguib et al. successfully constructed pelvic arterial vascular networks of subjects to be subject to uterine artery embolization (UAE), and found higher coincidence rate after comparing MRA images with internal iliac arteries closely related to UAE catheterization. In2010, Mori et al. compared the display rate of uterine artery origins between the unenhanced MRA and DSA, found that97%of uterine artery origins were clearly displayed in MRA, and found that ovarian arteries of5subjects were involved in blood supply of hysteromyoma, thus they considered that unenhanced MRA can provide UAE with reliable information on uterine artery and ovarian artery. However, MRA has disadvantages of complex imaging sequence, long examination time, unclear uterine artery and hysteromyoma angiography, and can not analyze blood supply distribution for hysteromyoma in details. Therefore, the pelvic arterial vascular network constructed by MRA can display internal iliac arteries, uterine arteries and other enlarged blood vessels closely related to UAE well, but there is no report on successful construction of smaller artery vascular network. In addition, poor skeleton display of MRA makes vessel recognition difficult.CTA is a brand new angiography developed based on spiral CT in the1990s, and now widely applied to clinical practice due to its advantages of relative non-invasiveness, convenience and quickness, large amounts of information, strong3D effect, high performance cost ratio, etc. Especially after64-slice spiral CT was applied to clinical practice in2004, temporal resolution and special resolution have been obviously improved, achieving real isotropy, enabling CTA to progress greatly, and allowing broader space for diagnosis of diseases. So far, may scholars have performed detailed anatomical researches on arterial vascular networks of multiple body parts such as skull and thyroid gland using this technology. Some studies show that CTA can basically replace the traditional DSA technology in terms of display of cardiac and cerebral arterial vascular networks.The successful application of CTA technology to cardiac and cerebral arterial vascular networks, etc. provides new research methods and development space for morphological study of human pelvic vessels. So far, application of this technology to morphological study of pelvic vessels is rare. In2006, Gao Chengjie et al constructed Level3-4branches of pelvic arterial vascular network models of16normal subjects (male and female) by64-slice spiral CT. However, smaller uterine arterial vascular networks were not displayed due to restrictions of the CT equipment. In2011, Chen Chunlin et al constructed a pelvic arterial vascular network model of one patient with adenomyosis using Mimics software based on64-slice CTA data set, but did not provide detailed anatomical and image data, and did not perform detailed anatomical and morphological studies on the origins, ostia and routes of all pelvic arterial vessels. In the same year, Chen Chunlin et al performed anatomical classification of female internal iliac arteries on CTA of170gynecological insubjects, described main branch types of internal iliac arteries, but did not provide anatomical, variation and image data of other small collateral vessels of pelvic organs. In2011, Bilhim et al performed comparative studies on major branches of internal iliac arteries of21male subjects by different imaging methods (i.e. MRA, CTA and DSA), and considered that CTA can display fine pelvic arterial vascular networks better compared with MRA, and was faster than DSA. The study provided detailed image and anatomical data, especially described small collateral vessels of pelvic arteries such as obturator arteries and iliolumbar arteries in details. Unfortunately, all objects of the study were male. Therefore, detailed CTA image and anatomical data studies on female pelvic arterial vascular networks have not yet been reported, especially studies on large samples.For this reason, we studied anatomical characteristics of the origins, routes, adjacent structures, etc. of adult female pelvic arterial vascular networks, especially small collateral arteries through observation and analysis of CTA images of normal pelvic arterial systems of33adult female using embedded software of CT machines based on the original CTA studies on normal female pelvic vessels for the purpose of recognizing CTA manifestation of pelvic arterial vessels, providing a platform for application of3D reconstruction technology to diagnosis and treatment of female pelvic diseases, and providing detailed anatomical and imaging basis for gynecological interventional radiotherapy and minimally invasive laparoscopic surgery.Chapter1Morphological Study and Clinical Verification of3D Reconstruction of Pelvic Arteries by64-slice Spiral CTPurpose:To construct normal pelvic arterial vascular networks of33adult female using embedded software of CT machines based on CTA data set, and study anatomical and morphological characteristics of the origins, routes, adjacent structures, etc. of all branch vessels of female pelvic