局部晚期宫颈癌灶在体动脉血管网数字化三维模型的构建及应用

Locally advanced cervical cancer (LACC) has many risk factors, simple surgery or radiotherapy for these patients often results in a poor outcome. Neoadjuvant trans-arterial chemotherapy improves resection rate and clinical effect, however some patients do not benefit a lot from it. Our previous study based on digital subtraction angiography in LACC patient received neoadjuvent trans-arterial chemotherapy showed that multiple vessels fed cancer lesions with different supplemental ratio. Currently, due to the insufficient knowledge of blood supply in LACC patients in advance, neoadjuvant trans-arterial chemotherapy is still a procedure by experience, which may be a contributing factor for the unsatisfied clinical effect. Therefore, it's quite necessary to carry out a thorough, noninvasive and individualized research on the blood supply of LACC before trans-arterial chemotherapy instead of traditional anatomical and DSA study. Based on our serial studies on the construction of digital three-dimensional model for normal uterine arterial network, our study plans to construct 220 digital three-dimensional in-vivo models for arterial network in LACC based on CTA datasets and techniques like image recognition, location, registration and three-dimensional resconstruction. Specific software is used to analyze the blood supplemental characteristics: origin, quantity of blood supplying vessels, blood volume in cancer lesions, blood flow and blood supplemental ratio. We hope our study is of reference and guiding significance to the operation and teaching of neoadjuvent trans-arterial chemotherapy and accurate distribution of anti-cancer durgs, and of great help to reach an individualized and accurate treatment.

局部晚期宫颈癌（LACC）高危因素多、单纯手术或放疗预后差，术前动脉化疗虽可提高其手术切除率和疗效，但仍有部分患者疗效欠佳。主要原因在于LACC癌灶不但有多条动脉参与供血，且供血比例不一，但临床医生在术前无法了解其特点，仅凭经验操作而使疗效不尽满意，故术前需详细了解LACC癌灶的血供特点，但传统解剖学及血管造影方法难以进行无创、个体化研究。因此本课题设想在前期构建正常子宫动脉血管网数字化三维模型系列研究的基础上，选择220例 LACC病例，利用其CTA数据集通过图像识别、定位配准、比对、三维重建等技术构建LACC癌灶在体动脉血管网数字化三维模型；应用计算机软件进一步分析其血供特点：供血动脉来源、数量及供血类型，癌灶内总血容量、血流丰富程度及各动脉供血比例等，以此指导LACC动脉化疗手术操作和抗癌药物的合理分配，达到术前解剖真人化、操作个体化、治疗精确化的目的，并为教学和科研提供研究平台。

局部晚期宫颈癌（LACC）高危因素多、单纯手术或放疗预后差，术前动脉化疗虽可提高其手术切除率和疗效，但仍有部分患者疗效欠佳。主要原因在于LACC 癌灶不但有多条动脉参与供血，且供血比例不一，但临床医生在术前无法了解其特点，仅凭经验操作而使疗效不尽满意，故术前需详细了解LACC 癌灶的血供特点，但传统解剖学及血管造影方法难以进行无创、个体化研究。本课题通过纳入220例LACC患者，获取宫颈癌术前CTA数据集，通过探讨数据采集和数字化三维重建方法，成功构建了宫颈癌灶动脉血管网数字化三维模型，并分析其与宫颈癌病理相关因素的关系，得出结论认为：①比较不同的CTA扫描方式，确定运用对比剂示踪法，以监测阈值为120HU触发扫描能获得良好的动脉显影；②成功构建出宫颈癌动脉化疗在体数字化三维血管网模型；③比较不同的重建阈值构建宫颈癌动脉血管网数字化三维模型，确定了构建模型的最优阈值为100HU至120HU；④宫颈癌灶的供血动脉主要为双侧子宫动脉，部分患者尚有阴道动脉或阴部内动脉等参与癌灶供血；⑤不同重建阈值的宫颈癌灶血管网容量不一样，随重建阈值的升高，癌灶血管网容量减少，但癌灶血管网所占子宫总体血管网容量的比例不随重建阈值的改变而改变；⑥明确不同分期宫颈癌血供类型：早期宫颈癌的血供主要呈非均衡型，晚期宫颈癌呈现出双侧血供更均衡的趋势。⑦明确不同分期宫颈癌血管化程度：随着宫颈癌的进展宫颈血管化越来越丰富，宫颈的血管化程度随分期的进展极富血管化型比例逐渐增大，一般血管化型比例逐渐减小。⑧宫颈癌患者癌灶血管化程度与浸润性指标如宫旁浸润、宫体浸润和宫颈浸润深度正相关，提示宫颈癌血管化程度增高可能是肿瘤浸润性生长的结果，也是预后不良的原因之一。⑨宫颈癌血供均衡性则与阴道浸润相关，提示阴道浸润可能是诱发或增强对侧子宫动脉供血的原因。根据以上结论，可指导LACC 动脉化疗手术操作和抗癌药物的合理分配，达到术前解剖真人化、操作个体化的目的，并为教学和科研提供研究平台。