The Influence To Reconstruct The Digital Three-dimensional Model And Analysis The Characteristic Of Blood Supply Of Arteries Network In Cervical Cancer By Different Threshold

Cervical cancer is one of the common malignant tumor of the modern woman, there are about140,000women have been detected in the disease in China each year, accounting for1/3of the global number of new cases. It’s a serious threat to women’s physical and mental health of our country. Locally advanced cervical cancer(LACC) refers to the cervical cancer which have high risk factors. The generalized is the stage IB to IVA of cervical cancer, narrow sense refers to the diameter of tumor is more than4cm of early cervical cancer (Stage ⅠB2and ⅡA2). The characteristic are about the great tumor in local and/or extensive infiltration of the surrounding tissue. It is also the main reason for its poor prognosis. LACC accounts for about70%of the first treatment cases, the five-year survival rate is about50%after surgery or radiotherapy alone. How to improve the efficacy is the problem the clinicians need to solve. The NCCN guidelines in2012points out that the recommended treatment of LACC is radiotherapy combined with chemotherapy. Although there is certain effect, the series side effects of radiotherapy induced the impact of quality of life on patients, especially for young patients. In recent years, researchers focused on researching the preoperative neoadjuvant chemotherapy to reduce tumor volume, so that the tumor reached the scope of indications for surgery, an increase the surgery ratio of LACC and improve the prognosis.Inter-arterial chemotherapy operation is divided into two parts:(1) internal iliac artery/uterine artery intervention intubation;(2) infusion the anti-cancer drug for chemotherapy. Neoadjuvant intra-arterial chemotherapy operation is rather difficult. Doctors who accept the regular train are permitted to take operation. One of the difficult is arterial intubation chemotherapy. Because the classification of the female pelvic arterial network is complex and tortuous changeable, we need to understand the source of tumor, as targeted as possible to take the artery intervention intubation in cervical cancer patients with intra-arterial chemotherapy. This is a challenge for doctors who operate. In order to super-selective intubation feeding artery embolization and to reduce the amount of embolic agents, it is even need more to know about the blood supply of the tumor’s feeding artery and uterine artery vascular network to perform the uterine artery infusion chemotherapy and embolization.Neoadjuvant chemotherapy, especially the arterial chemotherapy in the treatment of LACC, can play effectively in downgrade, making more and more patients with cervical cancer to gain the chance of operation and improve the survival rates. But there are still some cases of poor efficacy. Arterial chemotherapy for cervical cancer, perfusion arterial choice are regardless or anti-cancer drugs distribution are often based on the experience. There is existing subjectivity and randomness that affect further improve efficacy. If we can identify the feeding artery, the precise blood supply capacity and blood supply ratio of cervical cancer foci before arterial chemotherapy, and accordingly develop appropriate preoperative program that will guide the operative and rational allocation of the anti-cancer drug. It will be conducive to the improvement of the implementation and efficacy of intra-arterial chemotherapy.In recent years, with the perfection of CT equipment, CT angiography (CTA) became a wide range of clinical applications of the technology and the innovation of the three dimensional reconstruction software, making cervical cancer arterial vascular network digital three-dimensional model possible, in guiding the treatment for cervical cancer and has broad application prospects. Cervical artery vascular network digital three dimensional model can be reconstructed in the preoperative female abdominal and pelvic arteries in the preoperative vascular bifurcation angle measurement using Mimics3D reconstruction software, more intuitive guidance arterial chemotherapy intervention intubation, further reducing the clinicians and the patients received radiation by the line rate. Secondly, through the three dimensional segmentation and quantification of various parts of the vascular network of the uterine volume, about the proportion of blood supply to the uterus, in order to guide the allocation of anti-cancer drugs, to optimize the use of drugs, to improve the efficacy of such purposes.The adjustment of reconstructed threshold is based on the need to adjust the transparency of the different organizations in order to achieve the best developing state of the target tissue. Though reconstructing the cervical arteries digital three dimensional model in procession, we found that the abdominal and pelvic vascular anatomy did not change significantly when using different reconstruction threshold to building models, but the density of uterine artery vascular network of cervical cancer is increasing by decreasing the reconstructed threshold. The phenomenon of the characteristics of blood supply for uterine artery vascular network of cervical cancer main effects the display of the degree of development of the small arteries and segmentation boundaries of uterine arterial vascular network. When the reconstructed threshold is lower, the developing arterioles within the vascular network is easier. It is closer to the true state of the vascular net of the uterus in vivo. It is the ideal state of the model building. But when the uterine vascular network traffic branched developing more and more, the central axis of the uterus, making it less easily identified, but not conducive to the three dimensional segmentation of the uterine vascular network affect the analysis of the blood supply. Therefore, how should be the characteristics of blood supply of the uterine arterial vascular network adopted reconstruction threshold in order to achieve both build a rich vascular network, but also to analyze its blood supply? What indicator should be taken more reasonable assessment of the blood supply of the cervical uterine artery vascular network, in order to guide the distribution of drugs? Different reconstructed threshold characteristics of digital three dimensional model of blood for cervical cancer uterine artery vascular network in advanced study.In summary, in order to explore the different reconstructed threshold analysis on the arterial vascular network of digital three dimensional models and the blood supply to find the best reconstructed threshold build a model that reflects blood supply stability index, this study is divided into two parts:the first part intends to build digital three dimensional models of abdominal and pelvic arterial vascular network of a case based on CTA data set, the issue of the pelvic vascular volume of the angle and uterine arterial vascular network for quantitative analysis. The second part intends to build36case digital three dimensional models of cervical arteries in vivo and compare the effect of different reconstructed threshold. Part one The construction of digital three-dimensional model in vivo for arterial network of cervical cancer based on CTA[Objective]To construct a digital three-dimensional model in vivo for arterial network of cervical cancer based on CTA, and analysis the characteristic of the3D models.