European Radiology

, Volume 28, Issue 11, pp 4561–4569 | Cite as

The 3D reconstructions of female pelvic autonomic nerves and their related organs based on MRI: a first step towards neuronavigation during nerve-sparing radical hysterectomy

  • Pengfei Li
  • Ping Liu
  • Chunlin ChenEmail author
  • Hui Duan
  • Wenjun Qiao
  • Oldevie Hugueth Ognami
Computer Applications



To present in vivo female pelvic autonomous innervation and the relationship between nerves and their related organs by three-dimensional (3D) reconstruction based on magnetic resonance imaging (MRI).


Thirty patients with cervical cancer who underwent pelvic MRI and agreed to undergo additional magnetic resonance neurography (MRN) sequences were enrolled in the present study. MRI images from the same patient were acquired using T2-weighted fat saturation (T2W FS) and 3D-STIR-SPACE sequences. Detailed two-dimensional (2D) segmentation and 3D reconstruction of pelvic autonomic nerves (PAN) were performed on the basis of the images of the two sequences using 3D reconstruction software. The 2D segmentation and 3D reconstruction of pelvic organs were based on T2W FS images. The consistency of the 3D models of pelvic autonomous innervation constructed from the two sequences were analysed and compared, the pelvic autonomous innervation was presented, and the relationship between nerves and their related organs was characterised.


The 3D reconstructions of PAN were successfully obtained from 3D-STIR-SPACE and T2W FS sequences in 30 patients and showed high correspondence. T2W FS images also enabled 3D reconstructions of pelvic organs to visualise the 3D distribution of PAN and the positional relationships between nerves and their related organs.


The pelvic autonomic nerves and their related organs can be reconstructed on the basis of MRI to present personalised 3D anatomical information and offer individualised guidance during nerve-sparing radical hysterectomy (NSRH).

Key points

Nerve-sparing radical hysterectomy is a developing trend in cervical cancer surgery

MRI allows reconstructions of pelvic autonomic nerves and their related organs

The 3D reconstructions provide detailed 3D anatomical information on nerves


Three-dimensional imaging Hypogastric plexus Splanchnic nerves Magnetic resonance imaging Neuronavigation 







Hypogastric nerves


Inferior hypogastric plexus


Maximum intensity projection


Magnetic resonance imaging


Magnetic resonance neurography


Nerve-sparing radical hysterectomy


Pelvic autonomic nerves


Pelvic plexus


Pelvic splanchnic nerves


Superior hypogastric plexus


T2-weighted fat saturation



This study has received funding by the National Natural Science Fund of China (81571422), the National Science and Technology Support Program of China (2014BAI05B03), the National Natural Science Fund of Guangdong (2015A030311024) and the Science and Technology Plan of Guangzhou (158100075).

Compliance with ethical standards


The scientific guarantor of this publication is Chunlin Chen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in European Radiology.


