Ueno S, Yokoyama S, Soeda J, Tajima T, Mitomi T, Suto Y, Ishida H, Hayashi A
Department of Surgery, Tokai University School of Medicine, Isehara, Japan.
J Pediatr Surg. 1995 May;30(5):682-6. doi: 10.1016/0022-3468(95)90690-8.
Three-dimensional images of the pelvic structure of patients with anorectal malformation (ARM) were constructed by computer graphics based on radiographic computerized tomography (CT) and magnetic resonance (MR) images. Organ contour data from CT images and raw MR image data were transferred to a personal computer and to a graphic workstation respectively. On MR image processing, organs were extracted semiautomatically by thresholding enclosed areas. After several steps of image processing, three-dimensional anatomy of each anomaly was visualized with emphasis on position and shape of the muscle complex. In control patients without an anomaly, images showed that the rectum is supported by the levator muscle from behind and descends along with the urethra. In the male patient, the anal canal separates from the urethra and penetrates through the middle of the sphincter complex to reach the orifice. In those with low-type anomaly with a fistula opening to the perineum or the vestibule, images showed the fistula descending through the anterior portion of the sphincter complex. Images of those with a rectourethral fistula could show the muscle complex behind the rectum and at the region where the external sphincter should be. In those with cloacal anomalies, anatomical position and the shape of three different viscera were easily recognized, and the muscle complex was shown like that of rectourethral-type anomalies. This study is a new approach to the anomaly to facilitate understanding it and can assist a surgeon in planning a procedure. This kind of application would make it possible for a surgeon to consider the strategy on a display screen before the real surgery.
基于放射计算机断层扫描（CT）和磁共振（MR）图像，通过计算机图形技术构建了肛门直肠畸形（ARM）患者盆腔结构的三维图像。CT图像的器官轮廓数据和原始MR图像数据分别传输到个人计算机和图形工作站。在MR图像处理中，通过对封闭区域进行阈值处理半自动提取器官。经过几步图像处理后，着重观察肌肉复合体的位置和形状，可视化了每种异常的三维解剖结构。在无异常的对照患者中，图像显示直肠由提肌从后方支撑，并与尿道一起下降。在男性患者中，肛管与尿道分离，穿过括约肌复合体中部到达开口处。在那些低位型异常且瘘口通向会阴或前庭的患者中，图像显示瘘管穿过括约肌复合体前部下降。直肠尿道瘘患者的图像可以显示直肠后方和外括约肌所在区域的肌肉复合体。在泄殖腔异常患者中，三种不同内脏的解剖位置和形状易于识别，肌肉复合体显示与直肠尿道型异常相似。本研究是了解该异常的一种新方法，有助于外科医生制定手术方案。这种应用将使外科医生在实际手术前能够在显示屏上考虑手术策略。
