The Digital Anatomy Study And Clinical Application In Female Genital Tract Congenital Malformations

Female gential tract congenital malformations,represent benign deviations from normal anatomy resulting from maldevelopment of tthe embryological origin in Mullerian ducts or paramesonephric ducts between the 6th and 18th week of gestation.The prevalence of these malformations rangs from 5.5-6.7%.Magnetic resonance imaging(MRI)hold a distinct advantage over other techniques in that they simultaneously provide information about both the external contour and the cavity of the uterus.MRI has proved highly accurate in the diagnosis of female gential tract congenital malformations and has been considered the "gold standard" imaging technique.MRI image data set into a three-dimensional model,have the advantage of soft tissue identification,but solve the inadequate limitation of two-dimensional image.It could help gynecologists and obstetricians assessing the pelvic organs before surgery and provide a scientific information to assess the efficacy of surgery and complications.This study seeks to evaluate three-dimensional(3D)reconstruction’s ability to visualize these features in female genital tract congenital malformations and to analysis of the model and its associated function parameter measurements to assess the effect of laparoscopic vaginoplasty.[Objective]1.Methodological study of congenital anomalies of the female genital tract in vivo using the three-dimensional reconstruction technique2.The fine anatomical study of congenital anomalies of the female genital tract in vivo based on MRI databases3.Establishment of digital three-dimensional model in application for the MRKH syndrome.[Method]1.A female patient with congenital genital tract malformation and a healthy volunteer were selected for MRI scanning to conduct three-dimensional reconstruction of pelvic organs.;A total of 110 cases of female congenital genital tract malformation were further selected,and three-dimensional reconstruction of pelvic organs was conducted based on MRI data set,and classified and analyzed according to the classification of AFS.2.110 MRI data bases of female gential tract congenital malformations were imported for three-dimensional reconstructed,the 3D models and MRI were compared by the classification of AFS reviewed by radiologists and trained surgeons.3.86 MRI data bases of mayer-rokitansky-kuster-hauser syndrome(MRKH syndrome)were imported for three-dimensional reconstructed.The distance between urethral orifice,anus and Pouch of Douglas were compared with that of the 25 young nulliparous volunteers.10 MRI data bases of MRKH syndrome were imported for three-dimensional reconstructed.The distance between urethral orifice,anus and Pouch of Douglas were compared before and after surgery.[Results]1.The 3D Models of female gential tract congenital malformation and its surrounding structures were successfully built.The shape of the 3d model is clear,and the anatomical characteristics can be observed and evaluated in 3d space;110 patients of female gential tract congenital malformations based on the American Society for Reproductive Medicine system were classified.Eighty-six patients(78.2%)showed an agenesis of the uterus.Four patients presented with uterine didelphys(3.6%).Spectate uterus were detectable in 8 of 110 cases(7.3%).Arcuate uterus was detectable in 3 of110 cases(2.7%).The remaining patients presented with either unilateral(n=4;3.6%)or bilateral(n=5;4.5%)uterine horns.2.Reviewed by trained surgeons,95 of the MRI images were consistent with the clinical diagnosis,the confirmation rate was 86.4%.However,with the help of 3D MRI reconstruction models of 107 patients were diagnosed accurately in consistent with the clinical diagnosis,a confirmation rate of 97.3%.While reviewed by trained surgeons,The compliance rate between 3D MRI reconstruction models and MRI,and the clinical diagnosis was significantly higher(P=0.003).3.Compared the distance between urethral orifice and anus of young nulliparous volunteers group and MRKH syndrome group,the distance is 36.51±0.87mm and 22.18±1.35mm,there was significant difference(P=0.000),while distance between Pouch of Douglas and urethral orifice,70.79±2.56mm and 57.58±3.13mm,there was significant difference(P=0.001),respectively.Compared the distance between urethral orifice and anus of MRKH syndrome group before and after surgery,the distance is 16.38±0.77mm and 32.53±0.62mm,there was significant difference(P=0.000),while distance between Pouch of Douglas and urethral orifice,60.35±0.91mm and 77.61±0.74mm,there was significant difference(P=0.000),respectively.[Conclusion]It was an effective way to reconstruct the 3D model of congenital anomalies of the female genital tract using MRI dataset.Three-dimensional model can reflect the morphological characteristics of different types of female congenital genital tract malformations,and can help clinicians improve the accuracy of diagnosis.From the three-dimensional model,the pelvic floor anatomy differences between patients with MRKH syndrome and the normal population can be found,which is conducive to reducing the risk of surgical complications of vaginoplasty and evaluating the surgical effect.