多层螺旋CT对颈内动脉海绵窦瘘的诊断价值

目的探讨多层螺旋CT(MSCT)对颈内动脉海绵窦瘘(CCF)的诊断价值。方法回顾性分析12例具有完整临床资料并经临床证实的CCF患者的CT资料。均行颅脑CT平扫及血管成像(CTA)检查,采用容积再现(VR)、多平面重建(MPR)、多曲面重建(MCPR)、最大密度投影(MIP)技术处理图像。结果 4例为严重的复合性骨折,3例为颅骨骨折伴有脑挫裂伤,2例有颅骨、颅底骨折,3例无明显外伤;所有病例均有不同程度的眼球突出,眼上静脉迂曲扩张,7例眶内结构模糊、肿胀。患侧海绵窦均有扩大并提前显影,扩张呈典型多结节样改变7例,伴显著血管迂曲成团4例,轻度扩张伴血管迂曲1例。MPR薄层清晰显示12例颈内动脉或分支与海绵窦沟通处瘘口,MPR通过不同方位精确显示。VR通过带骨及减影后处理图像,从整体显示颈内动脉、海绵窦及眼静脉情况及相互关系。结论 MSCT对CCF的诊断及介入栓塞术后疗效观察有重要价值,可以作为CCF首选检查及诊断方法。

Diagnostic value of multi-slice spiral CT for carotid-cavernous fistula

Objective To discuss the value of multi-slice spiral CT(MSCT)in the diagnosis of carotid-cavernous fistula(CCF).Methods CT data of 12 patients with CCF,who owned complete clinical material and were proved by clinic,were reviewed and analyzed.They were examined both with routine CT scanning and CT angiography(CTA),and the images postprocessing including volume rendering(VR),multiplanar(MPR),multi-curved planar reconstruction(MCPR) and maximum intensity projection(MIP) were performed.Results The bone window showed that serious compound fractures were seen in 4 cases;skull fracture with cerebral contusion in 3 cases;skull fracture and basicranial fracture in 2 cases.Exophthalmus in different degree and tortuous dilatational superior ophthalmic vein were seen in all cases,vague and swelling orbital structure was seen in 7 cases.All cavernous sinuses in affected side had enlarging and advance developing;expansion presenting typical nodular change was seen in 7 cases;significant vascular tortuosity as a group in 4 cases;mild expansion with vascular tortuosity in 1 case.MPR of thin layer clearly showed the fistula orifice in communication site of internal carotid artery or its branch to the cavernous sinus in all cases,and MPR could accurately display different orientation.Through the bone and the subtraction image postprocessing,VR could entirely display images of internal carotid artery,cavernous sinus and ophthalmic vein and their relationship.Conclusions MSCT has a great value in the diagnosis of CCF and the observation of therapeutic effect after interventional therapy,and it can be used as the preferred examination and diagnostic method of CCF.