面神经管多层螺旋CT曲面重建的测量

目的　观察及测量多层螺旋CT曲面重建的面神经管。方法　用多层螺旋CT对 40例 (80耳 )病人行颞骨轴位高分辨率CT扫描 ,在轴面及多平面重建的矢状位、冠状位上行面神经管的曲面重建。观察及测量面神经管。结果　面神经管的平均长度为 (2 9.73± 1.0 7)mm。迷路段、鼓室段及乳突段的平均长度分别为 (5 .6± 0 .74)mm、(10 .66± 0 .79)mm及 (13 .47± 1.0 1)mm。迷路段、膝状神经窝、鼓室段及乳突段的平均直径分别为 (0 .76± 0 .16)mm、2 .3 7± 0 .63 )mm、(1.0 3± 0 .16)mm及 (1.5 7± 0 .3 1)mm。第一膝及第二膝的平均角度分别为 67.0 4°± 9.41°及 114 .2 5°± 8.44°。面神经管鼓室段与外侧半规管壶腹及弓部的平均距离分别为 (0 .5 7± 0 .19)mm及 (1.5 9± 0 .61)mm。鼓室段与外侧半规管成角 10 .63°± 3 .6°。面神经管鼓室段与矢状面平均成角为 3 4.65°± 5 .3 9°。 80耳中 89%可见面神经管的裂缺 ,73 .7%仅位于鼓室段 ,其余 2 6.3 %在鼓室段、乳突段均可见裂缺。结论　面神经管的多层螺旋CT曲面重建是研究面神经管CT解剖的良好影像学方法 ,结合颞骨高分辨率CT的轴面扫描及面神经管的多平面重建 ,能获得更多的信息。     

岩下窦的薄层断面影像解剖学研究

目的 以MSCT增强扫描为基础,探讨岩下窦(inferior petrosal sinus,IPS)的解剖行程和形态学表现,为经IPS静脉途径诊断和治疗相关疾病提供影像学参考依据.资料与方法 对120例患者行CT脑静脉成像(CTV),通过连续断面观察及多平面重组(MPR)技术,以第2例可视化人体数据集中的相关薄层解剖断面为参照,对IPS的位置、形态、大小、走行及与周围结构的关系进行观察和测量.结果 IPS起始部、垂直部和水平部、出颅部以及颅外段在CT薄层横断面上均能得到连续显示,与薄层解剖断面有良好的对应关系.IPS起始部与海绵窦后上部无明确界限,两侧借基底静脉丛(BVP)相互交通,其宽度左侧为(7.88±1.83)mm,右侧为(8.42±1.87)mm,两侧差异有统计学意义(P＜0.05);深度左侧为(2.90±0.83)mm,右侧为(2.90±0.71)mm,两侧差异无统计学意义(P＞0.05);IPS垂直段、出颅段为均匀强化的管状结构,垂直段直径左侧为(1.87±0.82)mm,右侧为(2.08±0.60)mm,两侧差异有统计学意义(P＜0.05);出颅段直径左侧为(1.96±0.74)mm,右侧为(1.95±0.68)mm,两侧差异无统计学意义(P＞0.05).结论 MSCT能够准确显示IPS的解剖结构及变异,是评价IPS解剖行程和形态学变化的准确的影像学检查技术.     

