Anatomy Of Fascia Propria Defined By Gross Dissection, Sectional Anatomy, And MRI Of Cadavers And MRI Of Healthy Volunteer

Objectives Observation of the anatomical characteristics of the fascia propria and adjacent structures on the basis of mircroanatomy and sectional anatomy for the total mesorectal excision of rectal cancer; Observation of the anatomical characteristics of the fascia propria and MRI through the body scan and MRI anatomy for diagnosis and staging of the rectum cancer; By comparing the MRI characteristics in vivo and in patients of rectal cancer for assessment of surgical risk, local recurrence rates and postoperative adjuvant therapy provide an objective basis for program development.Methodsâ‘ A total of 26 pelvic specimens of adult male were used in this study. Twenty pelvises were divided in the median sagittal plane for topographic anatomy, while another 6 were embedded by gelatin solution and were cut into contiguous sections in transverse, sagittal and coronal plane.â‘¡Selected 3 cases of pelvic specimens, followed by MRI scanning lines, frozen, molded, frozen and cut. Vertical band saw made by continuous pelvic CT specimens (including transverse, sagittal and coronal); selected 30 volunteers for pelvic magnetic resonance imaging, all patients had no contraindications, and finally sectional anatomy image and body MRI scans, MRI scans in vivo were compared.â‘¢Selected the 30 patients with rectal cancer: preoperative MRI scanning, observation of fascia propria in operation ,examination of the sample postoperationly. It is true that the relationship between fascia and the edge of the tumor can be idenfified on MRI clearly, which is best method to evaluate the risk of TME for rectal cancer. Results 1. Microanatomy and sectional anatomy:â‘ Denonvilliers fascia and fascia propria Microanatomy found that anterior space of the rectum was formed by Denonvilliers fascia and fascia propria; Sectional anatomy (horizontal position) shows the fascia propria is travelling from medial to lateral part, rectum within the outer Traveling, Denonvilliers fascia is just opposite, both of them and parietal fascia constitude neurovascular bundle.â‘¡Microanatomy of fascia propria and the parietal fascia found fascia propria and parietal fascia and constitude the latera space of rectum, with lateral ligament and the pelvic plexus travelling inside. Sectional anatomy (coronal) shows the fascia propria from the rectum to go down the line, which ends with the mutual integration of the parietal fascia, with pelvic blood vessels and nerves walking inside.â‘¢Fascia propria and the presacral fascia fascia propria and presacral fascia constitude the presacral space together, 80% of the level of the presacral space clear, and easy to separated, 20% of the presacral space is difficult to separate. Sectional natomy (sagittal) shows the presacral fascia and fascia propria is merged thickened, two layers of fascia is difficult to identify. 2. Sectional anatomy and MRI observations:â‘ Horizontal position: section anatomy shows the fascia propria is around the mesorectum, the presacral fascia and presacral fascia is adjacent, lateral and internal iliac vessels and pelvic nerve plexus adjacent to the fascia propria; MRI in cadavers showed that the rectum was the inherent low signal fascia, the thin-shaped enveloping mesorectum; MRI in vivo show the the same with MRI in cadavers.â‘¡Sagittal position: section anatomy shows that the fascia propria run parallel with the presacral fascia, anterior part of the fascia propria is close to Denonivillers fascia; MRI in cadavers showed that the fascia propria and the presacral fascia is seen as low signal like structure, the anterior part of the fascia propria is an inherent low signal linear structure; MRI in vivo show the same the MRI in cadavers.â‘¢Coronal position: section anatomy shows that the fascia propria run superior to interior and merge with the parietal surface of the levator ani; MRI in cadavers showed that the fascia propria is seen as low-signal structure, mesorectum is high signal; MRI in cadaves shows the smme with the MRI showed in cadavers. 3.Rectal cancer:â‘ Preoperative MRI showed fascia propria was inherent low signal, lined the mesorectum around and the relationship between the edge of the cancer and fascia propria is clear.â‘¡Intraoperative observation of the anterior part of the fascia propria and Denonivillers fascia found that there is no nerve and blood in fascia space, filled by the loose tissue.â‘¢Check the postoperative specimen showed mesorectal surface coated with fibrous connective tissue membrane, that is, the fascia propria.Conclusionsâ‘ 'Holy plane'of the rectum is between the fascia propria and Denonvilliers fascia anteriorly; between the fasacia propria and the parietal fascia laterally; between the fascia propria and the presacral fascia posteriorly;â‘¡Correlation study between sectional anatomy and MRI of the fascia propria give us normal MRI imaging data for identification of rectal fascia on MRI in vivo.â‘¢MRI can accurately evaluate the fascia propria and the edge of the rectal cancer for stage and provide individualized treatment plan developed imaging evidence.