CT血管成像对星点与静脉窦关系的研究

目的 利用CT血管成像(CTA)技术观察星点的位置,为临床手术操作提供解剖依据,同时评价减影CTA 技术在观察星点与横窦和乙状窦连接部(transverse and sigmoid sinus transition,TSST)关系的价值.资料与方法 回顾性重建100例行头部CTA检查患者的星点影像资料,观察星点与体表骨性标志及静脉窦位置的关系.结果 星点到乳突尖、颧弓根、颞鳞-顶乳缝交点、外耳道口的距离分别为(49.6±4.3)mm,(55.6±4.6)mm、(24.6±4.1)mm,(44.1±3.6)mm,横窦和乙状窦连接部内角到乳突尖、颧弓根、星点、外耳道口、颞鳞-顶乳缝交点的距离分别为(35.4±4.9)mm,(41.4±4.7)mm,(17.6±4.2)mm,(27.8±3.8)mm,(15.2±3.9)mm,星点及TSST位置男性高于女性,左侧TSST位置较右侧靠后.星点主要位于横窦末段,右侧星点3%位于TSST前上方,83%恰好位于TSST水平,14%位于TSST后下方,左侧分别为5%,79%,16%.结论 减影CTA可以清楚显示TSST与星点的关系,乙状窦后人路手术第一钻孔点应选在星点后下＞17mm以上位置,减影CTA术前检查获得个体解剖资料与传统定位TSST方法结合,对减少手术并发症及缩短手术进程具有重要价值.     

脑静脉系统64层螺旋CT血管成像研究

目的 探讨CTA减影技术对脑静脉(窦)的显示能力及优势.方法 采用64层螺旋CT双能量同步扫描CTA技术,先行平扫,再行CTA容积扫描的动静脉同期显示全脑血管成像.随机抽取50例血管显示正常的病例,回顾性分析常规CTA和减影CTA脑静脉(窦)的显示率.结果 减影CTA中上矢状窦、直窦、大脑大静脉、透明隔静脉、大脑内静脉、基底静脉、横窦、乙状窦、蝶顶窦、岩下窦、小脑幕窦、大脑浅静脉、Labbe静脉显示率为100%,下矢状窦为99%,Trolard静脉为95%,岩上窦为90%,海绵窦为60%.除岩上窦、岩下窦、海绵窦外,常规CTA和减影CTA在上述脑静脉(窦)显示率上并无明显差别,但在显示程度方面有所不同.结论 减影CTA是显示脑静脉系统影像可行、有效的方法.常规CTA与减影CTA恰当的互补,具有很高的临床应用价值.     

颈静脉球血液流速流量测量分析

目的 探讨测量正常人颈静脉球(JB)血流流速和流量的方法.方法 对68例正常人进行JB 3D-PC-MRV成像及PC-CINE序列的血液流速、流量测量.结果 (1)左侧JB的平均流速及流量为(5.67±2.97)cm/s、(2.81±1.90)ml/s.右侧JB的平均流速及流量为(7.20±2.14)cm/s、(4.22±2.11)ml/s.左、右侧JB的流速及流量有统计学差异(P＜0.05).(2)JB表现为平坦型44例,占32.5%,上突型92例,占67.5%.平坦型JB的流速及流量为(4.72±2.53)cm/s、(2.15±1.49)ml/s.上突型JB的流速及流量为(7.33±2.32)cm/s、(4.22±2.01)ml/s.上突型、平坦型JB的流速及流量有统计学差异(P＜0.05).结论 MRV结合PC-CINE序列可以为JB提供形态学及血液流速流量的量化信息,JB的高位与颅内优势引流所致血液流速流量高有关.     

