Diagnostic efficacy of three-dimensional images by helical CT for lesions in the maxillofacial region

The purpose of this study was to evaluate the efficacy of three-dimensional (3-D) images produced with a helical CT for the diagnosis of lesions occurring in the maxillofacial region. Thirty-four patients, who had lesions in the maxillofacial region, were examined by plain radiography (intra and extraoral) and the helical CT. Further, 3-D images were reconstructed from the data provided by the helical CT using the volume rendering method. These images were compared with plain radiographic images and conventional two-dimensional (2-D) CT images in terms of the information they provided for diagnosis. Using the 3-D images for tumors, bone destruction, inner components, extent of the lesion,the relationship between the lesion and surrounding anatomical landmarks, and the roots of the adjacent teeth were observed in overall views. We conclude that 3-D images produced by helical CT may provide useful information for the diagnosis of lesions.     

B超、穿刺、CT、MRI检查对潜突型舌下腺囊肿的诊断价值

【摘要】 目的 探讨B超、穿刺、CT和MRI检查对潜突型舌下腺囊肿的诊断价值。方法 36例颏下/颌下囊性肿物术前应用B超检查,穿刺检查,再行CT或MRI检查以明确嚢肿壁是否来自舌下腺。明确诊断的患者行口内切口摘除患侧舌下腺,不能明确的行颈部探查,术中发现为囊肿内容物为黏液成分后改为口内入路切除舌下腺。术后病理确诊。采用SPSS 13.0软件分析确诊率差异。结果 B超、穿刺、CT及MRI四种方法判断潜突型舌下腺囊肿的确诊率分别为53%,62%,87%和100%。统计分析显示4种检查方法确诊率有显著性差异（P<0.05）。所有术后病理确诊与术前诊断相符,随访3~36个月不等,未见有患者复发。结论 位于颏下/颌下区的囊性肿物可行MRI检查,明确囊肿来源,有助于术前明确诊断,以正确指导手术,避免颏下/颌下区探查手术。尤其对于不能配合穿刺造影检查的儿童患者,MRI检查更有优势。     

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.     

口腔颌面部肌间血管瘤不同病理分型的影像学表现

目的 ：探讨口腔颌面部高血循肌间血管瘤（IMH）的CT、MRI（包括磁共振动态增强）的表现特征与病理分型的关系。方法 ：回顾分析2001—2013年间18例经病理检查证实的口腔颌面部IMH患者的术前影像学资料。其中男3例,女15例,年龄5~57岁,平均年龄33.4岁。结果 ：CT、MR图像显示,6例患者累及多块肌肉,12例累及单块肌肉。好发于咬肌（6例）及舌体（6例）。3例患者影像学表现为高血循病变,磁共振动态增强的SI-time曲线为Ⅱ型：早期快速强化后出现平台期,病理分型为毛细血管型2例、混合型1例。15例患者影像学表现为低血循病变,SI-time曲线为Ⅰ型,病理分型为海绵血管型。4例发现静脉石。结论 ：IMH的 CT、MR影像学表现及其SI-time曲线分型,能进一步帮助诊断其病理分型。     

螺旋CT三维重建在颌面部骨折诊断中的价值

目的：探讨螺旋CT三维重建对颌骨骨折的诊断价值。方法：对72例颌面骨折患者采用螺旋CT扫描,使用不同旋转轴,观察不同角度骨折的三维病变图像,结合临床进行CT图像分析。对骨折的部位进行分类和测定。同时根据三维CT影像,从不同角度、不同方向对骨折部位进行检查。结果：螺旋CT三维重建能清楚显示复杂颌面骨折的立体解剖图像及其与周围结构的关系。与x线平片、二维CT影像比较,三维重建在显示颌骨骨折类型、位置、范围、骨折移位、塌陷深度等方面明显占优。对下颌骨和面中部等处的粉碎性骨折,其显示出畸形的立体形态更为直观,尤其对下颌骨骨折的诊断准确率较高,但三维CT对骨折片无移位的线性骨折诊断率较低。结论：螺旋CT三维重建对复杂颌面骨骨折具有较重要的临床应用价值,有利于确定复杂颌面骨骨折的程度与骨折的移位情况。有利于手术方案的设计与实施。     

