基于亚毫米CT的三维可视化技术在宫颈癌诊治中的应用

Application of micro-computed tomography-based 3D visualization in diagnosis and treatment of cervical cancer

目的探索宫颈癌患者亚毫米CT静脉扫描的最佳显影时间,建立活人体宫颈癌患者女性盆腔的三维可视化数字模型,探讨三维可视化技术在宫颈癌诊治中的应用价值。方法 30例不同分期的宫颈癌患者行动脉期及分别延时70、90、120 s的静脉期进行亚毫米CT扫描,由影像诊断科医师对各期图像进行判读,确定最佳静脉显影时间并进行影像学诊断,应用女性盆腔CT薄层扫描数据,在腹部医学三维可视化系统进行图像分割及三维重建,然后将重建模型导入FreeForm Modeling System平台进行平滑、上色、透明化、旋转等操作,获得三维可视化模型。结果确定自注射造影剂后90 s行静脉期扫描可获得最佳显影效果图像。亚毫米CT对≤ⅠB1期的宫颈癌诊断率并不高(1/5),对≥ⅠB2期的诊断率较高,本研究25例均诊断出,分期判断准确率达64%。以CT动脉期及90 s静脉期数据为基础成功重建出宫颈癌患者女性盆腔的三维图像,包括盆腔主要脏器、血管、宫颈癌肿块,肿瘤供血血管等,并可从任意角度观察子宫与毗邻主要脏器空间立体位置关系。结论恰当扫描条件的亚毫米CT扫描对中晚期宫颈癌的诊断及分期有重要的帮助。基于亚毫米CT数据重建的三维可视化女性宫颈癌盆腔数字模型,能够为宫颈癌患者的临床诊治提供一定的参考依据,并可为进一步的仿真手术研究提供基础。

Objective To define the optimal development time of micro-computed tomography （micro-CT） venography in cervical cancer patients and establish 3D CT-based digital pelvic model of the patients. Methods Thirty patients with cervical cancer stratified by FIGO surgical staging underwent micro-CT scanning of the arterial phase and the venous phase with a delay time of 70, 90 and 120 s. The images were interpreted independently by two experienced radiologists to define the optimal development time in venous phase and establish the imaging diagnosis. Based on the pelvic CT scan data, we segmented the images using the abdominal medical image-3D visualization system followed by 3D image reconstruction to establish the 3D digital pelvic model using FreeForm Modeling System to modify the reconstructed images. Results The optimal images were obtained by scanning with a 90-sec delay time. Micro-CT was not sensitive to IB1 phase or earlier phases （1/5）, but efficient in advanced stages （~IB2 phase）. In our cases, 25 were diagnosed by micro-CT with a diagnostic accuracy of 64%. Based on these CT data, the pelvic 3D model covering the main organs, vessels, cervical neoplasm, and supplying vessels of the tumor in the pelvic cavity were successfully reconstructed to allow spatial observations of the uterus and the neighboring organs. Conclusion The 3D digital pelvic model reconstructed provides a means for staging cervical cancer and facilitates further surgical simulation studies.