Analysis of the anatomical relationship between the uterine artery and the bony landmarks in cesarean scar pregnancy by CT angiography and digital subtraction angiography
Xiong Lang*, Wang Jinhua, Sun Jin, Deng Meixiang, Zheng Weizeng, Xiao Xinlan
Section of MR, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
Abstract：Objective To investigate the anatomical relationship between the uterine artery and the adjacent bony landmarks in cesarean scar pregnancy (CSP) with the method of sacroiliac vertical segmentation localization using CT angiography (CTA) and digital subtraction angiography (DSA).Methods From October 2013 to June 2014, 91 patients of CSP were examined by CTA and DSA in Department of Radiology of the Women′s Hospital of Medicine Zhejiang University. The mean age of the patients was (32.7±4.2) years (range from 23 to 44 years). The clinical data and the images of CTA and DSA from 91 patients were retrospectively reviewed. In the sacral side of the sacroiliac joint, the highest point of the sacrum(e. g. the left A point) and the bilateral lowest points of the ilium(point a and b) were defined as the bony landmarks of pelvis. According to the sacroiliac vertical segmentation localization mehtod, we drew a vertical line from point A to line ab which was the horizontal line through point a and b, point D was the intersection of the vertical line and line ab. Point A and B were two equal diversion points of AD line. Then, the vertical line was divided equally into four parts (namely AB, BC, CD and below D point), the distribution of the patients bilateral uterine artery (UA) orifice site at different parts of the vertical line were observed and analyzed on both CT image and DSA image.Results In the current study, 179 uterine arteries from 91 patients were demonstrated clearly at CTA and DSA, and three UA were ligated without visualized on CTA or DSA. The site of left UA orifice was lower than that of the right UA orifice, the left UA orifice located at AB in 0% (0), at BC in 3.3% (3/90), at CD in 70.0% (63/90), and at below D point in 26.7% (24/90), the right UA orifice located at AB in 0% (0), at BC in 11.2% (10/89), at CD in 85.4% (76/89), and at below D point in 3.4% (3/89). The most common site of bilateral UA orifice was at the level of CD, and a significant difference in the distribution of UA orifice was observed between left and right (χ2=22.618, P< 0.01).Conclusions The distribution of UA orifice has certain characteristics at different parts of the vertical line. Thus, when the origin of UA is difficult to be identified clearly in the patients of CSP treated with uterine artery embolization , the sacroiliac vertical segmentation localization method can provide a new imaging reference and guidance for uterine artery embolization.
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Xiong Lang, Wang Jinhua, Sun Jin, Deng Meixiang, Zheng Weizeng, Xiao Xinlan. Analysis of the anatomical relationship between the uterine artery and the bony landmarks in cesarean scar pregnancy by CT angiography and digital subtraction angiography. Chinese Journal of Anatomy and Clinics, 2015, 20(5): 410-414.
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2015, Vol. 20 