arteries, especially small collateral arteries so as to recognize CTA manifestation of pelvic arterial vessels, provide a platform for application of3D reconstruction technology to diagnosis and treatment of female pelvic diseases, and provide detailed anatomical and imaging basis for gynecological interventional radiotherapy and minimally invasive laparoscopic surgery.Method:1. Research object:Collect64-slice spiral CTA data of33adult female with normal pelvic cavity (no history of pelvic disease and operation, and no pelvic lesion based on CTA results) who were subject to middle and lower abdominal CTA examination for various reasons from Department of Gynecology and Obstetrics, Urinary Surgery and Gastrointestinal Surgery of Zhu Jiang Hospital of Southern Medical University and Pan-Yu Central Hospital from October2010to December2012. The subjects were aged from20to61years old, with an average age of(37.36±11.97)years. All subjects were accepted64-slice spiral CT scanning and3D reconstruction of pelvic vessels, and did not undergo any chemoradiotherapy or operation before data acquisition. Governing procedures of the study conform to ethical standards specified by the committee in charge of human trials in our hospital, in addition, the committee approved the procedures and signed information consent form.2. Apparatus: (1) CT scanner:Toshiba Aquilion64-slice spiral CT scanner (the detector assembly is0.5mm×64).(2) Double-syringe high pressure injector:MEDRAD(3) Image post-processing workstation:Start Vitrea2post-processing workstation of Aquilion64-slice spiral CT scanner(4) Ultravist (370mg/ml):manufactured by Schering AG.(5) CT viewing software:Med "Viewer image workstation of Huahai.3. CT scanning parameter setting and scanning method:Subjects were subject to fasting for4-6h before examination to properly fill their bladders (no other special treatment). The subjects were in supine positions, with median sagittal plane perpendicular to bed surface, and lay in the center of the bed surface, with heads in hands and legs stretched out together, and the scanning range was from midpiece of the fourth lumbar vertebra to3cm below greater trochanter of femur. Scanning conditions are as follows:tube voltage:120KV, tube current:250mAs, detector assembly:0.5×64row, slice thickness:0.5mm, inter-slice spacing:0.3mm, alignment pitch:0.984, and tube rotating period per cycle:0.4s. The subjects were subject to conventional scanning, then bolus injection of nonionic iodine contrast medium ultravist370(ultravist contains370mg/ml iodine) through median cubital veins by high pressure injectors at a dose of1.5ml/kg and injection rate of4.5ml/s, and injection of20ml normal saline at the same rate after injection of the contrast medium. Region of interest (ROI) was selected on upper margin slice of abdominal aortic bifurcation by contrast medium tracing method to dynamically monitor CT values and set3s after CT values within the ROI reach200Hu as an acquisition point, with scan delay time during the arterial phase of25s.4. Post-processing:Fault images from scanning was sent to the StartVitrea2post-processing workstation, and the reconstruction methods were as follows:(1) maximum intensity projection (MIP),(2) multi-planar reconstruction (MPR), and (3) volume rendering (VR). Different thresholds and models were adjusted according to the above three reconstruction methods to reconstruct satisfactory CTA images, and images were observed at any angle in a3D space based on systematic anatomical knowledge to analyze the panorama of pelvic vessels, and observe the display situation and morphological differences of pelvic arteries.5. Image analysis items:All arterial identification refer to clinical obstetrics and Gynecology map, Atlas of human anatomy atlas and interventional radiology obstetrics map, etc. The display situation of all branches of pelvic arterial vascular networks was analyzed, including length of bilateral common iliac arteries, ostium position and branch type of bilateral internal iliac arteries, origins, quantity, ostium imaging types and routes of bilateral uterine arteries as well as origins, routes and adjacent situations of bilateral superior gluteal arteries, inferior gluteal arteries, internal pudendal arteries, iliolumbar arteries, obturator arteries, umbilical arteries, lateral sacral arteries, median sacral arteries, ovarian arteries, etc.6. Statistical analysis:SPSS13.0software was used for statistical analysis of data. Enumeration data was expressed in%, and χ2tests were performed on data in2×4table for comparison of two sample rates. The measurement data were expressed by mean±standard deviation (x±s), t tests were performed on independent samples for comparison of sample means, and P<0.05was considered to be statistically significant.Results:1. CTA construction of adult female pelvic arterial vascular networks:Complete pelvic arterial vascular network images of the33subjects were successfully constructed. The arterial vascular networks were characterized by clearness and reality, regular morphology, natural routes and strong3D effect, and can