颞骨内面神经的影像学研究：多层面CT和高场强MR

目的探讨多层面CT和高场强MR对颞骨内面神经及面神经管检查的应用价值.材料和方法选择5例头颅标本行多层面CT和1.5TMR扫描.多层面CT扫描参数如下螺旋方式,管电压120kV,管电流230mA,扫描时间28,视野220mm,扫描层厚5mm,重建厚度1.25mm,螺距13,矩阵512×512.在工作站上行多平面重建.MR检查采用三维稳态射频傅立叶采集(3DRF-FAST)序列(TR50ms,TE13ms,FOV250mm,层厚1.5mm).头颅标本进行大体解剖,结果与CT、MR影像相对照.结果颞骨内面神经管可以通过多平面重建在一个平面内显示,与MR图像相比,多层面CT对于面神经管的显示较好.MR图像可以清晰显示面神经鼓室段、乳突段和膝状神经节.对于5例标本的双侧颞骨内面神经及面神经管分别于MR和多层面CT进行测量,直径分别为1.15±0.25mm,1.26±0.14mm.所测量结果与解剖标本相比无显著性差异(p＞0.05).结论高场强MR和多层面CT是颞骨内面神经和面神经管检查的理想方法,两者结合使用更有利于颞骨内面神经病变的检出.     

口服对比剂CT检查下咽环杓后区解剖测量值的临床价值

目的探讨口服对比剂后螺旋CT扫描环杓后区解剖结构的显示及其测量值的临床价值。资料与方法观察43例病人口服对比剂后环杓后区解剖结构的CT影像。分别测量杓状软骨上缘水平、环状软骨上缘水平及环状软骨下缘水平下咽前壁厚度、后壁厚度和前后壁厚度之和。测量数据分别采用配对t检验和独立样本t检验进行统计学分析。结果不同性别病人的杓状软骨上缘水平、环状软骨上缘水平及环状软骨下缘水平下咽前壁、后壁厚度分别比较,差异无统计学意义(P0.05)。男性杓状软骨上缘水平下咽前后壁厚度之和大于女性[男性(9.27±2.51)mm,女性(7.96±1.46)mm;P0.05]。环状软骨上、下缘水平的下咽前后壁厚度之和差异无统计学意义(P0.05)。同性别病人下咽前、后壁厚度比较显示,男性和女性病人环状软骨上、下缘水平的下咽后壁厚度均大于下咽前壁,而杓状软骨上缘水平的下咽后壁厚度均小于下咽前壁(均P0.05)。结论口服对比剂后螺旋CT扫描可以勾画出环杓后区解剖形态,弥补了临床喉镜的不足,并能提供不同层面解剖测量值,为疾病的早期发现和术前分期提供准确的影像学依据。     

多层螺旋CT面神经管曲面重建与解剖对照研究

目的探讨螺旋CT面神经管曲面重建(curved p lanar reform ation,CPR)的方法并研究其解剖学的可靠性。方法20具(40侧颞骨)成人尸头标本行高分辨CT扫描及面神经管轴位、冠状位和矢状位曲面重建并测量各段长度、直径和2个弯曲的角度,观察重建图像上面神经管各段的形态及走行;对40侧颞骨标本的面神经管进行解剖,测量相应各段长度、直径和2个弯曲角度,并观察面神经管形态及走行。结果①3个方向CPR图均能将面神经管全程直观地显示在1幅图像上,可清楚的显示面神经管在颞骨内的走行、形态和管壁等情况;②重建图像均可准确测得各段长度、直径及锥曲角度,冠状位和矢状位能准确测量膝状神经节角度,与解剖测量结果一致(P>0.05);③迷路段和膝状神经节的形态与走行方向在冠状位CPR显示好,水平段、锥曲及垂直段形态和走行在轴位CPR显示好,与解剖具有很好的对应性。结论面神经管高分辨率CT图像的CPR为研究面神经管影像解剖良好的、可靠的方法,可代替解剖测量与观察。     

