颈动脉分叉部的三维CT血管成像解剖测量

背景：解剖测量是临床医学的基础，可为临床影像学诊断与外科手术提供依据与参考。利用三维CT血管成像技术进行相关解剖测量具有明显的技术优势与很好的应用前景。 目的：应用64排螺旋CT血管成像对颈动脉分叉部的形态结构进行测量，为相关研究提供解剖基础。 方法：查阅2008年6月至2010年6月于厦门大学附属中山医院影像科行头颈部64排螺旋CT血管成像受检者的扫描图像，随机选取颈动脉分叉部无明显病变者92例。其中男45例，女47例；≤40岁者40例，> 40岁者52例。利用其断面图像进行三维成像处理，获得满意的三维图像后，对颈动脉分叉部相关结构进行解剖学测量。 结果与结论：三维图像可清晰显示颈动脉分叉部结构，实现其结构的单独和多结构、多方向观察及测量。测量结果显示受试者颈动脉分叉角为(43.5±12.3)°，颈总动脉远端内径(6.83±0.65) mm，颈内动脉膨大区近端内径(7.25±1.04) mm，颈内动脉膨大区最大内径(8.15±1.35) mm，颈内动脉膨大区远端内径(5.03± 0.55) mm，颈外动脉内径(4.22±0.60) mm。与≤40岁组比较，>40岁组颈动脉分叉角度、颈内动脉膨大区近端内径、颈内动脉膨大区最大内径、颈内动脉膨大区远端内径均明显粗大，颈外动脉内径明显细小(P < 0.05)，而颈总动脉内径差异无显著性意义(P > 0.05)。与男性组比较，女性组颈动脉分叉部各测量指标均显著细小(P < 0.05)。左、右侧组测量值比较，除颈动脉分叉角左侧明显大于右侧外，其他测量指标差异均无显著性意义(P > 0.05)。三维CT可客观、准确测量颈动脉分叉部相关解剖值，具有个体化特征，可为相关应用解剖、疾病诊断及介入或手术治疗提供客观依据。

Three-dimensional CT angiography for anatomic measurements of the carotid artery bifurcation

BACKGROUND: Anatomic measurement is the basis of clinical medicines. It can provide basis and reference for clinical diagnosis and surgical operation. The anatomical measurement with 64-spiral CT angiography has the obvious technical superiority and good application prospect. OBJECTIVE: To measure the anatomical structure of the carotid artery bifurcation with 64-spiral CT angiography, and to provide anatomic basis for relevant researches.  METHODS: A total of 92 subjects, who underwent 64-spiral CT angiography in head and neck without any pathology of carotid artery bifurcation from June 2008 to June 2010, were selected from Department of Radiology, Zhongshan Hospital Xiamen University. There were 40 male cases (≤40 years old) and 52 female cases (> 40 years old). The cross-sectional images were processed with three-dimensional imaging to obtain the three-dimensional image and to measure the anatomical structure of the carotid artery bifurcation. RESULTS AND CONCLUSION: The three-dimensional images could clearly display the structure of carotid artery bifurcation and could achieve the mono- or multi-structure and multi-directional observation of structure. The measurement results showed the carotid artery bifurcation angle was (43.5±12.3)°, the distal inner diameter of the common carotid artery was (6.83±0.65) mm, the proximal inner diameter of the internal carotid artery enlargement area was (7.25±1.04) mm, the width of the internal carotid artery enlargement area was    (8.15±1.35) mm, the distal inner diameter of the internal carotid artery enlargement area was (5.03±0.55) mm, and the inner diameter of the external carotid artery was (4.22±0.60) mm. Compared with the ≤ 40 years old group, the carotid artery bifurcation angle, proximal inner diameter of the internal carotid artery enlargement area, width of the internal carotid artery enlargement area and the distal inner diameter of the internal carotid artery enlargement area in the > 40 years old group were increased significantly, while the inner diameter of the external carotid artery was small (P < 0.05), and there was no significant difference in inner diameter of common carotid artery between two groups (P > 0.05). Compared with the male group, the measurement indexes of carotid artery bifurcation in the female group were significantly smaller (P < 0.05). The carotid artery bifurcation angle on the left side was bigger than that on the right side, and there were no significant differences in the other measurement indexes of carotid artery bifurcation between left and right group (P > 0.05). Three-dimensional CT image can objectively and accurately measure the anatomical values of carotid artery bifurcation. It has individual characteristics that can provide the objective basis for applied anatomy, disease diagnosis and surgery treatment.