乳突导静脉管的HRCT表现

目的:评估正常成人乳突导静脉管的出现情况、形态特征及其与邻近血管的关系。方法:分析符合纳入标准的受检者影像资料220例(440侧)。其中男113例,女107例,年龄18～61岁。所有图像均通过64层CT容积扫描骨算法重建,传输至Extended BrillianceTM Workspace(EBW)工作站,重建横断面图像,观察并测量其内口直径。结果:正常成人乳突导静脉管出现率约51.82%(228侧)。不同侧别间乳突导静脉管出现率差异无统计学意义(P男=0.183,P女=0.285)。男性乳突导静脉管的出现率较女性高(P=0.001)。脑静脉回流优势侧乳突导静脉管的出现率较对侧高(P=0.026)。颈静脉球窝高位侧乳突导静脉管的出现率较无高位侧高(P=0.013)。成人乳突导静脉管中Ⅰ型最为常见,出现率约43.64%,Ⅱ型占3.18%,Ⅲ型占0.91%,Ⅳ型占2.95%,V型约1.14%。男性乳突导静脉内口直径平均约(3.01±1.08)mm,女性平均约(2.61±0.87)mm。男性乳突导静脉内口直径较女性大,差异具有统计学意义(P=0.013)。结论:乳突导静脉管在不同个体间有较大变异,HRCT可清晰显示其形态以评估颅内外静脉引流情况。     

儿童颞骨正常变异的CT影像分析

目的：研究儿童期正常颞骨变异的发生率,ＣＴ表现及其临床意义。方法：通过对１９０位儿童的颞骨ＣＴ影像回顾性分析,将颞骨的正常变异归为：①颈静脉球高位;②颈静脉球高位伴静脉球裸露;③颈静脉孔显著不对称;④乙状窦前位;⑤扩大的耳蜗导水管开口。结果：上述正常颞骨变异在儿童期的发生率分别为（１）１２．６％;（２）３．７％;（３）３．１％;（４）１．５％;（５）４．４％。结论：儿童期颈骨正常变异较常见。在外科     

颞骨-中内耳解剖变异畸形高分辨CT表现及临床意义

目的探讨先天性颞骨-中内耳解剖变异畸形的高分辨CT(HRCT)特征表现,为耳科诊治疾病提供有价值的参考依据。方法收集41例(76耳)病例采用HRCT横断面扫描+冠状位扫描,分析先天性颞骨-中内耳解剖变异畸形的HRCT表现。结果颈静脉高位20例(23耳)、鼓室盖不连续13例(15耳)、乙状窦前位8例(13耳)、岩鳞隔过长8例、中颅窝低位5例、颈静脉裸露5例、乳突窦未发育1例、Michel畸形1例、Mondini畸形3例(6耳)。结论 HRCT可清晰显示颞骨-中内耳解剖变异畸形的表现,能明确颞骨-中内耳解剖变异畸形的诊断并对临床诊疗及手术路径具有指导意义。     

岩尖病变的CT及MRI诊断

岩尖是颞骨岩部内侧的锥形结构,位于颅底中部两侧.岩尖疾病临床无法直接检查,CT及MRI对该区疾病的诊断具有重要价值. 1 岩尖的解剖及正常变异 颞骨岩部斜位于颅底中部,尖端指向前内,底部位于后外.岩尖的外界是内耳,内侧为岩枕裂,前方是岩蝶裂及颈内动脉,后方为后颅窝.岩尖的上面是中颅窝、Meckel腔及颈内动脉,下面是颈静脉球及岩下窦.内听道将岩尖分为含骨髓的较大的前部及衍生自听囊较小的后部.     

64排CT容积再现技术在颈静脉球高位中的应用

目的 探讨64排多层螺旋CT容积再现技术在颈静脉球高位中的临床应用价值.方法 颈静脉球高位患者20例(36耳)及正常者20例(40耳)行64 排螺旋CT薄层扫描,分别在容积再现(VR)及常规轴位状态下,对颈静脉球与内耳地周之间的距离进行测量.结果 64排CT容积再现技术能更好地显示颈静脉球与内耳地周的关系,36例颈静脉球高位耳(36/40),常规轴位测量距离均值为3.896 4 mm,而重建后测量距离均值3.085 5 mm,两者统计学比较有差异(P＜0.001);在重建状态下,颈静脉球高位耳颈静脉球至内耳地周最短距离均值为3.127 3 mm,非高位耳为8.250 0 mm,两者统计学比较有差异(P＜0.001).结论 64排CT容积再现技术能更加清晰显示颈静脉球与内耳地周之间的空间关系,为两者位置关系的研究提供了新的手段.     

