磁共振成像在脉管性疾病诊断中的应用

脉管性疾病是口腔颌面部比较常见的病变,在磁共振成像中有特征性的表现。由于磁共振成像具有优越的软组织对比率,特别是高场强的磁共振对显示脉管畸形和血性产物具有高敏感性,因此可以对该疾病进行更好的分类诊断和治疗。本文就磁共振成像在脉管性疾病诊断中的应用作一综述。     

磁共振成像在脉管性疾病诊断中的应用

脉管性疾病是口腔颌面部比较常见的病变，在磁共振成像中有特征性的表现。由于磁共振成像具有优越的软组织对比率，特别是高场强的磁共振对显示脉管畸形和血性产物具有高敏感性，因此可以对该疾病进行更好的分类诊断和治疗。本文就磁共振成像在脉管性疾病诊断中的应用作一综述。     

聚桂醇硬化剂治疗口腔颌面部血管瘤和脉管畸形专家共识

[提要] 血管瘤和脉管畸形是一组复杂的来源于脉管系统的疾病。婴幼儿血管瘤以内皮细胞增殖为特征,是最常见的婴幼儿良性肿瘤。脉管畸形是胚胎发育时期脉管系统发育异常所致,超过60%的脉管畸形发生于头颈部。血管瘤和脉管畸形可能引起严重的面部畸形和功能障碍,硬化治疗是其常用的治疗方法。过去常用的硬化剂有平阳霉素、博来霉素、无水乙醇、十四烷基硫酸钠、OK-432、强力霉素、鱼肝油酸钠等。近年来,国产硬化剂聚桂醇被广泛用于血管瘤和脉管畸形的治疗,泡沫化硬化治疗技术的发展推动了其临床应用,其治疗有效性和安全性已被大量研究所证实。为了进一步规范该技术的应用,我们组织专家制定了该专家共识。今后将依据最新出版的文献和临床治疗经验及时更新,为该领域的临床医师提供指导。     

声弹性成像诊断淋巴结转移癌的初步经验

该文旨在研究声弹性成像在鉴别甲状腺癌和下咽癌患者颈部淋巴结良、恶性的精确度。应用前瞻性研究方法，对141个颈部淋巴结（43例患者）进行检测，其中60个为转移性、81个为非转移性淋巴结。对诊断为甲状腺癌或下咽癌并准备接受手术的患者行颈部灰阶超声、多普勒和声弹性成像检查。在灰阶超声、多普勒检测的过程中，记录淋巴结的影像学特点，如淋巴结短轴直径、短长轴比、内部回声、钙化和血流特点。     

聚多卡醇治疗血管瘤及脉管畸形研究进展

血管瘤与脉管畸形是临床常见病,头颈部发病率约40%~60%,不仅造成颜面部畸形,影响美观,还可影响吞咽、呼吸等生理功能,严重者可能因感染、溃疡、压迫呼吸道等危及生命。复杂血管瘤与脉管畸形的治疗,一直是临床上面临的难题与挑战,目前主要治疗方法有手术切除、硬化治疗、激光治疗、介入治疗等,其中硬化治疗不仅在静脉畸形、淋巴管畸形等疾病中得到广泛应用,而且逐渐应用于血管瘤、化脓性肉芽肿等疾病的治疗。作为硬化治疗的药物—硬化剂,聚多卡醇在临床上的应用越来越广泛。本文从硬化原理、临床应用、安全性及有效性等方面,对聚多卡醇治疗血管瘤及脉管畸形的相关背景及研究进展做一综述。     

超声成像技术在口腔医学中的应用

随着超声诊断仪器和诊断技术的迅速发展,超声成像技术已成为检测口颌系统各组织形态结构及病理改变,实时动态记录肌肉功能活动过程的有效方法,本文对超声成像技术在口腔软硬组织疾病、骨组织疾病、颞下颌关节疾病、涎腺疾病及错(牙合)畸形中的应用进行综述。     

颞下颌关节MRI技术的应用和进展

颞下颌关节疾病是较为常见的头颈部疾病之一。目前,磁共振成像(magnetic resonance imaging,MRI)已成为检查颞下颌关节的首选方法之一。本文简要介绍了应用于颞下颌关节解剖和疾病诊断的常规及特殊MRI方法(包括增强MRI、MR关节造影、动态MRI和三维MRI),并简述了这些技术的研究进展状况。     