与心律失常射频消融治疗相关的右心房结构64排CT特征

目的 探讨右心房内与心律失常及其射频消融治疗相关的重要解剖结构的MDCT特征.方法 搜集在本院行64排CT冠状动脉血管造影术的153例连续受检者的影像学资料,使用GE ADW4.4高级工作站观察右心房内与心律失常及其射频消融治疗相关的重要解剖结构特征,并测量相关参数.结果 上腔静脉入口右侧和下腔静脉入口右侧之间的平均距离(48.9±6.9) mm;上腔静脉入口右侧和下腔静脉入口右侧连线中点和心房右侧壁的平均垂直距离(37.9±5.6) mm,该垂线和右房壁交点水平横轴位图像界嵴平均厚度(5.8±1.8) mm.下腔静脉三尖瓣峡隔旁部平均长度(16.2±3.2) mm,峡隔部平均长度(9.8±2.6) mm;峡中央部平均长度(19.5±4.4) mm,峡中央部平均深度(7.3±3.1) mm,峡中央部深度>5 mm者72例;峡下侧部的平均长度(24.8±4.8) mm.100例患者中,Eustachian嵴/环的形态呈结节样见于31%患者(31/100),明显的Eustachian环起自Eustachian嵴见于22%患者(22/100).100例患者中,Thebesian瓣下窦深度>5 mm者见于54%患者(54/100).结论 64排CT可清晰显示右心房内与心律失常及其射频消融治疗相关的重要解剖结构的特征.     

MSCT的MPR矢状位重建对慢性化脓性中耳炎的临床应用价值

目的探讨MSCT的MPR矢状位重建对慢性化脓性中耳炎的临床手术应用价值。方法对61例76耳慢性化脓性中耳炎行MSCT检查,在轴位HRCT及矢状位MPR图像上观察中耳结构及病变显示情况并与手术结果进行对照。结果矢状面MPR图像可良好显示颞骨结构及其周围结构的毗邻关系,对面神经鼓室段及垂直段、乙状窦板及颈静脉球等结构显示尤佳。在MPR矢状位重建图像上38耳中耳炎可见中耳骨壁及听骨链的“人”字形结构有不同程度的破坏。16耳(肉芽肿型5耳,胆脂瘤型11耳)面神经管破坏鼓室段12耳,乳突段4耳,其中3耳胆脂瘤型的面神经管鼓室段和乳突段均有骨质破坏;骨性半规管受累伴骨质破坏12耳;解剖变异有乙状窦前置8耳,乙状窦的前壁至外耳道后壁的最短距离约0.4～0.8cm,平均0.6cm;2例高位颈静脉球;均得到手术证实。结论矢状位MPR图像对慢性中耳炎累及面神经骨管损伤程度、位置及与周围位置的毗邻关系的显示具有重要的临床应用价值。     

三维螺旋CT对骨性椎间孔解剖测量分析

目的 探讨腰椎间盘突出症(lumbar disc herniation, LDH)患者与正常人群椎间孔三维CT数据，为临床椎间孔镜手术减压范围提供解剖依据。方法 选取我院行腰椎三维CT检查的LDH患者60例(为突出组)与同期60例体检腰椎正常者(为正常组)的CT影像资料，在腰椎三维CT图像定位二维矢状面图像对L4-5节段椎间隙高度、两侧腰椎间孔高度、椎间孔宽度、椎间孔面积进行测量。结果 L4-5突出组腰椎椎间隙高度(6.992±1.889) mm,两侧平均椎间孔高度(18.664±2.309) mm,椎间孔宽度(8.327±1.026) mm,椎间孔面积(116.445±19.414) mm²;L4-5正常组腰椎椎间隙高度、两侧平均椎间孔高度、宽度、面积分别为(9.628±1.745) mm、(20.069±2.017) mm,(9.070±1.255) mm,(161.083±25.545) mm²,L4-5节段突出组与正常组椎间孔三维参数相比明显变小，差异有统计学意义(P<0.05)。结论 L4-5节段突出症患者骨性椎间孔高度、宽度...     