clearly display abdominal aorta, superior rectal arteries, common iliac arteries, median sacral arteries, external iliac arteries, internal iliac arteries, uterine arteries on anterior branches of internal iliac arteries, obturator arteries, umbilical arteries, superior vesical arteries and inferior vesical arteries, iliolumbar arteries on posterior branches of internal iliac arteries, superior gluteal arteries, inferior gluteal arteries, lateral sacral arteries, internal pudendal arteries, femoral arteries and inferior epigastric arteries of their branches, superficial iliac circumflex arteries, deep iliac circumflex arteries, medial femoral circumflex arteries, external pudendal arteries, deep femoral arteries, lateral femoral circumflex arteries and their branches, etc. under physiological conditions. The ostia, origins, routes and adjacent relationship of pelvic arteries and their Level3-4vascular branches can be clearly recognized by arbitrary scaling and360°rotation of CTA images.2. Length changes and types of common iliac arteriesCommon iliac arteries were divided into5types according to their length and relationship:(1) Long common iliac arteries:3subjects, accounting for9.1%.(2) Short common iliac arteries:1subjects, accounting for3.0%.(3) Longer left common iliac artery than right common iliac artery:13subjects, accounting for39.4%.(4) Longer right common iliac artery than left common iliac artery:1subjects, accounting for3.0%.(5) Equal common iliac arteries:15subjects, accounting for45.5%.3. Anatomy of internal iliac arteries(1) Ostium position and height measurement of internal iliac arteries:The ostium of internal iliac artery is located between1/2above the fifth lumbar vertebra and1/2below the first sacral vertebra. Comparison of the ostium heights of bilateral internal iliac arteries showed that the subjects with ostia of the right internal iliac arteries higher than those of the left internal iliac arteries accounted for42.4%(14/33), the subjects with ostia of the left internal iliac arteries higher than those of the right internal iliac arteries accounted for6.1%(2/33), and the subjects with equal height of ostia of bilateral internal iliac arteries accounted for51.5%(17/33).(2) Branch type of internal iliac artery:By reference to Adachi typing method and combination of three branches of the internal iliac arteries (superior gluteal artery, inferior gluteal artery and internal pudendal artery), internal iliac arteries were divided into five types. For Type I, the internal iliac arteries originated the superior gluteal artery and the inferior pudendal trunk successively; for Type Ⅱ, the internal iliac arteries originated the superior gluteal artery, the inferior gluteal artery and the internal pudendal artery successively; for Type Ⅲ, the internal iliac arteries originated the gluteal trunk and the internal pudendal artery successively; for Type Ⅳ, the internal iliac arteries originated a main trunk which further originated the superior gluteal artery, the inferior gluteal artery and the internal pudendal artery; and for Type V, two inferior gluteal arteries had different origins, with one inferior gluteal artery originating from the superior gluteal artery and the other one having sharing trunks with the internal pudendal artery. In this study, only Type Ⅰ, Type Ⅱ and Type Ⅲ were seen, and Type IV and Type V were not seen. The percentage of the first three types in left internal iliac arteries accounted for63.6%(21/33)、30.3%(10/33)及6.1%(2/33) respectively, while the percentage of the three subtypes in right internal iliac arteries accounted for69.7%(23/33)、21.2%(7/33)及9.1%(3/33) respectively. Although63.6%(21/33) of subjects had the same types in bilateral internal iliac arteries, this difference was not statistically significant when it was compared with the percentage of various types to bilateral internal iliac arteries (χ2=6.398, P=0.171) (3) CTA manifestation of posterior trunk of internal iliac artery:CTA images of22subjects (66.7%) can display iliolumbar artery which is the branch at the highest position in internal iliac arteries and most commonly seen in the main trunk and posterior trunk of internal iliac arteries. CTA images of24subjects (72.7%) can display lateral sacral artery which most commonly originated from trunk terminal of internal iliac artery, followed by superior gluteal artery and inferior gluteal artery. Among66branches of obturator arteries of33subjects,55branches (83.3%) can be clearly displayed. The origins of obturator arteries varied greatly, and most of the obturator arteries originated from internal iliac arteries or their branches, superior gluteal artery, trunk of inferior gluteal pudendal artery, main trunk of internal iliac artery, inferior gluteal artery, etc. As the terminal branch of the posterior trunk of the internal iliac artery and the biggest branch of the internal iliac artery,66branches of superior gluteal arteries (100%) were totally displayed. It can be seen from CTA images that most of superior gluteal arteries originated from the internal iliac artery, and formed gluteal trunk with inferior gluteal arteries for only7.5%of subjects.