血管瘤与脉管畸形的鉴别诊断研究进展

血管瘤和脉管畸形是婴幼儿比较常见的血管疾病,过去由于对两者的分类和诊断比较混乱,给临床治疗带来诸多不便,也给患者增加了不必要的痛苦。1982年,Mulliken和Glowacki提出了脉管性疾病的生物学新分类,将血管瘤和脉管畸形归类为2种性质完全不同的病变。血管瘤是多发于婴幼儿的良性肿瘤,大多数可以自行消退;而脉管畸形是血管结构的发育异常,不会自行消退,随患者的生长发育持续增长。因此,对于确诊的脉管畸形,应尽早采取干预措施。这就要求临床医师能及时、准确、有效地鉴别诊断血管瘤和脉管畸形。本文就目前关于血管瘤和脉管畸形的鉴别诊断进展作一综述。     

彩色多普勒超声在颌面部血管畸形诊断、分类及疗效评价中的应用

目的：评价彩色多普勒超声在颌面部血管畸形诊断、分类及疗效评价中的作用。方法：对110例颌面部血管畸形进行二维及彩色多普勒超声检查,根据超声特点,将其分为高流速病变和低流速病变。对DSA检查证实为高流速血管畸形者,常规行供血动脉栓塞治疗。所有数据采用SPSS10.0软件包进行t检验和χ2检验。结果：110例血管畸形中,67例二维显示形态不规则的网格状混合性回声,部分伴强回声静脉石,多谱勒显示彩色血流稀少或较丰富,动脉收缩峰血流速度（PSV）平均为（28.53±8.1）cm/s,超声诊断为低流速血管畸形。43例显示72条供血动脉增粗,病变内血流信号极丰富,PSV平均为（144.53±38.9）cm/s,呈低阻动脉型频谱,超声诊断为高流速血管畸形。经DSA检查或术后病理证实,高流速和低流速病变的超声诊断正确率分别为100%和97.02%。43例高流速血管畸形的供血动脉全部行栓塞治疗,栓塞前、后的PSV分别为（144.53±38.9）cm/s和（86.2±36.3）cm/s,阻力指数（RI）分别为（0.55±0.04）和（0.80±0.05）（P均〈0.01）。结论：彩色多普勒超声检查能对血管畸形病变做出较正确的诊断和分类,对临床选择合理的治疗方案及动脉栓塞术后疗效评价均具有重要的指导意义。     

超声成像技术在口腔医学中的应用

随着超声诊断仪器和技术的迅速发展，超声成像技术已成为检测口颌系统各组织形态结构及病理改变，实时动态记录肌肉功能活动过程的有效方法，本文对超声成像技术在口腔软硬组织疾病、骨组织疾病、颞下凳关节疾病、涎腺疾病及错He畸形中的应用进行综述。     

Characterization of maxillofacial soft tissue vascular anomalies by ultrasound and color Doppler imaging: an adjuvant to computed tomography and magnetic resonance imaging.

PURPOSE: The special imaging and physical properties of ultrasound and color Doppler offer opportunity for continued investigation in oral and maxillofacial surgery. This study prospectively investigated ultrasound and color Doppler in addition to computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of several vascular or suspected vascular anomalies and assesses the value of ultrasound and color Doppler in their diagnoses. PATIENTS AND METHODS: Six patients with vascular or suspected vascular anomalies seen between 1997 and 1999 composed the study group. All patients were clinically evaluated, imaged by CT with contrast and/or MRI with contrast, ultrasound, and Doppler (including color, spectral, and power). Ultrasound studies were performed in the presence of the referring oral and maxillofacial surgeons to provide consultation on anatomy and differential diagnosis as well as to witness the dynamic study. Three patients were further studied by angiography. The Mulliken/Glowacki classification (Plast Reconstr Surg 69:412, 1982) and designations and the Jackson et al modification (Plast Reconstr Surg 91:1216, 1993) are used in this study. RESULTS: A spectrum of lesions emerged in this small case series. Detailed clinical and imaging findings and a summary of diagnostic impressions allowed general and specific observations and permitted assessment of the value of ultrasound and color Doppler in the diagnosis of these lesions. The diagnostic accuracy of ultrasound and Doppler was equal to or better than that of CT and/or MRI in 4 of 6 cases. In the other 2 cases ultrasound did not specifically diagnose the lesions but did allow assessment of vascularity. In one of these cases the correct diagnosis was made by a combination of CT and angiography, and in the other the diagnosis was made by nonenhanced MRI. An ancillary study showed that the combination of nonenhanced MRI with ultrasound and Doppler provides more information than contrast-enhanced MRI alone and is more cost effective. CONCLUSIONS: 1) A single imaging modality is frequently unable to provide sufficient diagnostic information to allow confident clinical management of a vascular malformation. 2) A team approach and conferencing between imaging specialists and clinicians promote better diagnosis and management. 3) Nonenhanced MRI with ultrasound/color Doppler can be substituted for enhanced MRI to provide the best diagnostic information and at reduced cost. 4) Ultrasound/color Doppler is an important adjuvant to CT and MRI in the diagnosis of vascular or suspected vascular anomalies.     