舌下神经管及舌下神经CT/MRI配准对照研究

目的:探讨CT、MRI对舌下神经管及舌下神经的显示价值。方法:回顾性分析复旦大学附属肿瘤医院22例无颅神经侵犯鼻咽癌患者的CT、MRI。研究CT、MRI横断面像上舌下神经管的显示情况(显示层数、左右侧、全管显示、半管显示,两侧纵径、内径以及纵径与矢状面的角度)。结果:CT对舌下神经管:单侧显示11.6%、双侧显示55.8%、未显示32.6%;全管显示58.1%、部分显示9.3%;左管径(6.17±1.3)mm、左管长(6.5±2.0)mm、左管倾角(44.2±0.6)°、右管径(5.78±1.2)mm、右管长(6.8±1.9)mm、右管倾角(44.5±1.7)°。两侧管径比较(t=1.202,P>0.05)。两侧管长比较(t=-1.216,P>0.05)。两侧管倾角比较(t=0.252,P>0.05)。MRI均为全管双侧显示舌下神经管,双侧显示100%;左管径平均(6.3±1.3)mm、左管长平均(6.6±1.8)mm、左管倾角平均(44.1±0.7)°、右管径平均(5.9±0.9)mm、右管长平均(6.9±1.7)mm、右管倾角平均(44.3±1.7)°。两侧管径比较(t=1.11,P>0.05);两侧管长比较(t=-0.984,P>0.05);两侧管倾角比较(t=0.532,P>0.05)。MRI可显示舌下神经池内段和管内段,但显示不出管外段。结论:MRI可同时显示舌下神经管及舌下神经,对病灶的评估更准确,有利于治疗计划的精确制定。     

颞骨岩乳突部X线摄影的几种改进方法

CT扫描尤其是高分辨率CT扫描能清晰显示耳部及其邻近组织的精细解剖结构，对耳部的先天畸形、外伤、各种中耳炎症及某些耳源性颅内并发症，如硬膜外脓肿，乙状窦周围脓肿、脑脓肿、以及肿瘤等都具有较高的诊断价值，所以已逐步取代颞骨岩部乳突部的传统X线摄影。但是我国目前仍有大量基层医院没有购置CT扫描机，颞骨岩乳突部X线摄影对于耳部某些疾病的诊断来说，仍然发挥重要作用。     

Persistent stapedial artery: CT findings

CT of a patient with conductive hearing loss showed a small vascular structure leaving the carotid canal and passing through the stapes to join the facial nerve canal. The small bony channel paralleled the anterior tympanic segment of the facial nerve, continuing beyond the geniculate ganglion into the middle cranial fossa. Otoendoscopic photography documented the presence of a persistent stapedial artery.     

The bony crescent sign--a new sign of facial nerve schwannoma.

Schwannomas of the facial nerve are rare slowly growing lesions that have a predilection for the geniculate ganglion. Radiological evaluation is important in their diagnosis and in the assessment of their extent. In our series of 4 cases the facial nerve schwannoma was seen on high resolution CT as a soft tissue mass bounded anteriorly by a thin rim of bone. This bony crescent sign is a previously undescribed sign of facial nerve schwannoma which appears on the basis of this small series to be strongly indicative of the presence of this tumour. Schwannomas are relatively uncommon intracranial tumours. They most commonly involve the acoustic nerve followed in frequency by the trigeminal nerve. Other cranial nerves are rarely involved. Facial nerve schwannomas occurring within the petrous temporal bone are very rare. Their diagnosis may be missed prospectively even when appropriate CT scans are performed. Even in retrospect the site of abnormality may be difficult to identify, especially if there is an associated middle ear mass such as a cholesteatoma. Lesions occurring in the petrous area are all rare. The differential diagnosis includes cholesterol granuloma, epidermoid, carotid aneurysm and, very rarely, primary and secondary bone tumours. We describe a new sign associated with facial nerve schwannoma on CT, that of a bony crescent. Recognition of this sign makes those tumours arising in the region of the geniculate ganglion easy to diagnose prospectively.     