64层螺旋CT三维减影技术在颈脑血管成像中的可行性研究

目的应用64层螺旋CT数字减影技术进行颈脑血管成像,以探讨东软医疗公司研发的三维减影软件的可行性。资料与方法对71例患者行颈脑血管数字减影CTA检查,得到平扫和常规CTA图像;其中49例同时接受数字减影血管造影(DSA)检查。先利用GE工作站Add/Sub软件进行二维减影得到二维减影CTA图像;然后采用东软医疗公司研发的BSCTA软件进行三维减影得到三维减影CTA图像。由一名高年资放射科医师记录并比较常规CTA、二维减影CTA、三维减影CTA进行容积再现(VR)及最大密度投影(M IP)后处理的时间,同时由两名高年资放射科医师采用双盲法比较三种CTA技术重组所得颈脑血管图像质量,并与DSA比较。结果经单因素方差分析两两比较,三种CTA技术后处理时间两两之间差异均有显著统计学意义(P<0.05),三维减影CTA最短,二维减影CTA次之。三种CTA技术进行三维重组所得颈脑血管图像评分经过非参数Mann-Whitney U检验,两两之间差异均有显著统计学意义(P<0.05),三维减影CTA图像质量最佳,二维减影CTA次之。49例同时接受DSA检查,结果与三维减影CTA一致。结论 64层螺旋CT颈脑血管成像数字减影技...     

横窦-乙状窦憩室引起搏动性耳鸣的CT诊断

目的 探讨横窦-乙状窦憩室引起的搏动性耳鸣的CT表现.方法 搜集18例横窦-乙状窦憩室引起的搏动性耳鸣患者资料,分析其脑CT动静脉血管造影(CT Arteriography and Venography,CTA/CTV)检查的影像表现.结果 18例横窦-乙状窦憩室均发生在静脉窦优势引流侧;静脉窦双能量减影图像直观地显示横窦-乙状窦憩室,表现为静脉窦管腔局部呈囊袋样、指状及棘样突起;CTV图像能清楚地显示局部膨隆的静脉窦经邻近骨壁缺损处疝入邻近的乳突.结论 脑CTA/CTV检查对诊断横窦-乙状窦憩室引起的搏动性耳鸣具有重要的价值.     

内听道后前位X线摄片的解剖学基础研究

目的为内听道后前位摄片提供解剖学基础。方法用数码游标卡尺、量角器等测量30例受检者内听道的下缘与外耳门的上缘到同一水平面的距离，分析颅骨前后径与左右径比值与内听道与矢状面的夹角之间的关系。结果内听道下缘与外耳门上缘在同一水平面，颅骨前后径与左右径的比值与夹角呈负相关，两侧夹角有显著差异。结论外耳门上缘可作为内听道平面的体表标志。长头型者夹角小，内听道与乳突重叠多，内听道显示不良。     

64层CT正常颅内静脉成像

目的观察横窦和小脑幕侧窦的常见形态、变异及其临床意义．比较最大密度投影（MIP）和容积再现（VR）对颅内静脉（窦）结构的显示率。资料与方法25例CT脑静脉成像（CTV）．分别观察VR、MIP对13个颅内静脉（窦）的显示情况。结果25例总共显示494个结构。VR显示481个,MIP显示431个,经X^2检验差异有统计学意义（P〈0．001）。上矢状窦、直窦、窦汇、大脑大静脉、海绵窦、大脑内静脉和下矢状窦在VR、MIP两种重组方法中显示率均为100％。大脑中浅静脉、岩下窦、Labbe静脉、Trolard静脉VR优于MIP。小脑幕侧窦两者未见显著性差异。左侧横窦优势型4例,右侧横窦优势型11例,其中横窦发育不良2例,10例为中间型。小脑幕侧窦可分三型。结论CTV可较完整地显示颅内静脉及静脉窦,显示颅内静脉（窦）VR优于MIP;正确认识横窦、小脑幕侧窦的形态有重要的临床意义。     

3D-FIESTA序列在内耳及内听道MRI中的应用探讨

目的:探讨3D-FIESTA序列内耳及内听道成像技术及其临床应用价值.方法:用GE signa 3.0T超导型磁共振对25例共50耳应用3D-FIESTA序列做颞骨三维容积扫描,采用多平面重组(MPR)、最大强度投影(MIP)及仿真内窥镜(VE)行后处理,观察3D-FIESTA序列对内耳及内听道内各解剖结构的显示.结果:3D-FIESTA序列扫描结合MPR、MIP和VE重组对内耳迷路及内听道内神经及血管显示清晰,能够清晰显示两者之间的关系,MPR和VE重组对神经的显示优于MIP重组,MIP对半规管显示与双斜面MPR并无明显差别,VE和斜矢状面对于内听道内各神经孔的位置关系具有重要意义.结论:3D-FIESTA序列对内耳及内听道的结构显示清晰,具有较高的临床应用价值.     