人工耳蜗植入术前的影像学评估

目的分析人工耳蜗植入(CI)术前颞骨MRI及CT表现,并探讨术前影像学对人工耳蜗植入的价值。方法拟行CI的160例患者均行高分辨率CT扫描,64例同时行横、冠状面扫描,119例行MR检查。结果320耳乳突均气化良好,乳突蜂房向后超过乙状窦前壁206例。左、右侧乳突长度分别为(2.34±0.42)、(2.25±0.40)mm(U=1.887,P<0.05),宽度分别为(1.57±0.30)、(1.50±0.27)mm(U=2.35,P<0.05)。中耳炎8耳,CT示鼓室及乳突蜂房不含气,MRI为长T1,长T2信号。颈静脉球窝扩大或高位18耳,蜗窗龛狭窄2耳。迷路炎9耳,8耳CT表现耳蜗、半规管及前庭不同程度的骨化,MRI表现为长T1,短T2及短T1、等T2信号,并且T2WI信号不连续。1耳膜迷路闭塞,CT为阴性,MRI表现为等T1、等T2信号。耳蜗完全未发育1耳,耳蜗发育周数不足6耳,Mondini畸形5耳。前庭导水管扩大40耳,前庭、半规管发育畸形10耳,内耳道狭窄5耳。结论术前的颞骨影像学诊断,对于CI成功实施能够提供重要信息。     

颞骨段-鼓室内面神经鞘瘤误诊1例分析

颞骨段-鼓室内面神经鞘瘤极为少见,临床首发症状多为面瘫,早期诊断困难,易误诊为贝尔面瘫或者听神经瘤.影像学上和颈静脉球瘤的鼓室型、胆脂瘤型中耳炎鉴别困难;当肿瘤破坏岩骨后壁侵入脑桥小脑角池后,和岩骨后壁硬膜起源的脑膜瘤,及小脑脑桥角(CPA)脉络膜起源的脉络丛乳头状瘤也难以鉴别,确诊多依靠手术和病理证实.笔者曾遇见1例,临床误诊为胆脂瘤型中耳炎或鼓室型颈静脉球瘤,现结合文献复习报道如下.     

岩尖部囊性病变影像学研究

颞骨岩锥位于内耳迷路内前方的一段称为岩尖部,处于前方的蝶骨和后方的枕骨之间,尖端以破裂孔为界[1],此锥体的底部以骨迷路和颈内动脉前为界,其上面由中颅窝、Meckel腔及颈内动脉升段构成,后面为后颅窝及展神经走行的Dorello管,下面由颈静脉球和岩下窦组成.     

颞骨骨纤维异常增殖症HRCT研究

目的 探讨颞骨骨纤维异常增殖症HRCT表现，评价HRCT 的诊断价值。资料与方法回顾性分析资料完整的16例颞骨骨纤维异常增殖症的HRCT扫描图像。结果 颞骨单侧发病lO例，双侧发病6例。腿cT示受累颞骨弥漫性膨大，骨皮质变薄。根据病变的密度分为3种类型：硬化型9例(56．25％)，表现为均匀一致的高密度；变形性骨炎型6例(37．5％)，表现为高密度病灶中散在点或片状低密度区；囊型1例(6．25％)，病变明显膨胀，表现为多个球形或卵圆形透亮区，有薄的骨壳包绕。骨纤维异常增殖症可导致颞骨的自然腔隙、孔道狭窄，如外耳道、鼓室腔、内听道、前庭导水管、耳蜗导水管及面神经乳突段骨管；一般不破坏听小骨和内耳骨迷路；常见并发症为炎症、胆脂瘤，3例(18．75％)继发胆脂瘤分别位于外耳道、乳突及上鼓室，乳突窦，其中上鼓室，乳突窦胆脂瘤破坏邻近听小骨、上半规管。此外，还可引起岩段颈内动脉管、颈静脉孔、茎乳孔和颞下颌关节形态的改变。结论HRCT可清楚显示颞骨骨纤维异常增殖症骨质改变、病变范围及并发症，在本病的诊断、治疗及随访中起重要作用。     

颈静脉球瘤的MR诊断

目的探讨MR检查在颈静脉球瘤诊断中的应用价值。方法对15例病变进行回顾性分析,重点分析其部位、信号及其侵袭性表现等情况。结果15例患者中,右侧病变8个(8/15),左侧7个(7/15);肿瘤形态为类圆形或不规则形,12例较大病变不同程度侵犯颈静脉孔区、乳突、岩骨、岩尖、斜坡等处骨质;肿瘤信号欠均匀,12个(12/15)肿块在MR平扫出现“盐和胡椒征”,以“胡椒”表现最为显著;13个肿块(13/13)均有明显强化,其中10个肿块出现“盐和胡椒征”。9例行MRA检查,颈内动脉和颈内静脉不同程度移位和包绕。结论根据肿瘤的部位、“盐和胡椒征”等MR表现,可在手术前正确诊断颈静脉球瘤。     

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.     