面神经管膝状神经窝扩大:一种面神经管骨折的CT新征象

目的 探讨CT显示膝状神经窝扩大在面神经管骨折诊断中的价值。方法 对30例面神经管骨折患者行轴面和冠状面CT成像，以术中观察结果为准，评价膝状神经窝扩大与面神经管膝状神经窝骨折的相关性，比较轴面和冠状面图像对面神经管膝状神经窝扩大的显示情况。结果 术中发现面神经管膝状神经窝骨折30例，术前CT检查显示膝状神经窝骨折18例，术中发现膝状神经节肿胀30例，CT图像显示膝状神经窝扩大28例。CT检查及术中均显示膝状神经窝骨折、扩大18例，CT检查仅显示膝状神经窝扩大，未显示骨折12例。结论 外伤性面神经麻痹患者CT检查不能显示骨折线时，膝状神经窝扩大是诊断膝状神经窝骨折的重要依据。     

面神经瘤的CT和MRI诊断(附六例报告)

目的 探讨CT,MRI对面神经瘤的诊断价值,方法 回顾分析了6例经手术病理证实的面神经瘤CT,MRI表现,结果 6例面神经瘤中位于颞内段4例（迷路段1例,鼓室段2例,鼓室段＋乳突段1例）,颅,内脑池段,内听段及颞内段（迷路段＋鼓室段）1例,颞内段（鼓室段＋乳突段＿并颅外肋腺段1例,肿瘤的影像学表现与肿瘤的部位有关,CT影像上,颞内段面神经瘤显示受累段面神经管扩大,破坏;中耳腔和（或）乳突软组织肿块及膝状神经窝区内质破坏,如肿瘤扩展到中颅窝或肋腺也可一并显示,1例起源于内听道,桥脑小脑角区的面神经瘤,CT,MRI清楚地显示了桥脑小脑角区肿块,内听道扩大,迷路段面神经管扩大,以及扩展到膝状神经窝区的病灶。结论 CT和MRI能准确地描绘面神经瘤的受累情况,CT在显示骨破坏细节方面极佳,而增强MRI对肿瘤本身的显示优于CT。     

Epidermoidomas of the cerebellopontine angle and temporal bone: CT and MR aspects

Epidermoidomas were found in four locations within and adjacent to the temporal bone: cerebellopontine angle, petrous apex, facial geniculate ganglion region, and tympanic-mastoid cavity. Lesions in each of these locations presented different clinical and imaging characteristics. Cerebellopontine angle epidermoidomas were seen on computed tomography (CT) as low-attenuation masses in the posterior fossa. Petrous apex and geniculate ganglion region lesions destroyed and expanded the bone of their respective regions. Tympanic-mastoid cavity epidermoidomas were relatively nonspecific, soft-tissue masses. CT study of the brain and temporal bone was the single most informative imaging procedure in the preoperative evaluation of these lesions. Magnetic resonance images complemented CT scans for evaluation of the size and extent of the abnormality but were relatively nonspecific and did not allow preoperative differentiation of epidermoidomas from other temporal bone lesions.     

正常人面神经管垂直部与颈静脉窝距离的CT测量及其临床价值

目的：通过对正常人群面神经管垂直部至颈静脉窝之间水平距离的MSCT测量,得到国人该距离的正常值及其变异情况,并探讨其临床应用价值。方法：采用64层螺旋CT对4具干颅标本进行扫描,将锯开削面测量值与相同影像平面测量值对照后取得测量平面。以同样方法对随机入选无耳部疾患的118人行颌面部扫描面HRCT扫描。在MPR影像上测量面神经管垂直部至颈静脉窝之间的水平距离,并行统计学分析。结果：面神经管垂直部至颈静脉窝之间的距离：女性（5．29±2．44）mm,右侧（4．55±2．21）mm,左侧（6．04±2．45）mm;男性（5．54±2．58）mm,右侧（4．99±2．46）mm,左侧（6．09±2．61）mm;性别之间无统计学差异（P〉0．05）,而左、右侧之间有显著统计学差异（P〈0．05）。按年龄分组（≤18岁,19～35岁,36—60岁,〉60岁）,女性4组间测量值差异有统计学意义（P〈0．05）,组间两两比较〉60岁组与19～35岁组、36～60岁组间差异无统计学意义（P〉0．05）,其余组间差异有显著性（P〈0．05）;男性4组间测量值差异无统计学意义（P〉0．05）,组间两两比较≤18岁组与19—35岁组之间差异有统计学意义（P〈0．05）。不同年龄组间性别差异统计分析,≤18岁和19～35岁这两个年龄组男、女间测量值差异均有统计学意义。结论：研究获得的数据,可为耳鼻喉科、颅脑外科及显微外科手术术式的选择提供参考,也可以为解剖学的教学提供帮助。     