减影CTA成像技术在脑动脉瘤诊断中的优势

目的合理应用64层螺旋CT减影CTA的优势,提高对脑动脉瘤的诊断率。资料与方法对61例临床有蛛网膜下腔出血的患者行CT检查,并用减影CTA和常规CTA进行对比,重组技术用最大密度投影(MIP)和容积再现(VR)。以手术及部分DSA为标准评价两种检查结果;由两名有经验的神经外科医师、两名放射科医师双盲法评价图像质量。结果减影CTA检出动脉瘤63个,检出动脉瘤的敏感性为100%、特异性为100%,阴性似然比为0.0000,评价者对动脉瘤检出的一致性为1.00;常规CTA检出动脉瘤60个,漏检3个颈内动脉床突下动脉瘤,检出动脉瘤的敏感性为95%,特异性为100%,阴性似然比为0.0500,评价者对动脉瘤检出的一致性为0.9565。结论减影CTA技术对颈内动脉床突下动脉瘤的检出具有明显的优势。     

螺旋CT对双侧横窦管径的研究分析

目的 探讨螺旋CT静脉期成像在测量双侧横窦管径中的价值.方法 回顾性分析在本院行脑血管增强扫描检查的200例窦汇区血管影像,常规使用CT原始图、减影CT静脉成像(CTV)的容积再现(VR)及最大密度投影(MIP)的方法,观察窦汇区血管解剖结构不同表现,并进行优势横窦判定及分型(Ⅰ~Ⅵ型);并在CT原始图上进行双侧横窦管径的测量,按性别分2组,按年龄分4组(20~30岁、30~40岁、40~50岁、50~60岁)进行统计学分析.结果 不同性别组间,右侧横窦管径男性大于女性,差异有统计学意义(P<0.05);左侧横窦管径差异无统计学意义(P>0.05);各年龄组间,双侧横窦管径差异均无统计学意义(P>0.05).结论 螺旋CT能够较好地评价横窦的管径,为临床疾病提供相关解剖学基础,具有重要意义.     

颞骨气化与颈静脉球高位关系的CT分析

目的探讨乳突及岩尖气化与颈静脉球高位间的相关性。方法回顾性分析477例(954侧)颞骨CT片,统计乳突和岩尖的气化分型及各型颈静脉球高位的发生率,并对其作统计学分析。结果477例中颈静脉球高位的出现率右侧为40.67%(194例),左侧为21.38%(102例);女性出现率为35.37%,男性28.75%,差别均有统计学意义。岩尖气化I型与III型颈静脉球高位的发生率分别为31.25%及30.58%,乳突气化型与其它型颈静脉球高位的出现率分别为31.64%及29.02%,差别均不存在统计学意义。结论颈静脉球高位的发生率在两侧及性别间存在差异;颞骨气化与颈静脉球高位没有相关性。     

Computed tomographic evaluation of surgically significant vascular variations related with the temporal bone

Variations of the vascular structures related with the temporal bone may cause important problems in diagnosis, treatment planning and surgery. High resolution computed tomography (CT) scans of 700 temporal bones of 350 patients were retrospectively examined for the incidence of dehiscent jugular bulb, high jugular bulb, diverticulum of jugular bulb, anteriorly located sigmoid sinus and dehiscent internal carotid artery. Dehiscent jugular bulb was seen in 27 (3.9%), high jugular bulb was seen in 142 (20.3%), jugular bulb diverticulum was seen in 55 cases (7.9%). The average distance between external acoustic canal and sigmoid sinus was found to be 13.3 mm and in 12.4% of the cases this distance was < 10 mm. Of 700 temporal bones, 10 (1.4%) showed dehiscent carotid canal. To aid diagnosis, treatment planning and surgery, CT scanning is currently a very reliable tool in determining these conditions. Special attention should be paid to the position of the vascular structures in the preoperative temporal bone CT scans.     