(4) CTA manifestation of anterior trunk of internal iliac artery:The umbilical artery is extended from main trunk of the internal iliac artery, originates superior vesical artery at proximal end, and bends inward into2-3branches to reach over superior ramus of pubis and bend inward. The66internal pudendal arteries can be clearly displayed. As a smaller branch of two terminal branches of anterior trunk of the internal iliac artery, the internal pudendal artery had co-trunk with inferior gluteal artery or originated from single trunk, but very few internal pudendal arteries have co-trunks with superior gluteal arteries. As the biggest terminal branch of anterior trunk of the internal iliac artery, inferior gluteal arteries had co-trunk with the internal pudendal artery originated from anterior trunk of the internal iliac artery in most subjects, or single branch originated from the internal iliac artery in a few subjects.4. Anatomy of uterine artery (1)Origin of uterine artery:The images can show ostia, routes, size and main branches of66uterine arteries (100%). The uterine arteries had varied origins, in which31branches originated from main trunk of internal iliac artery (15branches at left and16branches at right), accounting for47.0%,20branches originated from pudendal trunk of inferior gluteal artery (11branches at left and9branches at right), accounting for30.3%,11branches originated from umbilical artery (6branches at left and5branches at right), accounting for16.7%,1branches originated from internal pudendal artery (1branches at right), accounting for1.5%, and other3branches originated from superior gluteal artery or inferior gluteal artery (1branches at left and2branches at right), accounting for4.5%. In this study,51.5%of subjects (17/33) had asymmetric origins of left and right uterine arteries.(2) Ostium types of uterine arteries:Among66branches:①51branches appeared to be acute angle (25branches at left and26branches at right), accounting for77.4%,②3branches appeared to be right angle (3branches at left and0branches at right), accounting for4.5%,③9branches appeared to be rotary (4branches at left and5branches at right), accounting for13.6%, and④3branches appeared to be spiral (1branches at left and2branches at right), accounting for4.5%.5.ovarian artery:The33subjects had66ovarian arteries, and4subjects showed ovarian arteries, accounting for12.1%, with3subjects having left developing and1subjects having right developing. The developing rate of ovarian arteries was6.1%(4/66).Conclusions:1.Data of64-slice spiral CT and the embedded software of CT machine can help construct ideal female pelvic arterial vascular network models, so64-slice spiral CT is a good method for researching living female pelvic artery and worthwhile for promotion in clinical practice.2.The pelvic arterial vascular network models constructed based on64-slice CTA can provide detailed imaging anatomy basis for morphological study of pelvic arteries, provide individualized and accurate morphological basis for minimally invasive pelvic surgery and vascular interventional treatment of pelvic cavity, provide new diagnosis and treatment technique of pelvic vascular diseases for clinicians and lay a foundation for practice of individualized treatment.Chapter2Clinical Application of3D Reconstruction of Pelvic arterial vascular Network by64-slice Spiral CT Section1Application and Significance of3D Reconstruction of Pelvic arterial vascular Network by64-slice Spiral CT to Postpartum HemorrhagePurpose:Based on64-slice data set of21subjects with postpartum hemorrhage suffering from invalid conservative treatment, embedded software of CT machine was used to reconstruct pelvic arterial vascular networks to study construction method and significance of pelvic arterial vascular networks for subjects with postpartum hemorrhage, and observe angiographic manifestations of ovarian arteries as sources of postpartum hemorrhage.Method:1. General data:from21subjects (including3subjects with concomitant placenta implantation) who were hospitalized for delivery in Department of Obstetrics of Pan-Yu Central Hospital from January2012to December2012, and underwent pelvic64-slice CTA for invalid conservative treatment upon postpartum hemorrhage for various reasons (drug, uterus massage, curettage of uterine cavity, etc.). All subjects had over500mL bleeding within24h upon cesarean section or delivery. After conventional conservative treatment, colporrhagia did not decrease or slightly decreased and increased again. They aged from21to34years, with average age of27.24±3.45years. Among the subjects,12subjects were primipara,9subjects were multipara;7subjects underwent vaginal delivery and14subjects underwent cesarean section;13subjects suffered from uterine inertia,6subjects suffered from placental factors,1patient suffered from laceration of soft birth canal and1patient suffered from cesarean scar hematoma. Among21subjects,3subjects suffered from concomitant placenta implantation, with amount of bleeding up to565ml-330ml and average amount of bleeding