寰枢关节前后位张口投照测量方法的改进

寰椎、枢椎和寰枢关节的前后位张口投照,要求将患者的上领门齿咬合面至乳突尖部联线与暗盒垂直。但不少患者乳突尖部不明显,尤其是肥胖者及乳突发育较小者,定位有困难,联线的误差度较大,影响照片的质量,其结果寰枢部不是被牙齿重叠就是被枕骨重叠。我们经过反复摸索与测量,求得了一条新的联线,即上颌门齿咬合面至耳垂下缘的联线(见线条图),它与至乳突尖部的联线基本相一致,完全可以代替使用。由于耳垂下缘轮廓分明,容易测量,操作方便,应用这条联线投照,既部位显示清     

环枢椎张口位CR投照位置改进法

第1—2颈椎张口位照片用于观察寰椎与枢推正位骨折及脱位等病变。常规第1—2颈椎照片枢惟齿状突显示经常有小部分与枕骨或上颌切牙重叠，所显示的影像效果往往不满意。我们经过摸索与实践，在第1—2颈椎张口位摄影位置上略加改变后，摄影发现枢椎齿状突显示清晰，无重叠影像，摄影效果满意。     

环枢关节张口位摄影体会

颈部外伤的患者，经常需拍张口位，以观察脱位及骨折情况，经过长期摸索，总结了近30例病例，找出一套适合于诊断环枢外伤或由于上颌门齿和枕骨重叠，不能清晰显示环枢椎的摄影方法。     

枢椎齿状突摄影体位的改进

枢椎齿状突张口位投照常受患者张口困难的影响,容易与上颌门齿或枕骨粗隆重叠而显示不佳.据了解在大医院其已完全被CT扫描所取代.笔者在基层工作中根据齿状突周围解剖关系,利用X射线投照原理对枢椎齿状突摄影体位进行改进.通过对18例患者图像分析,发现患者的年龄与体型对其影响有限.而对颌面部外伤致张口困难者尤为重要,且效果较好,现介绍如下.     

闭口位投照寰枢关节法

寰枢关节投照，我们常规采取颈椎张口位。但在外伤（如颢颌关节外伤）等情况下，患者由于疼痛等原因，无法很好配合。因此，不能提供准确影像的X线片。笔者在实际工作中摸索出一种闭口位投照寰枢关节法。特介绍如下，以供同行参考。     

DR全颈椎正位摄片方法的改进

目的分析改进数字化X射线摄影投照全颈椎正位片的方法。方法选择50例患者分别行数字化X射线摄影投照全颈椎张口正位和全颈椎常规正位进行比较。结果50例患者中，数字化X射线摄影全颈椎张口正位40例可清楚显示寰枢关节，50例均可清晰显示下颌骨和第3～7颈椎；数字化x射线摄影全颈椎常规正位21例可清楚显示寰枢关节，46例可清晰显示下颌骨，48例可清晰显示第3～7颈椎。结论全颈椎张口正位是数字化x射线摄影投照全颈椎正位相对满意的方法。     

喉咽、食管入口的解剖学观测对高位食管内支架置入的临床意义

目的对喉咽、食管入口进行解剖学观测,为介入放射学置入食管内支架治疗高位食管疾病提供解剖学依据。方法180名健康体检志愿者在胃肠造影机下口服钡剂进行直立仰头位、低头位咽腔和食管造影;将X线片上颈椎体平分三等份、椎间盘一份,记录梨状隐窝下极对应的颈椎椎体位置,使用两脚规和游标卡尺测量梨状隐窝下极与C5下缘基线的距离;测量61具尸体标本梨状隐窝下极与环状软骨板下缘之间的距离。结果①梨状隐窝下极在仰头位和低头位时活动度平均为2．0cm(相当于5个1／3颈椎高度);②梨状隐窝下极与环状软骨板下缘之问距离平均2．0cm。结论以梨状隐窝下极定位法放置高位食管内支架比颈椎定位法更加准确、合理。     