Ultrasonographic findings of mesenchymal chondrosarcoma of the mandible: report of a case

Today, ultrasound imaging is being widely used to assess soft tissue lesions in the maxillofacial region. However, ultrasound investigations of intra-osseous lesions are rare, especially for tumors of the jaws. This report emphasized the capability of this useful imaging modality in identification of the characteristics of malignant conditions involving the bone. Mesenchymal chondrosarcoama, one of the unusual malignant conditions of the jaw, was presented in a young male with significant facial swelling. Different imaging modalities parallel with the histopathologic investigation confirmed the diagnosis. Interestingly, destruction of the bony cortex and new bone formation with a characteristic "sun ray appearance", highly suggestive of sarcomas, was manifested on the ultrasonograph. Thus, this report presented the ultrasonographic features of chondrosarcoma of mandible and considered the ultrasonography to be a useful imaging modality to evaluate intra-osseous jaw lesions.     

Role of Ultrasonography in Oral and Maxillofacial Surgery: A Review of Literature

Maxillofacial surgery, like any other surgical specialty is greatly dependent on the discipline of radiology. This poses a greater challenge because of the complex anatomy of this region. Various investigation modalities have been applied in diagnosing various diseases which are found in the maxillofacial region, including IOPA, PET, USG, CT, MRI and panoramic radiographs. Of these, USG can easily diagnose non invasive and soft tissue diseases. It is very useful in diagnosing the diseases which are not usually evident on a conventional radiograph. However; many of the dentists are not aware of the benefits of USG in diagnosis of oral diseases. In this article, the use of ultrasound in diagnosing the various pathologies of maxillofacial region is elaborated.     

口腔颌面部复发性肿瘤破坏中颅底的CT表现

目的显示口腔颌面部复发性肿瘤侵犯中颅底的ＣＴ表现。方法３７例口腔颌面部复发性肿瘤患者被行以横轴面和冠状面（２６例）ＣＴ检查,所有病变均经病理检查证实。结果ＣＴ上显示的中颅底破坏方式有四种：（１）颅底骨外板吸收（５例）;（２）颅底骨内外板均吸收（２４例）;（３）卵圆孔扩大（３例）;（４）颅底骨硬化和吸收并存（５例）。复发性肿瘤破坏中颅底最多的结构是蝶骨大翼（３６例）。ＣＴ显示病变侵入颅内者共２４例,受累的颅内结构有海绵窦（１６侧）,大脑颞叶（１５侧）和脑垂体（１例）。结论ＣＴ上显示的颅内侵犯与上述中颅底破坏方式密切相关。ＣＴ检查有助于临床上评价颌面复发性肿瘤侵犯中颅底。     

颌面专用CT茎突检查技术的确立

目的：观察茎突的形态、长度及其比邻关系。探讨颌面专用CT（QR—DVT 9000 NEWTOM）茎突检查技术在常规X线检查中的优势。方法：对茎突疾病患者进行颌面专用CT扫描，对感兴趣区重建成像。结果：颌面专用CT是不需要特殊的体位，对被检查部位的扫描一次完成，对感兴趣区重建轴位影像进行矢状面、3D等影像处理分析，可以显示出茎突的真实影像。结论：颌面专用CT成像技术优于常规X线、平面及曲面断层检查，清楚地显示茎突的形态、长度及其比邻关系等信息。对茎突疾病具有重要的诊断价值，更能有效地指导临床手术。     