up to813.10±182.08ml.2. Apparatus and method:special treatment was not required before scanning. Others are the same as those described in Chapter1.3. Image post-processing:the same as those described in Chapter1.4. Statistical method:the same as those described in Chapter1.Results:For21subjects, complete pelvic arterial vascular network models were constructed successfully. The vascular network had clear edge, regular morphology, natural route and strong3D effect, can be arbitrarily scaled and rotated by360°for observation, thus clearly displaying internal iliac arteries and Level3to4branch vessels, and displaying3D images of all pelvic vessels including ovarian arteries. Among21subjects, CTA images of12subjects can show ovarian arteries, accounting for57.1%, with6subjects having bilateral display and6subjects having unilateral display at left or right. The display rate of ovarian arteries was42.9%(18/42). Among12subjects with ovarian arteries showed, ovarian arteries were enlarged, with diameter up to2.0-11.6mm,2subjects having abnormal ovarian arteries distension, with diameter up to11.6mm, early developing of ovarian vein was seen, indicating possibility of ovarian arteriovenous malformation.Conclusions:1. CTA data set and the embedded software of CT machine can help construct ideal pelvic arterial vascular networks of subjects with postpartum hemorrhage, thus providing new diagnosis and treatment technique for clinicians and anatomical basis for pre-interventional operation evaluation of subjects with postpartum hemorrhage.2. ovarian artery can participate in blood supply of postpartum pelvic lesion, which is probably one of the reasons for uncontrollable hemorrhage of bilateral internal iliac arteries-uterine arteries in conventional embolism.Section2Application of Vascular Reconstruction by3D Spiral CT to Feeding Arteries of Giant Pelvic TumorsPurpose:At present, there are many reports on CT diagnosis of pelvic tumors at home and abroad, but research on application of3D vascular reconstruction by64-slice spiral CT to giant pelvic tumors is rarely reported at home and abroad. For this article, vascular network was reconstructed for patients with giant pelvic tumors confirmed by surgical pathology using64-slice spiral CT3D reconstruction technique to observe display conditions of tumor vessels and feeding arteries and evaluate the value of the technique in diagnosis of giant pelvic tumors, thus helping formulate clinical therapy.Method:1. Collection of general data:clinical data of11female patients with giant pelvic tumors who were aged from27to54years with an average age of41.73±8.58years, subject to64-slice spiral CTA examination from October2010to October2012and confirmed by surgical pathology. The size of tumors was8.5cm-27.0cm, with an average size of (13.64±6.07) cm. Four patients had hysteromyoma. Seven patients had ovarian tumors, including one patient with serous cystadenoma, one patient with borderline mucinous cystadenoma, two subjects with serous cystadenocarcinoma and two subjects with mucinous cystadenocarcinoma. One patient had metastatic oophoroma (primary gastric cancer). Clinical symptoms: abdominal mass, abdominal distention, abdominal pain, sense of bearing down, menoxenia, irregular colporrhagia, etc. All subjects had signed CT examination consent forms.2. Apparatus and method:the same as those described in Chapter1.3. Image post-processing:the same as those described in Chapter1.4. Judgment criterion of feeding artery:the enlarged artery with branches extending into tumors and distributed as net shape or radial pattern is called as feeding artery. Tumors with blood supplied by uterine branch (UB) were supposed to originate from uterus. Tumors with blood mainly supplied by ovarian artery (OA) and/or ovarian branch (OB) were supposed to originate from ovary.5. Statistical method:the same as those described in Chapter1.Results:1.Complete pelvic arterial vessel images of11patients were successfully constructed, with clear vessel edges, regular morphology, strong3D effect and natural route. The images can be arbitrarily scaled and rotated by360°to observe the pelvic vessels and feeding arteries. The vessel images of11subjects can show abdominal aorta, common iliac artery, external iliac artery, internal iliac artery, uterine artery, ovarian branch of uterine artery or ovarian artery clearly, and also displayed feeding arteries of11subjects.2.Giant hysteromyoma:4patients. The maximum diameter of the tumors was8.5-27.0cm, and average diameter was14.63±8.38cm. Vascular post-processing reconstruction showed that unilateral and bilateral UB blood supply was present in the tumors, with the incidence of100%(4/4). Blood supply of one patient was jointly provided by bilateral UB and right OA, with the incidence of25.0%(1/4), representing that bilateral UB and OA peripheral branch in the tumor body. The accuracy rate of anatomical diagnosis of tumors was100%(4/4).3. Giant ovarian tumor:7patients including6patients with primary ovarian tumor and1patient with metastatic ovarian tumor. The maximum diameter of the tumors was9.0-22.0cm, and