寰枢关节退变性骨关节病的影像学表现及与临床的相关性

目的　探讨寰枢关节退变性骨关节病 (AAOA)的影像学表现及与临床的相关性。方法　对 164例主要接受头颅CT检查病人的寰枢 (AA)关节行CT扫描 ,部分加摄X线张口位片。结果　AAOA的影像表现为关节间隙变窄、骨赘及关节周围钙化。AA外侧关节退变与枕颈区痛有相关性。结论　CT较X线能更好地显示AAOA的病理改变 ,对于有单侧枕颈区痛的 5 0岁以上患者 ,应考虑是否有AA外侧关节骨关节病     

儿童齿状突的发育程度

作者分析了508例(男310例、女198例)3～18.9岁正常儿童的颈椎片,以确定儿童齿状突的正常发育程度及其与环椎前弓的关系。通过两种测量法对齿状突进行评价:1.测量枢椎关节块上缘至齿状突尖的高度,是为齿状突总高度;2.从环椎前弓上缘至后弓上缘作一连线,测量齿状突尖至此线的距离,称此测量值为齿状突“低位”值,高于此线为正值,低于此线为负值。为避免后伸位可能形成的齿状突发育不全的假象,应于中间位时摄颈椎侧位片。测量结果作了统计学分析。分析表明:齿状突高度随年龄增加而增高,齿状突低位值从8岁以下儿童的明显负值在年龄更大的儿童中变成了正值。除15～18.9岁年龄组中女性齿状突高度小于男性(P<0,001)外,其余各年龄组男女间无显著     

颈椎关节突关节摄影位置的研究

目的研究一种能够显示颈椎上、下关节突及关节突关节的最佳摄影位置。方法测量63例正常人颈椎关节突关节(第3~7颈椎)CT横断扫描片(920个有效数据),在颈椎关节突关节CT片上做椎体前后缘中点连线的延长线和颈椎上关节突关节面两端点连线的延长线,两直线相交所形成的夹角即人体矢状面与颈椎关节突关节的角度,称颈椎关节突关节角。结果颈椎关节突关节角为70°~75,°经统计学处理,颈椎的关节突关节在不同性别、不同椎体、不同侧别之间无明显差异。在摄影时,使人体冠状面与胶片成70°~75°摄片,此时关节突关节与胶片垂直,与中心线平行,可得到清晰的关节突关节影像,此摄影位置称颈椎关节突关节位。结论颈椎关节突关节位能清晰显示颈椎上、下关节突及关节突关节间隙。     

腰椎退变性(假性)滑脱的CT诊断与鉴别诊断

目的研究腰椎退变性滑脱的CT特征,使之与腰椎峡部裂引起的真性滑脱鉴别。方法对80例无腰椎外伤史和腰椎椎弓峡部裂史腰椎退变性滑脱的CT资料作回顾性分析。CT扫描范围从滑脱椎体椎弓开始至下位椎体上缘,所扫层面与椎间盘平行。结果 CT扫描有以下特征:①椎间盘退行性改变。②椎骨和椎小关节退行性改变,腰椎椎体边缘骨质增生及腰椎骨质疏松,椎小关节面增生硬化、关节面下囊变、碎裂、关节间隙变窄或不对称和关节囊钙化;滑脱腰椎椎弓完整,椎体及附件整体向前(后)移位,向前滑脱时,滑脱椎体下关节突向前移位,其前缘几乎与下位椎体上椎小关节突前缘相平或超出下位椎体上椎小关节突前缘,关节方向向矢状方向转化。③椎管、椎间孔和侧隐窝狭窄。④终板双重轮廓。结论腰椎退变性滑脱有其CT特征,能与腰椎峡部裂引起的真性滑脱鉴别。     

Age estimation from pulp/tooth area ratio in maxillary incisors among Egyptians using dental radiographic images

Age estimation from dental radiographs is a non-destructive, simple method to obtain information. The aim of this study was to determine the reliability of age estimation from Egyptians' incisors radiographs. 144 periapical radiographs of maxillary (central & lateral) incisors (both sexes) aged 12-60 were used. Digital camera was used to image the radiographs. Images were computed and pulp/tooth area ratios were determined by AutoCAD Program. Data were subjected to correlation and regression analysis which showed statistically significant correlation (r?=?0.23 &P?=?0.006 for maxillary central incisors and r?=?-0.2 &P?=?0.05 for maxillary lateral incisors) between age and pulp tooth area ratio. Linear regression equations were determined separately for both central and lateral incisors along with the corresponding Standard Error of Estimate, which ranged from 1.2 to 5.08 years. Consequently, it was concluded that pulp/tooth area ratios of incisors are reliable for estimation of age among Egyptians in forensic work.     