• observational

• performed at one institution


  1. 1.
    Koh WJ, Greer BE (2015) Cervical Cancer, Version 2.2015. J Natl Compr Canc Netw 13:395–404CrossRefGoogle Scholar
  2. 2.
    Balaya V, Rossi L (2017) Where does pelvic nerve injury occur during radical hysterectomy for cervical cancer? Gynecol Oncol 145:199–200CrossRefGoogle Scholar
  3. 3.
    Chen C, Li W (2012) Classical and nerve-sparing radical hysterectomy: an evaluation of the nerve trauma in cardinal ligament. Gynecol Oncol 125:245–251CrossRefGoogle Scholar
  4. 4.
    Moszkowicz D, Alsaid B (2011) Female pelvic autonomic neuroanatomy based on conventional macroscopic and computer-assisted anatomic dissections. Surg Radiol Anat 33:397–404CrossRefGoogle Scholar
  5. 5.
    Chen C, Guo H (2012) The measurement of vesical detrusor electromyographic activity during nerve-sparing radical hysterectomy. Reprod Sci 17:1144–1152CrossRefGoogle Scholar
  6. 6.
    Possover M, Stober S (2000) Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type III. Gynecol Oncol 79:154–157CrossRefGoogle Scholar
  7. 7.
    Raspagliesi F, Ditto A (2004) Nerve-sparing radical hysterectomy: a surgical technique for preserving the autonomic hypogastric nerve. Gynecol Oncol 93:307–314CrossRefGoogle Scholar
  8. 8.
    Sakuragi N, Todo Y (2005) A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer 15:389–397CrossRefGoogle Scholar
  9. 9.
    Bertrand MM, Macri F (2014) MRI-based 3D pelvic autonomous innervation: a first step towards image-guided pelvic surgery. Eur Radiol 24:1989–1997CrossRefGoogle Scholar
  10. 10.
    Kraima AC, Derks M (2016) Careful dissection of the distal ureter is highly important in nerve-sparing radical pelvic surgery: a 3D reconstruction and immunohistochemical characterization of the vesical plexus. Int J Gynecol Cancer 26:959–966CrossRefGoogle Scholar
  11. 11.
    Zaitouna M, Alsaid B (2013) Identification of the origin of adrenergic and cholinergic nerve fibers within the superior hypogastric plexus of the human fetus. J Anat 223:14–21CrossRefGoogle Scholar
  12. 12.
    Kim J, Lee J (2016) Survival outcome of cervical cancer patients staged with magnetic resonance imaging. Int J Radiat Oncol Biol Phys 96:E321CrossRefGoogle Scholar
  13. 13.
    Chhabra A, McKenna CA (2016) 3T magnetic resonance neurography of pudendal nerve with cadaveric dissection correlation. World J Radiol 8:700–706CrossRefGoogle Scholar
  14. 14.
    Soldatos T, Andreisek G (2013) High-resolution 3-T MR neurography of the lumbosacral plexus. Radiographics 33:967–987CrossRefGoogle Scholar
  15. 15.
    Li H, Jia J (2015) Anatomical basis of female pelvic cavity for nerve sparing radical hysterectomy. Surg Radiol Anat 37:657–665CrossRefGoogle Scholar
  16. 16.
    Chen C, Huang L (2014) Neurovascular quantitative study of the uterosacral ligament related to nerve-sparing radical hysterectomy. Eur J Obstet Gynecol Reprod Biol 172:74–79CrossRefGoogle Scholar
  17. 17.
    Lemos N, Souza C (2015) Laparoscopic anatomy of the autonomic nerves of the pelvis and the concept of nerve-sparing surgery by direct visualisation of autonomic nerve bundles. Fertil Steril 104:e11–e12CrossRefGoogle Scholar
  18. 18.
    Wu M, Ma SQ (2015) A preliminary report of a prospective randomized controlled study: effects of water-jet in laparoscopic nerve sparing radical hysterectomy for patients with cervical cancer. J Minim Invasive Gynecol 22:S78–S79CrossRefGoogle Scholar
  19. 19.
    Mantzaris G, Rodolakis A (2008) Magnifying lenses assisted nerve-sparing radical hysterectomy and prevention of nerve plexus trauma. Int J Gynecol Cancer 18:868–875CrossRefGoogle Scholar
  20. 20.
    Skinner SA (2014) Pelvic autonomic neuromonitoring: present reality, future prospects. J Clin Neurophysiol 31:302–312CrossRefGoogle Scholar
  21. 21.
    Howe FA, Filler AG (1992) Magnetic resonance neurography. Magn Reson Med 28:328–338CrossRefGoogle Scholar
  22. 22.
    Chhabra A, Carrino J (2015) Current MR neurography techniques and whole-body MR neurography. Semin Musculoskel Radiol 19:79–85CrossRefGoogle Scholar
  23. 23.
    Pham M, Oikonomou D (2015) Magnetic resonance neurography detects diabetic neuropathy early and with proximal predominance. Ann Neurol 78:939–948CrossRefGoogle Scholar
  24. 24.
    Robbins NM, Shah V (2016) Magnetic resonance neurography in the diagnosis of neuropathies of the lumbosacral plexus: a pictorial review. Clin Imaging 40:1118–1130CrossRefGoogle Scholar
  25. 25.
    Wolf M, Baumer P (2014) Sciatic nerve injury related to hip replacement surgery: imaging detection by MR neurography despite susceptibility artifacts. PLoS One 9:e89154CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
  2. 2.Department of Diagnostic Imaging Center Nanfang HospitalSouthern Medical UniversityGuangzhouChina

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