MRI-based 3D pelvic autonomous innervation: a first step towards image-guided pelvic surgery

Area of Science:

• Anatomy
• Radiology
• Surgical Planning

Background:

• Nerve preservation is critical in pelvic surgery.
• Accurate anatomical knowledge of pelvic innervation is essential for surgical success.
• Current imaging techniques may have limitations in visualizing fine neural structures.

Purpose of the Study:

• To analyze pelvic autonomous innervation using magnetic resonance imaging (MRI).
• To compare MRI findings with anatomical macroscopic dissection in cadavers.
• To evaluate the feasibility of MRI for preoperative nerve mapping.

Main Methods:

• Eight adult human cadavers underwent pelvic MRI with T1, T1 fat saturation, T2, and diffusion-weighted sequences.
• Segmentation software was used to extract nervous tissue from MRI data.
• Key innervation points were identified, and distances to anatomical references were measured and compared with dissection data.

Main Results:

• MRI provided adequate visualization of pelvic autonomous innervation.
• 3D MRI images showed concordant anatomical representation compared to dissections.
• Statistical analysis revealed a mean difference of less than 1 cm between MRI and dissection measurements, with good concordance correlation coefficients.

Conclusions:

• The developed MRI acquisition and post-processing method is suitable for detecting autonomous pelvic innervation.
• MRI can provide a preoperative nerve cartography, aiding in surgical planning.
• This study represents a foundational step towards image-guided pelvic surgery.