口腔颌面部肿瘤侵犯翼腭间隙的CT检查和诊断

为了给临床治疗提供有益的经验，作者回顾分析了３３例经病理检查证实的口腔颌面部肿瘤侵犯翼腭间隙的ＣＴ表现，结果显示翼腭间隙区肿瘤侵犯的ＣＴ表现主要是软组织肿块的占位和其各壁结构破坏，不同中心部位的口腔颌面部肿瘤对翼腭间隙的侵犯具有不同的ＣＴ表现特点。作者从组织发生和ＣＴ表现两方面对原发性翼腭间隙肿瘤进行了探讨，并提出了ＣＴ诊断标准。ＣＴ对诊断该区的病变具有重要作用。     

口腔颌面肿瘤侵犯翼腭间隙的CT检查和诊断

为了给治疗提供有益的经验，作者回顾分析了３３例病理检查证实的口腔颌面部肿瘤犯翼腭间隙的ＣＴ表现，结果显示腭间隙区犯的ＣＴ表现主要是软组织肿块的占位和其各壁结构破坏，不同中心部位的口腔颌面部肿瘤对翼腭间隙的侵犯具有不同的ＣＴ表现特点。作战人组织发生和ＣＴ表现两方面对原发性翼腭间隙肿瘤进行了探讨，并提出了ＣＴ诊断标准。ＣＴ对诊断该区的病变具有重要作用。     

融合CT和MRI数据构建颌面部3D数字化模型

目的 探索通过精确、高效配准CT和MRI数据,建立包含颌面部主要肌肉和骨骼组织的3D数字化模型.方法 对1名志愿者行颌面部螺旋CT及MRI扫描,数据分别导入Mimics 15.0中,在3个视窗,即横断面、矢状面、冠状面,分别调整两种数据至同一断层,以树脂球为配准点,至少5个点配准两组数据.再利用CT分割并重建颌骨和面部皮肤3D模型,利用MRI分割重建面部主要肌肉3D模型.结果 建立了包含3对咀嚼肌、12对表情肌、面部皮肤与颌骨组织的3D模型,配准模型具有较高的一致性和相对位置精度.结论实现了CT与MRI两种影像学数据的配准融合.     

Application of computed tomography for diagnosis of alveolar bony defects

This study was performed to evaluate the usefulness of computed tomography (CT) in analyzing the three-dimensional structure of alveolar bony defects. The result showed that differences between CT film and actual readings from the cusp ridge to the bone crest were negligible, and the reading on CT film was underestimated approximately 1 mm at the distance from the cusp ridge to the bottom of the bony defect. By reading a series of CT films, one can easily evaluate the type of bony defects. Therefore, application of CT maybe useful for analyzing three-dimensional structure and diagnosis of the alveolar bony defects.     

螺旋二维及三维CT对颌面骨折的影像学研究

目的探讨螺旋二维CT、三维cT对颌面骨折的临床应用价值。方法对185例颌面骨折患者螺旋CT扫描，应用表面遮盖技术（shaded surface display，SSD）、多层面重建（multiplanar reformation，MPR）、应用Syngo软件勾画删除技术对图像进行分割，比较二维、三维CT诊断准确率。结果三维CT能清楚显示复杂颌面骨折的立体解剖图像与结构关系，并同时获得患者软组织实时图像，二维CT更好的提供细微骨折及深部骨折的信息，二者互补。扫描层厚越薄重建图像越清晰。结论三维CT有利于确定颌面骨折的程度与骨折的移位真实情况，对颌面部骨折的术前诊断和手术计划制定具有较大临床意义，是显示颌骨骨折的影像新技术。     

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随着锥形束CT在口腔颌面部应用的开展,锥形束CT也逐渐应用于颞下颌关节疾病的影像诊断中。本文介绍锥形束CT在颞下颌关节疾病中的应用现状,包括颞下颌关节紊乱病、颞下颌关节发育畸形、关节创伤、关节强直以及关节肿瘤等,结果表明锥形束CT作为一种有价值、有前途的影像检查方法,可以用于颞下颌关节疾病特别是关节骨性改变的评估中。     