the average diameter was13.07±5.04cm. Feeding arteries were displayed in the vessel images of7subjects,3patients had bilateral feeding arterials and4patients had unilateral feeding arterials,10sides in total. Vascular post-processing reconstruction showed bilateral blood supply from UB, OB and OA, trilaterial blood supply from OA and OB, unilateral blood supply from OA and quadrilateral blood supply from OB. The blood supply incidence of OA was50.0%(5/10), and that of OB was90.0%(9/10). The accuracy rate of anatomical diagnosis of tumors was100%(10/10).Conclusions:As a noninvasive imaging examination method,3D-CTA can clearly display the feeding arteries of giant pelvic tumors and can provide accurate diagnostic basis owing to obvious advantages in diagnosis of giant pelvic tumor.Section3Construction and Significance of Pelvic Arterial Vascular Network with Cesarean Scar PregnancyPurpose:Uterine artery embolization (UAE) has become a safe and effectively method for treating cesarean scar pregnancy (CSP). It can be used as the first treatment choice for young CPS subjects requiring preserving fertility and having extraordinarily abundant local blood flow at scars prompted by ultrasound. Many researches have demonstrated that3D reconstruction of pelvic arterial vascular network using CTA before UAE and the implementation of UAE directly instructed by the network accordingly can improve success ratio of surgery, and also can obviously reduce exposure time of X-ray dose and the dosage of contrast medium, thus playing a very important instructive role in treatment. At present, the research on application of the technology to CSP has not been reported. For this reason, we successfully built pelvic arterial vascular network models of5patients with CSP using CTA3D reconstruction technology, and discussed the value of applying the vascular network to CSP. Method:1. Selection of general data CTA data set of5patients with CSP who were hospitalized in Obstetric and Gynecologic Department of Pan-Yu Central Hospital from October2010to October2012and subject to CTA examination of pelvic cavity. Five patients were aged from28to37years, with an average age of33.40±3.58years. Gravidity was3-6, with an average of4.20±1.30. Parity was1-3, with an average of1.80±0.84. Five subjects had history of menostasia, with the shortest menolipsis being34days, longest menolipsis being112days and an average of68.6±31.9days. The interval time of the pregnancy and the previous caesarean section was6months at least and11years at most, with an average of4.94±4.32years.2. Diagnostic criteria:①history of cesarean section and menostasia;②colporrhagia:natural profuse bleeding or massive bleeding, massive and endless bleeding in abortion operation without embryonic tissue discharged in drug abortion, and massive and endless bleeding in clearing uterus;③stomachache:no stomachache or slight stomachache;④enhanced serum β-hCG;④color doppler ultrasonography:gestational sac was not seen in uterine cavity and cervical canals, gestational sac was located at isthmus of uterus, and muscular layer of isthmus became thin; or myometrium lacked between gestational sac and bladder or muscular layer had defect; color Doppler prompted abundant and high-rate blood flow around foetal sac or mass.3. Course of treatment:one patient with concomitant incomplete rupture of uterus was subject to embryo remove surgery at cesarean scar in emergency treatment, one patient was subject to embryo remove surgery at cesarean scar under a laparoscope, and two patients were subject to MTX treatment. One patient required to return back to local hospital for treatment due to financial difficulty.4. Apparatus and method:the same as those described in Chapter1.5. Image post-processing:the same as those described in Chapter1.6. Statistical method:the same as those described in Chapter1. Results:Complete pelvic arterial vascular network images of5patients with CSP were successfully constructed, with clear vessel edge, regular morphology, strong3D effect and natural routes. Bone structure of pelvis, cacroiliac joint, sacrococcygeal joint, pubic symphysis, etc. can be clearly showed; and common iliac artery, external iliac artery, internal iliac artery, uterine artery and other branch vessels in physiological condition can be reproduced truly. The vessel distribution and richness of blood supply of scar pregnancy lesions can be clearly displayed by arbitrarily scaling and rotating the3D structure of vessel networks by360°.Conclusions:Ideal pelvic arterial vascular network models of patients with CSP can be constructed with the embedded software of CT machine based on CTA data set, thus providing accurate morphological basis for selecting proper therapy and pre-interventional operation evaluation for subjects with CSP.Section4Application of Vascular Reconstruction by64-slice Spiral CT to Uterine Arteriovenous MalformationPurpose:At present,3D reconstruction based on MSCTA achieved many progresses in treatment of liver diseases, cerebral diseases, etc., but it is... |
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