[Method]l.A series of CTA data set were obtained from a woman with cervical cancer Contemplated to intraarterial neoadjuvant chemotherapy from Nanfang Hospital.2.Then the Mimics10.01was used to construct a digital three-dimensional model in vivo for arterial network of cervical cancer through images automatically located, organize, interpolated and threshold setting.3.The model was be segmented by using the tools of Cut With Polyplane and Cut With Curve, and be calculated the blood volume and the proportion of blood distribution of the models;4.Import DSA images collected to Photoshop software, and register by using intrauterine contraceptive ring as a registration point. The digital three-dimensional model in vivo for arterial network of cervical cancer based on CTA was compared with DSA registration image to investigate its anatomical characteristics.[Results]1. The characteristics of arterial network of cervical cancerIn the present study, base on CTA data sets using Mimics software to successfully construct a case of cervical cancer patient with abdominal and pelvic and uterine artery vascular network digital three dimensional model, which can be any angle of rotation, size scaling, not only faithfully reproduce the abdominal course and pelvic artery branch, can also understand the arterial vascular network of cervical cancer, and observe the feeding arteries sources. 2. The perspective view of the digitized three dimensional model of body cervical artery network segmentationWire cutting and surface cutting three dimensional tool for uterine artery vascular network segmentation, divided into the uterus, uterine body, cervix, left/right uterine body, left/right cervical vascular network.3. The measurement of the digitized three dimensional model of the uterine arterial vascular networkUsing the Mimics software, we can accurately measure the angle and uterine vascular network of the various parts of the body cervical arteries digital three dimensional model of the artery bifurcation volume.4. Digital three dimension model of the network of arteries in the body of cervical cancer compared with DSAThe patient underwent neoadjuvant intra-arterial chemotherapy, abdominal aorta and digital three dimensional model of pelvic blood vessels, uterine artery DSA angiography chart with digital three dimensional model of uterine artery vascular network Morphometric analysis, the reconstruction of three dimensional picture of the model and its having a high degree of similarity and comparability.[Conclusion]Using related software like Mimics with database collected through CTA, the cervical cancer’s arterial network model in vivo could be successfully constructed, which may contribute to the materialization of digital models and be used for individualization evaluation and therapy. Part two The influence of analysing blood supply in digital three-dimensional model of cervical cancer arterial vascular network by different reconstruction threshold[Objective]Intended to compare different threshold body cervical arteries digitized three-dimensional model to understand the proportion of its blood supply are the same, in order to optimize the reconstruction methods in digital three-dimensional model of the arterial vascular network of the body of cervical cancer, guidance arterial chemotherapy clinical applications.[Method]36series of CTA data set were obtained from36women with cervical cancer Contemplated to intraarterial neoadjuvant chemotherapy from Nanfang Hospital. Then the Mimics10.01was used to construct a digital three-dimensional model in vivo for arterial network of cervical cancer through images automatically located, organize, interpolated and threshold setted. The threshold was setted by80HU,100HU and120HU. The model was be segmented by using the tools of Cut With Polyplane and Cut With Curve, and be calculated the blood volume and the proportion of blood distribution of the models. The digital three-dimensional model in vivo for arterial network of cervical cancer based on CTA was compared with different digital three-dimensional model of cervical cancer arterial vascular network by different reconstruction threshold constructed by different threshold and to investigate its anatomical characteristics.[Results]1. The digital three-dimensional model in vivo for arterial network of cervical cancer of different t reconstruction threshold We successfully constructed digital three-dimensional models for arterial network of cervical cancer by using80HU,100HU,120HU three reconstruction thresholds.:the lower the threshold, the dense the LACC arterial vascular network model; the higher the threshold, the sparse the LACC arterial vascular network model. The digital three-dimensional model reconstructed in100HU threshold clearly showed the uterine artery and its branches, and display the anatomic form of the vascular network artery of cervical cancer truly.2. The comparison of the blood volume of each part of the uterus in cervical cancer arterial vascular network between different thresholdThrough the blood volume calculation of the three digital three-dimensional models for arterial network of cervical cancer using80HU,100HU,120HU reconstruction thresholds, we found that:the blood volume of the total uterine, Corpus uteri, cervix uterus, the left part of Corpus uteri, the right part of Corpus uteri, left part of cervix uterus, the right part of cervix uterus increase with the reconstruction threshold decrease. The difference was statistically significant (p<0.05), while the difference of the blood volume of cervix uterus and the left/right part of cervix uterus was no significant differences when compared100HU with120HU reconstruction thresholds. There was a negative correlation between uterine blood volume and reconstruction threshold.3. The comparison of circulation ratio of each part of the uterus in cervical cancer arterial vascular network between different thresholdThrough the blood volume calculation of the three digital three-dimensional models for arterial network of cervical cancer using80HU,100HU,120HU reconstruction thresholds, we found that:Corpus uteri and cervix uterus percentage of the overall proportion of blood supply, the left/right part blood volume percentage of the corpus uteri, the left/right part blood volume percentage of the cervix uterus are independent of reconstruction threshold. There was no statistical significance (p>0.05)[Conclusion]Digital three-dimensional model of the cervical arteries network in various parts of the uterine vascular capacity and reconstruction threshold value is negatively related to the proportion of various parts of the blood supply is not changed with the change of the threshold. Thus, through the optimization of the construction method based on the the CTA datasets digitized three-dimensional model, the building closest to the physiological state of the vascular network model, in order to assess the difficulty of operation to guide the allocation of intra-arterial chemotherapy operation and chemotherapy drugs.