Study of Preoperative 3D-CT Angiography of Uterine Artery in Patients with Uterine Cervical Cancer.

Abstract

Depiction of the fine vessel can provide useful preoperative information for patients with uterine cervical cancer. Although angiography can visualize vessels in detail, it is invasive. MR-angiography is a minimally invasive method to depict vessels, but the resolution of images is insufficient for preoperative evaluation. In this study, we used less invasive three-dimensional CT angiography (3D-CTA) and reconstructed images of adaptive iterative dose resolution 3D (AIDR 3D) with display field of view (D-FOV), which are suitable for arteries with large and small diameters, and created the fusion images. Created images allowed the observation of vessel branch in wide area compared with angiography, and it was less invasive. We evaluated the utility of 3D-CTA for visualizing fine vessels branching from uterine artery as preoperative evaluation for radial hysterectomy. 3D-CTA was obtained in nine patients. Conventional reconstruction and magnification reconstruction (D-FOV: 320‒360 mm, 150 mm) was made using arterial phase. Normal volume rendering image (N-VR) was made from conventional reconstruction image, and hybrid volume rendering image (H-VR) was made from conventional and magnification reconstruction image. Visual evaluation of each VR image was performed by 5 trained radiologists. A Wilcoxon rank sum test was performed for each result. No statistical significance was found in the visualization of vessels with large diameter (p=0.81), but statistical significance was detected in the visualization of the uterine artery and its ascending/descending branches (p<0.05). H-VR could visualize fine vessels clearer than N-VR, and H-VR could depict a vascular map including fine vessels in a large field. Therefore, H-VR could provide useful information for surgical operation. Additional depiction of vein and ureter could clearly visualize the anatomical relationship of each structure, and new clinical finding of anatomical relationship between uterine artery and ureter was suggested. This new clinical finding was useful in radical hysterectomy in which crossing site of the uterine artery and ureter is dissected. This method is simple to create and useful for various clinical surgery.