Dehiscence of the jugular bulb and vestibular aqueduct: findings on 200 consecutive temporal bone computed tomography scans

OBJECTIVE: To determine the incidence of dehiscence between the vestibular aqueduct and the jugular bulb on computed tomography (CT) scans and assess its implication as a cause of dizziness or hearing loss. METHODS: Two hundred temporal bone CT scans were evaluated for the prevalence of dehiscence between the jugular bulb and vestibular aqueduct. Correlation of the imaging findings and clinical data was performed. RESULTS: A total of 11.5% of patients had dehiscence of the jugular bulb with the vestibular aqueduct; 75% of these cases occurred on the right side and in the setting of a high jugular bulb. Nine (39.1%) of 23 patients with dehiscence had dizziness, and 11 (47.8%) had hearing loss. The correlation between the incidence of dizziness, hearing loss, and dehiscence was not significant. CONCLUSION: The incidence of a dehiscent jugular bulb with a vestibular aqueduct is 11.5%. The prevalences of vertigo and hearing loss associated with this finding are 39.1% and 47.8%, respectively. The depiction of dehiscent jugular bulb-vestibular aqueduct should be considered with caution as the sole cause of symptoms.     

Pulsatile tinnitus and imaging diagnosis. A case report

Tinnitus is the perception of sound in one or both ears when no external noise exists to cause that perception. It can be otological, neurological, drug-related, traumatic, due to exposure to high decibel levels, or associated with a vascular abnormality—the latter usually causing pulsatile tinnitus. We present the diagnostic image of a patient with pulsatile tinnitus with terminal plate dehiscence of the jugular bulb and review the diagnostic workup. Jugular bulb dehiscence is a venous variant that consists of an upper and lateral extension of the jugular bulb into the middle ear through a dehiscent sigmoid plate. It is the most common vascular anatomical variant of the petrous portion of the temporal bone. Imaging studies are essential for establishing a diagnosis and defining possible anatomical variants.     

小鼠出生后嗅球层状结构发育变化研究

目的探讨小鼠出生后嗅球层状结构的发育变化。方法取小鼠出生当天、出生后10、20、30、45、60、75、90 d嗅球,采用HE染色,以神经元核心抗原(NeuN)特异性抗体进行免疫组化染色,观察其结构变化。结果新生小鼠嗅球无层状结构,NeuN在周边散在分布,出生后10 d嗅球层状结构可初步辨识,NeuN表达逐渐向内迁移;出生后20 d嗅球清晰出现突触小球层;出生后30 d嗅球层状结构清晰,NeuN迁移至内丛状层;出生后30~90 d,嗅球结构无明显变化。结论小鼠出生后10~20 d嗅球层状结构发育变化明显,出生后30 d完成嗅觉在嗅球水平的修饰。     

Vascular anomalies, sutures and small canals of the temporal bone on axial CT

PURPOSE: Subtle bony structures, small canals and fine sutures cause sometimes problems in the analysis of CTs of the temporal bone. The aim of this study was: to analyze the visibility of subtle structures and to estimate the incidence of vascular anomalies. PATIENTS AND METHOD: We retrospectively analyzed axial scans of 223 high-resolution CTs of the temporal bone obtained as single slice or spiral CT with 1mm slice thickness. All CTs had clinical indications. Two experienced radiologists studied CTs regarding the visibility of the fine sutures, fissures and small canals and the occurrence of vascular anomalies. RESULTS: The following structures were seen commonly: sphenosquamosal suture (76%), arcuate artery canal (93%), vestibular aqueduct (89%), mastoid emissary vein (82%), singular canal (56%). Not so commonly were observed: tympanosquamosal suture (31%), mastoid canaliculus (28%), lateral sigmoid sinus (28%), petrotympanic fissure (24%), tympanomastoid suture (10%). Seldom we identified: the inferior tympanic canaliculus (6%), high jugular bulb (6%), anterior sigmoid sinus (5%), dehiscent internal carotid artery canal (2%), persistent petrosquamosal sinus (1%), dehiscent jugular bulb (1%). Persistent stapedial artery, aberrant internal carotid artery, dehiscent jugular bulb, high jugular bulb with diverticulum, anterior and dehiscent sigmoid sinus were detected in below 1% of the analyzed temporal bones. The frequency of asymmetry of the jugular foramen, which varied between 3% and 42%, depended on different criterions of size. CONCLUSION: A profound knowledge of normal anatomy and anomalies of the temporal bone avoids misinterpretation as pathological lesions and iatrogenic bleedings.     

