颈动脉海绵窦瘘的影像学诊断

目的探讨超声、CT及MRI检查对颈动脉海绵窦瘘诊断的意义。方法对1997至2004年临床资料完整并行超声、CT及MRI检查的58例颈动脉海绵窦瘘患者进行回顾性分析,详细观察B超、彩色多普勒超声、CT及MRI检查结果,总结颈动脉海绵窦瘘的影像学表现以资诊断。结果颈动脉海绵窦瘘的影像学表现主要包括眼上静脉扩张、海绵窦膨大、眼球突出及眼外肌增粗。眼上静脉扩张是颈动脉海绵窦瘘最具特异性的影像学征象,分别为：B超发现51例,呈管状无回声腔,有与心脏同步的搏动;彩色多普勒发现49例,显示眼上静脉内充满反向流动的动脉化血流;CT检查发现58例,显示扩张的眼上静脉呈从前内向后外的梭形血管影;MRI检查发现眼上静脉扩张58例,信号特征为在T1WI和T2WI均为流空的无信号血管影。海绵窦膨大是另一特异性征象,分别为：CT检查发现41例,显示膨大的海绵窦呈高密度影;MRI发现37例海绵窦膨大,显示在T1WI和T2WI上均呈流空的无信号影。结论颈动脉海绵窦瘘具有独特的影像学表现,B超、彩色多普勒、CT及MRI检查均能清晰呈现,并且对颈动脉海绵窦瘘的临床诊断和鉴别诊断有重要意义。

Imaging diagnosis of carotid-cavernous fistula

OBJECTIVE: To evaluate the diagnostic value of ultrasound, CT and MRI in carotid-cavernous fistula. METHODS: A retrospective analysis was made of 58 patients with carotid-cavernous fistula who had complete clinical data from 1997-2004. The imaging findings of B-ultrasound, color Doppler ultrasonography, CT and MRI were analyzed and summarized for the diagnosis of carotid-cavernous fistula. RESULTS: The imaging findings of carotid-cavernous fistula included of dilation of superior ophthalmic vein, enlargement of cavernous sinus, proptosis, and thickness of extraocular muscle. Dilation of superior ophthalmic vein was the specific imaging sign of carotid-cavernous fistula. This was presented in 51 cases by B-ultrasound which showed one tubular no-echo space; presented in 49 patients by color Doppler imaging which showed obvious dilated superior ophthalmic vein with artery blood flow; presented in 58 cases by CT scan which showed fusiform vascular imaging from anterior-inside to posterior-outside; and presented in 58 cases by MRI with the characteristic manifestation: flow void signal of dilated superior ophthalmic vein on T(1)WI and T(2)WI scan, and on the Gd-enhanced MRI. Another specific imaging sign was enlargement of cavernous sinus. This sign was presented in 41 cases by CT with high density imaging and presented in 37 cases by MRI, which showed flow void signal on T(1)WI and T(2)WI scan. CONCLUSION: Carotid-cavernous fistula has specific imaging signs which can be found by B-ultrasound, color Doppler ultrasonography, CT and MRI. These imaging signs are important to clinical diagnosis and different diagnosis of carotid-cavernous fistula.