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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

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Abstract

Objectives

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).

Methods

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.

Results

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.

Conclusion

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

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Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

HN:

Hypogastric nerves

IHP:

Inferior hypogastric plexus

MIP:

Maximum intensity projection

MRI:

Magnetic resonance imaging

MRN:

Magnetic resonance neurography

NSRH:

Nerve-sparing radical hysterectomy

PAN:

Pelvic autonomic nerves

PP:

Pelvic plexus

PSN:

Pelvic splanchnic nerves

SHP:

Superior hypogastric plexus

T2W FS:

T2-weighted fat saturation

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Funding

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).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Pengfei Li, Ping Liu, Chunlin Chen, Hui Duan & Oldevie Hugueth Ognami

  2. Department of Diagnostic Imaging Center Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Wenjun Qiao

Authors
  1. Pengfei Li
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  2. Ping Liu
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  3. Chunlin Chen
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  4. Hui Duan
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  5. Wenjun Qiao
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  6. Oldevie Hugueth Ognami
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Corresponding author

Correspondence to Chunlin Chen.

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Guarantor

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.

Methodology

• observational

• performed at one institution

Additional information

Pengfei Li and Ping Liu contributed equally to this work.

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Cite this article

Li, P., Liu, P., Chen, C. et al. 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. Eur Radiol 28, 4561–4569 (2018). https://doi.org/10.1007/s00330-018-5453-8

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  • DOI: https://doi.org/10.1007/s00330-018-5453-8

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