Salivary gland lipomas: ultrasonographic and magnetic resonance imaging

To facilitate a diagnosis of a lipoma, specific imaging is needed such as ultrasound or magnetic resonance imaging (MRI). Two male patients exhibiting a soft tissue tumor in the salivary gland area were examined using sonography and MRI. Final diagnosis was identified by excision biopsy. Ultrasound showed a hypoechoic, feathered, mostly ovoid structure. Color Doppler sonography does not detect any signals besides in cases of angiolipoma. This is accompanied by vessels and does not show the typical feathered structure. With MRI, it is possible to confirm the diagnosis by visualization of fat-equivalent intensity values. Diagnosing soft tissue swelling in the salivary gland, clinical examination and an ultrasound or MRI scan are recommended.     

颏下岛状肌皮瓣血管的解剖与超声评价

目的探讨应用彩色多普勒超声检测颏下岛状肌皮瓣(submental musculocutaneous island flap),SMIF血管的显示价值,为SMIF的临床应用提供影像学信息。方法选取拟行SMIF移植的患者35例,术前应用彩色多普勒超声测量双侧颏下动脉起始处距离下颌骨下缘、下颌角及颏中点的距离;在超声下探测血管走行,同时行面前静脉、颌外动脉体表标记,并与术中所见血管解剖情况进行对比。结果 35例患者术前超声检测与术中所见符合率为100%;经超声探测出面前静脉的6种走行方式,颌外动脉的4种走行方式;测得左侧颏下动脉起始处距离下颌骨下缘的距离为(0.53±0.09)cm,距离下颌角的距离为(1.82±0.33)cm,距离颏中点的距离为(6.08±0.52)cm;右侧颏下动脉起始处距离下颌骨下缘的距离为(0.52±0.09)cm,距离下颌角的距离为(1.75±0.29)cm,距离颏中点的距离为(6.12±0.63)cm。结论彩色多普勒超声可以直观地显示SMIF血管的走行、分布及变异情况,从而为SMIF的制备提供影像学依据。     

应用高频彩超血流显像和能量图诊断腮腺肿瘤

评价高频彩色多普勒在诊断腮腺肿瘤中的作用。方法：采用具备彩色多普勒血流显像（ＣＤＦＩ）和彩色多普勒能量图技术功能的彩色多普勒电脑声像仪对３６例腮腺病变进行二维超声病变进行二维超声定位下良,恶性肿瘤周边及内部血流信号,频谱测值和ＣＤＥ图像观察。     

Use of ultrasound, color Doppler imaging and radiography to monitor periapical healing after endodontic surgery

This study evaluated the effectiveness of ultrasound, color Doppler imaging and conventional radiography in monitoring the post-surgical healing of periapical lesions of endodontic origin. Fifteen patients who underwent periapical surgery for endodontic pathology were randomly selected. In all patients, periapical lesions were evaluated preoperatively using ultrasound, color Doppler imaging and conventional radiography, to analyze characteristics such as size, shape and dimensions. On radiographic evaluation, dimensions were measured in the superoinferior and mesiodistal direction using image-analysis software. Ultrasound evaluation was used to measure the changes in shape and dimensions on the anteroposterior, superoinferior, and mesiodistal planes. Color Doppler imaging was used to detect the blood-flow velocity. Postoperative healing was monitored in all patients at 1 week and 6 months by using ultrasound and color Doppler imaging, together with conventional radiography. The findings were then analyzed to evaluate the effectiveness of the 3 imaging techniques. At 6 months, ultrasound and color Doppler imaging were significantly better than conventional radiography in detecting changes in the healing of hard tissue at the surgical site (P < 0.004). This study demonstrates that ultrasound and color Doppler imaging have the potential to supplement conventional radiography in monitoring the post-surgical healing of periapical lesions of endodontic origin.     