PET/CT在诊断口腔颌面部肿瘤颈淋巴结转移中的价值

目的:通过与MRI检查比较,评价PET/CT(integrated PET-CT system)在诊断口腔颌面部肿瘤颈部淋巴结转移中的临床价值.方法:前瞻性分析2008-2011年47例口腔颌面部肿瘤患者,于术前2周内分别进行PET/CT、MRI检查.分别获取PET/CT影像和MRI影像.以病理结果为金标准,分析2种方法判断颈部淋巴结转移的敏感度、特异度及准确率方面的差异.采用SPSS13.0软件包对数据进行x2检验.结果:PET/CT、MRI判定颈淋巴结转移的敏感度分别为89.5％和73.7％(P＜0.05);特异度分别为89.3％和78.6％(P＞0.05);准确率分别为89.4％和76.6％(P＜0.05).结论:PET/CT在口腔颌面部肿瘤颈部淋巴结转移判定中的敏感度及准确率均优于MRI,差异具有统计学意义;PET/CT在口腔颌面部肿瘤颈淋巴结转移判定中作为一种辅助诊断方法,具有重要的临床价值.     

婴幼儿血管瘤的影像学诊断

血管瘤是婴幼儿软组织肿瘤中最常见的良性肿瘤,口腔颌面部是其高发部位。目前该病的影像学检查手段主要包括超声、X线平片、CT、MRI和X线血管造影。本文对这几种影像学检查方法在血管瘤诊断中的应用现状进行了回顾。     

颅外原发性病变破坏颅中窝底的CT表现

目的 评价颅外原发性病颅中窝底的ＣＴ表现特点。方法 将４９例经病理证实的破坏颅中底的颅外的发病变分为两组;颅中窝底原发骨性病变;１０例;颌面部原发病变;３９例。结果 颅外病变破坏颅中窝底的方式有４种;（１）骨吸收（３０例）,包括１６例颅中窝底外板吸收和１４例内外板均吸收;（２）颅中窝底硬化增厚（４例）;（３）圆孔和卵圆孔扩大（９例）;（４）硬化和吸收并存（６例）。受累的颅内结构：海绵窦１２例,颞叶     

螺旋CT三维重建在复杂颌面骨折的应用

目的:探讨螺旋CT三维重建对复杂颌面骨折的临床应用价值。方法:对26例复杂颌面骨折患者行螺旋CT 扫描,层厚3 mm或5 mm,应用表面阴影显示法进行三维图像重建,用不同的旋转轴观察不同角度骨折的三维病变图像。若怀疑下颌骨骨折时,应用勾画删除技术对图像进行切割删除处理,以便单独显示下颌骨的三维图像。结果:螺旋CT三维重建能清楚显示复杂颌面骨折的立体解剖图像及与周围结构关系;应用勾画删除技术可清楚显示下颌骨骨折部位与移位,尤其是髁突骨折移位的方向和程度。结论:螺旋CT三维重建有利于确定复杂颌面骨折的程度与骨折的移位情况,有利于手术方案的设计与实施。     

颌面部神经内分泌癌

目的：探讨颌面部神经内分泌癌的诊断和治疗特点。方法：2名面部原发神经内分泌癌患者和3名面部转移性神经内分泌癌患者，经手术治疗并在术后随访最长达30个月，CT、MRI和PET检查用于帮助诊断。结果：2名面部原发神经内分泌癌患者中，1名任术后出现局部复发并经历第二次手术，另一名患者术后接受放疗，随访20个月未见复发。3名转移性神经内分泌癌患者中，1名住术后4个月死亡。结论：颌面部神经内分泌癌，是一种少见的高度恶性的肿瘤，原发神经内分泌癌术后易复发，CT、MRI和PET检查有助于诊断。