头颈部双源CT血管成像诊断硬脑膜动静脉瘘的价值探讨

目的探讨头颈部双源cT血管成像（CTA）诊断硬脑膜动静脉瘘（DAVF）的价值。方法收集2009年6月至2012年6月8例DAVF患者的头颈部CTA资料,以8例性别及年龄相似的正常头颈部CTA为对照组,对比分析DAVF患者与正常头颈部CTA的征象差异,分析征象包括畸形血管的供血动脉数量,患侧硬膜窦边缘是否规整,有无异常穿颅血管通道,大脑皮层静脉是否扩张以及双侧颈内静脉密度是否对称等。结果多支（≥3条）供血动脉诊断DAVF的特异性、敏感性分别为88％、100％。患侧静脉窦边缘不规则的敏感性较低（50％）,特异性很高（100％）。出现异常穿颅血管通道的敏感性较低（38％）,特异性较高（88％）。DAVF组的双侧颈内静脉密度不对称性差异存在统计学意义（P=0．017）。结论头颈部双源CTA对诊断DAVF具有较高的价值,出现多支供血动脉、患侧静脉窦边缘不规则及双侧颈内静脉密度不对称高度提示DAVF。     

十二指肠球部溃疡钡餐检查体位的评价

本文复习了1990年连续的上胃肠道钡餐检查1800例,显示十二指肠球部有典型溃疡龛影154例,我们发现只能由俯卧右前斜位显示的球部龛影为55.1%,水平和半立仰卧左后斜位为28.6%,水平和半立仰卧右后斜位为6.4%。这三种体位的组合配套能显示97.4%的球部龛影。     

MR imaging of transverse/sigmoid dural sinus and jugular vein thrombosis

Magnetic resonance (MR) imaging was performed on six patients with thrombosis involving the transverse/sigmoid sinus and jugular bulb/vein. Venographic confirmation was obtained in five cases. Thrombi were characterized by increased intraluminal signal on all planes of section and pulse sequences. The change in signal intensity from first to second echo for thrombi was qualitatively less than that found with slow flow. Partial thrombosis in one case was seen as a ring pattern of central intermediate intensity corresponding to the thrombus, surrounded by a peripheral ring of signal void related to flowing blood. The MR findings closely correlated with venography in predicting thrombosis. Evidence of thrombi was not available from CT. Magnetic resonance is well suited for the diagnosis of occlusive disease of the dural venous sinus and jugular bulb.     

Development of posterior fossa dural sinuses,emissary veins,and jugular bulb: morphological and radiologic study.

PURPOSETo report the anatomic and radiologic development of the transverse, sigmoid, and occipital sinuses, the emissary veins, and the jugular bulb formation from the jugular sinus in humans before and after birth.METHODSRoentgenograms of 33 injected brains showing the cranial venous system in human fetuses from 3 to 7 months of gestational age and cerebral angiograms of newborns and infants up to 6 years of age (23 clinical cases) were made and analyzed in detail. Special attention was focused on the inner diameters of the transverse and sigmoid sinuses and of the internal jugular veins, particularly at the sigmoid sinus-internal jugular vein junction.RESULTSMarked increase in venous flow from the rapidly growing cerebral hemispheres leads to ballooning of the transverse sinuses in the absence of an increase in the inner diameters of the sigmoid and jugular sinuses. The ballooning also results in formation of the occipital sinus, marginal sinus around the foramen magnum, and emissary veins. The formation of the jugular bulbs from the jugular sinuses begins after birth when a shift from a fetal to a postnatal type of circulation (or from a lying-down position to an erect posture) takes place.CONCLUSIONThe morphological changes of the posterior fossa dural sinuses, emissary veins, and jugular bulb are closely related to the development of the brain, shift to postnatal type of circulation, and postural hemodynamic changes.