Identification of cutaneous perforators for microvascular surgery using hyperspectral technique – A feasibility study on the antero-lateral thigh

Aim of the study was to compare perforator vessel location using color-coded Doppler ultrasound and hyperspectral imaging in the area of the antero-lateral thigh. In a cross-sectional case-control study, the bilateral antero-lateral thigh region was examined for perforator vessel location via color-coded Doppler ultrasound (control) and hyperspectral imaging (test). For hyperspectral imaging, all measurements were conducted without cooling (T0) and after 1 (T1), 2 (T2) and 3 min (T3) of cooling. Additionally, in the reperfusion period after cooling, hyperspectral imaging was conducted at 1, 2 and 3 min (T4/T5/T6). Results from color-coded Doppler ultrasound and hyperspectral imaging were matched at all time points (T0–T6). In total, 71/73 perforator vessel locations could be matched (sensitivity: 97%). Matching of color-coded Doppler ultrasound and hyperspectral imaging was significantly influenced by the cooling protocol and the highest matching values were seen at T3 (3 min cooling; 60 perforator vessels) and T4 (3 min cooling & 1 min reperfusion; 62 perforator vessels) without significant differences (sensitivity 98%; p = 0.9). There were significant differences between T4 and T0, T1 (both p < 0.001), T5 (p = 0.045) and T6 (p = 0.012). For clinical proof of concept, a patient case using a free antero-lateral thigh flap for reconstruction of a facial defect after perforator vessel identification via color-coded Doppler ultrasound and hyperspectral imaging (3 min cooling & 1 min reperfusion) was carried out successfully. In conclusion, hyperspectral imaging potentially offers an additional opportunity for non-invasive, user-independent perforator-site assessment if prior cooling of the site is conducted.     

彩色超声多普勒、DSA在颈动脉体瘤和神经鞘瘤诊断与鉴别诊断中的应用

目的：总结彩色超声多普勒（CDFI）与数字减影血管造影（DSA）在颈动脉体瘤与神经鞘瘤诊断与鉴别诊断中的影像学特征。方法：对1990年1月～2005年12月收治的8例颈动脉体瘤和14例神经鞘瘤患者进行CDFI与DSA检查，对其影像学特征进行比较。结果：颈动脉体瘤的CDFI和DSA特征为：颈总动脉分权处单发性肿块，并与其紧密相连，瘤体内血流极为丰富，瘤体使颈外动脉向前内移位、颈内动脉向后外移位，颈内、外动脉分权角度增大明显，DSA呈高脚杯状改变；神经鞘瘤紧邻颈动脉，颈总动脉分权处角度无改变，瘤体内血流信号不丰富。瘤体使颈动脉向前、外移位。结论：颈动脉体瘤与神经鞘瘤均有明确的影像学特征，CDFI及DSA在两者的诊断与鉴别诊断方面具有重要的临床实用价值。     

MRI结合动脉造影检查在头颈部血管畸形中的应用价值

目的：建立头颈部血管畸形合理的影像检查流程。方法：采用磁共振（ＭＲＩ）检查４５例头颈部血管畸形患者。其中１５例还进行了增强ＣＴ检查,１５例进行了动脉造影（ＤＳＡ）检查。比较这３种检查手段的影像特征。结果：ＭＲＩ对各种头颈部血管畸形检查都有意义,多于其它任何一种血管影像方式可提供的病变信息。但在显示高流速及混合性血管畸形的供应动脉及回流静脉方面,ＤｓＡ明显优于ＭＲＩ。结论：以ＭＲＩ作为头颈部血管畸形的最初检查手段,在高流速及混合性血管畸形中结合ＤＳＡ。