Dynamic close-mouth view radiograph method for the diagnosis of lateral dynamic instability of the atlantoaxial joint

The purpose of the current study is to establish the dynamic close-mouth view radiograph method. Seven healthy volunteers were enrolled. Dynamic open-mouth and close-mouth view radiographs were obtained. The odontoid lateral mass interval and the dynamic atlantodental lateral shift (ADLS) were measured. The ADLS was 9.4±5.3% by the close-mouth view, showing a significantly greater percentage than that of 5.3±4.0% by the open-mouth view. The dynamic close-mouth view can be useful for diagnosis of atlantoaxial lateral instability.     

The craniocervical venous system in relation to cerebral venous drainage

BACKGROUND AND PURPOSE: Passing from the supine to the upright position favors cerebral venous outflow into vertebral venous systems rather than into the internal jugular veins. We sought to determine venous connections between dural venous sinuses of the posterior cranial fossa and craniocervical vertebral venous systems. METHODS: Corrosion casts of the cranial and cervical venous system were obtained from 12 fresh human cadavers, and anatomic confirmation was made by dissection of three previously injected fresh human specimens. MR venography was performed to provide radiologic correlation. RESULTS: The lateral, posterior, and anterior condylar veins and the mastoid and occipital emissary veins were found to represent the venous connections between the dural venous sinuses of the posterior cranial fossa and the vertebral venous systems. This study revealed the nearly constant presence of the anterior condylar confluent (ACC) located on the external orifice of the canal of the hypoglossal nerve. The ACC offered multiple connections with the dural venous sinuses of the posterior cranial fossa, the internal jugular vein, and the vertebral venous system. All these structures were shown by MR venography. CONCLUSION: The lateral, posterior, and anterior condylar veins and the mastoid and occipital emissary veins connect the dural venous sinuses of the posterior cranial fossa with the vertebral venous systems. These connections are clinically relevant, because encephalic drainage occurs preferentially through the vertebral venous system in the upright position. The ACC is a constant anatomic structure that may play an important role in the redirection of cerebral blood in the craniocervical region.     

Posterior cranial fossa dimensions in the Chiari I malformation: Relation to pathogenesis and clinical presentation

Summary Skull dimensions were measured on lateral skull radiographs in 33 adult patients with MRI-verified Chiari I malformations and in 40 controls. The posterior cranial fossa was significantly smaller and shallower in patients than in controls. In the patients, there was a positive correlation between posterior fossa size and the degree of the cerebellar ectopia, which might indicate that a posterior cranial fossa which was originally too small had been expanded by the herniation of hindbrain structures at an early stage. Pyramidal signs and cerebellar symptoms and signs, which may be due to compression of neural structures, were associated with a large degree of ectopia and a relatively large posterior cranial fossa. Syringomyelia and headache, which may be due to the valve action of the herniated cerebellar tissue, were not associated with a particularly large posterior fossa or herniation. No special clinical presentation was associated with a very small posterior cranial fossa, which may indicate that a small posterior cranial fossa per se has little or no clinical significance, although it may be the primary developmental anomaly.     

三叉神经瘤的CT及MRI诊断(附27例分析)

目的提高三叉神经瘤的CT、MRI的诊断水平.材料与方法对经手术病理证实的27例三叉神经瘤行CT及MRI检查.结果颅后窝型12例,颅中窝型6例,跨颅窝型5例.位于颅中窝、颅后窝的肿瘤呈椭圆形;跨颅窝生长者呈哑铃形或不规则形.CT扫描显示稍高密度区、混合密度区、囊性低密度区,不均匀增强或环形增强.MRIT1WI呈不均匀低信号,T2WI呈不均匀高信号,肿瘤边缘清楚,有显著占位效应.结论CT、MRI定性诊断困难时,应结合临床三叉神经受损表现诊断.     

