RESUMEN
It was the objective of this study to construct a model of the uterine vascular supply through vascular casting and thin slice computed tomography scanning. This will provide a teaching aide for the understanding of uterine artery embolization (UAE) procedures, as well as normal uterine and ovarian arterial anatomy. Using 20% chlorinated poly vinyl chloride, we infused and cast a set of a normal uterus, vagina and bilateral adnexa through the uterine artery and ovarian artery. After thin slice CT scanning, we obtained the three-dimensional (3D) reconstruction by maximum intensity projection (MIP) and surface-shaded display (SSD), and then observed its figure and characteristics. A model of the uterine vascular supply can be successfully reconstructed by vascular casting and thin slice CT scanning. The 3D reconstruction offers a clear view of the course of the uterine artery and its blood supply distribution. It has two major branches: The intramuscular uterine branch and the cervicovaginal branch (1). Blood supply is generally unilateral, with communicating branches between the two sides and possible anastomoses between the arterial blood supply of the uterus and the ovaries. The major blood supply of the cervix comes from the cervicovaginal branch of the uterine artery, while the vaginal arterial supply derives directly from the internal iliac artery. The CT technique allows real-time 360 degrees rotation and changes in model for in-depth study of the vascular network and its adjacent tissues. It is possible to construct an in vitro uterine arterial network by vascular casting and CT scanning, which can provide unique insight into the female genitourinary system arterial network. Based on this, we can create reconstructions as well as models for different diseases such as leiomyomata, adenomyosis, and endometrial cancer. These models will provide morphological evidence to the interventional therapy and UAE teaching in Obstetrics and Gynecology.
Asunto(s)
Modelos Anatómicos , Tomografía Computarizada por Rayos X/métodos , Útero/irrigación sanguínea , Anexos Uterinos/anatomía & histología , Femenino , Humanos , Imagenología Tridimensional/métodos , Ovario/irrigación sanguínea , Cloruro de Polivinilo/química , Arteria Uterina/anatomía & histología , Embolización de la Arteria Uterina/métodos , Vagina/irrigación sanguíneaRESUMEN
It was the aim of this study to discuss the efficacy of computed tomography angiography after failed uterine artery embolization. We performed a review of cases where embolization of myomata failed to relieve symptoms, or shrink myomata. If MRI showed continued uptake, patients were offered CT angiograms to better direct therapy. Repeat embolization details were compared with findings on CT angiogram. During the study, 675 patients underwent uterine artery embolization. 229 patients underwent follow-up MRI with intravenous contrast, 29 of which showed persistent uptake into myomata. Twelve patients had CT angiogram of the abdomen following MRI and six elected to undergo repeat UAE after CT angiogram. There was a 75% concurrence between CT angiograms and live studies (angiogram during repeat uterine artery embolization). With CTA, five patients showed a unilateral non-uterine blood supply, one showed a bilateral non-gonadal supply to the uterus, and two showed a normal blood supply, with all but two cases confirmed on live angiogram. Based on post-repeat MRI, one of the six repeat UAE patients shows no continued uptake of intravenous contrast to myomata. Four show continued uptake, however, one patient did show decreased size of myomata. CT angiography is a valuable tool to identify collateral and persistent uterine artery supply, and offers great potential for accurate identification and evaluation of extra-gonadal supply to the uterus. It will allow for pre-operative planning, as well as discussion of risks and benefits with patients.