Skull-base foramina of the middle cranial fossa: reassessment of normal variation with high-resolution CT.

PURPOSETo evaluate by means of high-resolution CT the anatomic variations of the middle cranial fossa foramen.METHODSWe examined 123 CT studies of the temporal bone in patients with no evidence of disease that might alter foraminal anatomy. A checklist of known variants and suspected structures was used as each case was systematically examined for the presence or absence of these foramina; variations in size, shape, and location; and relationship of structures to each other. Inclusion criteria were established to eliminate error.RESULTSThe foramen rotundum had a constant appearance. We identified the inferior rotundal canal in 16% of patients and the lateral rotundal canal in 8%. The foramen of Vesalius was present, at least unilaterally, in 80% of our cases. Asymmetry of the foramen of Vesalius did not indicate disease in our patient group. We did not find an inverse relationship between the size of the foramen of Vesalius and that of the ipsilateral foramen ovale. We found variations in the size and shape of the foramen ovale and its confluence with the foramen spinosum (n = 2) and the foramen of Vesalius (n = 8). We did not find an inverse relationship between the size of the foramen ovale and that of the foramen spinosum. The canaliculus innominatus for the lesser superficial petrosal nerve was identified in 16.3% of our patients. Variations of the foramen spinosum that we found include a medial bony defect (26.8%) and absence (3.2%).CONCLUSIONAlthough it is unlikely that well-formed foramen will be misinterpreted as diseased, it is nonetheless important to recognize foraminal variants and associated neurovascular anatomy.     

Exploration of the facial nerve canal by high-resolution computed tomography: Anatomy and pathology

Summary A correlative study of the anatomy and the radiological appearance of the intratemporal course of the facial nerve canal was carried out. Isolated temporal bones and temporal bones of cadaver heads were examined with thin-section high-resolution computed tomography in the axial, coronal and Stenvers' projections, then sectioned with a microtome and the radiologic and anatomic images were correlated. Appropriate projections for visualization of each segment of the facial nerve canal on CT were established. The high-resolution CT Stenvers' projection proved very useful for visualization of the geniculate ganglion fossa, as also of the tympanic and mastoid segments in their full length. The high-resolution CT appearance of lesions characteristic for each segment of the facial nerve canal are presented.     

POU3F4基因突变致耳聋的HRCT和MRI表现

目的：探讨POU3F4基因突变致耳聋患儿的颞骨高分辨率CT（high resolution CT ,HRCT）及MRI表现特征,提高对该病的认识。方法结合文献回顾性分析5例（10耳）经临床诊断POU3F4基因突变致耳聋患儿的影像学资料。结果5例（10耳）双侧内听道底“球茎状”扩大,以下壁扩大明显;5例（10耳）内听道底与耳蜗底圈骨性间隔缺失;4例（7耳）蜗神经孔扩大;5例（10耳）蜗轴缺失;2例（2耳）前庭水管扩大;2例（4耳）半规管发育异常;1例（2耳）Mondini畸形;1例（2耳）前庭扩大;4例（4耳）颈静脉窝高位。结论 POU3F4基因突变致耳聋的影像学表现具有特征性,对本病诊断及指导手术有重要价值。