颈椎间盘突出症146例CT分析

目的探讨颈椎间盘突出症的CT诊断价值。方法对146例颈椎间盘突出症的CT表现及颈椎间盘突出的大小、类型、部位等进行分析。结果①颈椎间盘突出症为多节段性,常发生于颈4～5及颈5～6节段。②颈5～6节段最多见,本组共142例,占97.3％。③在中央型及侧方型中,以中央型多见,共135例,占92.5％。④在153例中央型突出中,轻度(<2mm)54例,中度(2～4mm)66例,重度(>4mm)15例。结论CT诊断颈椎间盘突出症方便、快速、准确,是诊断颈椎间盘突出症的首选检查。     

鼻咽癌咀嚼肌间隙侵犯的MRI表现

目的：探寻鼻咽癌咀嚼肌间隙侵犯的各种MRI表现。方法：100例病理确诊无远处转移NPC病例放疗前MRI检查。结果：100例中咀嚼肌间隙受侵犯58例。按咀嚼肌间隙侵犯途径及各部分受侵情况分为由内向外侵犯53例：翼内肌侵犯53例,翼内肌及间隙受侵33例,翼内外肌受侵21例,翼肌及颞肌受侵2例,翼肌、颞肌及咬肌受侵1例。经咽颅底筋膜与中颅窝底之间隙直接侵犯翼外肌3例;肿大淋巴结侵犯颞肌及咬肌各1例。按信号改变分为同时表现为T1WI信号降低,T2WI信号升高,增强后异常强化47例;MRI平扫未显示,仅增强后异常强化11例。结论：咀嚼肌间隙侵犯一般沿从内到外的途径。MRI咀嚼肌间隙侵犯的主要表现为T1WI信号降低,T2WI信号升高及增强后异常强化。     

神经根型颈椎病推拿治疗的MSCT评价

目的:探讨神经根型颈椎病进行推拿治疗后的疗效及其MSCT扫描三维重建显示的价值。方法:临床确诊神经根型颈椎病患者30例纳入研究,男11例,女19例,平均年龄(50.97±12.43)岁(27～67岁)。在实施推拿手法治疗前后分别完成颈椎MSCT检查,记录临床症状、体征及VAS疼痛评分。采用16或64层MSCT,层厚0.625～1mm,完成MPR和VR重建,观察颈椎曲度、寰枢关节关系、棘突与中线的关系、椎体前后径线和左右径线与中轴线角度、各椎体水平方向旋转角度、椎间孔和椎间盘。结果:治疗后患者临床症状及体征明显好转,VAS评分从9.30±0.65分降至1.10±0.89分。MSCT显示治疗后颈椎弧度平均为(5.08±3.61)mm,较治疗前的(1.91±4.99mm)明显增大(t=-4.27;P=0.000);治疗后椎间孔狭窄数量明显减少(80/230下降为35/320);治疗后两侧寰齿关节不等距的数量从15例减至2例;治疗后棘突-中线距离为(0.87±1.70)mm,明显小于治疗前的(2.11±1.68)mm(t=7.53;P=0.000);治疗后椎间盘突出/膨出数为42个,较治疗前的63个明显减少。结论:MSCT扫描和重建可以有效评价神经根型颈椎病治疗效果,推拿可以改善颈椎生理曲度、椎间孔大小及椎间小关节位置关系。     

Unilateral aplasia of the middle cranial fossa floor in atypical hemifacial microsomia

We present the first report of a patient with atypical hemifacial microsomia (HFM) and unilateral aplasia of the floor of the middle cranial fossa, glenoid fossa, and portions of her posterior fossa. The patient also developed a Chiari I malformation with cervical syrinx over a 3-year interval. This case report highlights the critical role of imaging in revealing serious, but clinically occult, structural abnormalities, as well as the evolution in the pathogenetic understanding of HFM.