Middle ear cholesteatoma extending into the petrous apex: evaluation by CT and MR imaging

CT and MR imaging findings were reviewed in four cases of acquired cholesteatoma of the middle ear that extended medially into the petrous apex and middle cranial fossa. In one case the lesion further extended anteromedially into the sphenoid sinus. CT demonstrated the lesions as nonenhancing hypodense masses with bone destruction, extending medially from the middle ear cavity to the petrous apex region. On MR imaging, the lesion was slightly hypointense relative to brain on T1-weighted images and hyperintense on T2-weighted images. MR imaging clearly delineated the extraaxial location of the lesion and associated brain displacement. The medial extension of the cholesteatomas seems to have proceeded via a detour around the bony labyrinth into the petrous apex region by following normal pathways of temporal bone pneumatization.     

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.     

Petrous apex cephaloceles.

BACKGROUND AND PURPOSE: Petrous apex cephaloceles (PACs) are uncommon lesions that are usually incidental but may be symptomatic. We reviewed MR and CT studies in 10 patients with PACs to identify characteristic imaging features that facilitate their diagnosis. METHODS: MR and CT studies from 10 patients with PACs were reviewed retrospectively. In each case the PAC was characterized by lesion center, signal intensity or attenuation, adjacent petrous apex pneumatization, and its relationship to Meckel's cave. Intraoperative findings were reviewed in the three cases in which surgery was performed. RESULTS: All 10 patients had lobulated expansile cystic petrous apex lesions centered along the posterolateral margin of Meckel's cave. All cysts were contiguous with Meckel's cave. Three patients had bilateral PACs. Four patients had symptoms that could potentially be explained by the PAC, while findings in the other six were incidental observations. Three patients underwent surgery, during which two lesions were diagnosed as meningoceles while the third was diagnosed as an arachnoid cyst protruding through a dural defect. CONCLUSION: PACs represent a protrusion of meninges and CSF from the posterolateral portion of Meckel's cave into the petrous apex, which is their characteristic imaging appearance. PACs are usually incidental but may be symptomatic. Surgical intervention should be approached cautiously and undertaken only when symptoms are clearly linked to the presence of this lesion.     

Computed tomography of temporal bone pneumatization: 1. Normal pattern and morphology

The pneumatization of 141 "normal" temporal bones on computed tomography (CT) was evaluated in 100 patients (age range, 6-85 years). Because of the controversy surrounding the sclerotic squamomastoid (mastoid), temporal bones with this finding were discarded. A CT index of pneumatization was based on the pneumatized area and the number of cells seen within a representative scanning section. Results suggest that squamomastoid pneumatization follows the classic normal distribution and does not correlate with age, gender, or laterality. A high degree of symmetry was found in 41 patients who had both ears examined. In 35% of all temporal bones, the petrous apex was pneumatized, concordant with the findings of other investigators. Pneumatization extending into other regions of the temporal bone corresponded linearly with squamomastoid pneumatization. Air-cell configuration was variable. Air-cell size tended to increase progressively from the mastoid antrum. The scutum "pseudotumor" appearance caused by incomplete pneumatization was seen frequently, and should not be mistaken for mastoiditis or an osteoma. Thick sections producing partial-volume effect may also produce this spurious finding. Therefore, when searching for mucosal thickening due to mastoiditis, large air cells should preferably be analyzed.     

颞岩部胆脂瘤对面听神经损害的特征与治疗对策

目的探讨岩部胆脂瘤发病特征、对面听神经损害特点及治疗方法。方法回顾性分析1991年7月—2005年6月间收治的17例岩部胆脂瘤的临床资料。结果 17例中16例重度耳聋及全聋,1例为中度混合性聋,15例伴有面瘫,其中11例为迷路段缺损,1例垂直段缺损,CT检查岩部均有膨胀性改变及骨性破坏,手术采用乳突迷路进路6例次,颅中窝进路8例次,乳突颅中窝联合进路3例,颞骨扩大切除术2例,行面神经全程减压4例,由内听道段与水平段面神经端端吻合5例,舌下神经-面神经吻合1例。全部病例均顺利恢复,无感染和复发。结论岩部胆脂瘤发病率低,早期症状多不明显,中晚期可有面肌抽搐、耳流脓等症状,应详细检查,颞骨CT及MRI是最佳的检查和诊断方法 ,对已确诊岩部胆脂瘤应争取早作手术,避免颅内感染和对面听神经的进一步损害,根据病变的部位及破坏程度选择适当的手术途径。     

Jugular bulb diverticula in medial petrous bone

Upward extension or diverticulum of the jugular bulb is rare. Most often, it protrudes into the middle ear. Three patients are reported in whom direct superior extension from the medial portion of the jugular bulb resulted in a defect in the medial part of the petrous bone. In this position, a jugular bulb diverticulum relates directly to the posterior wall of the internal auditory canal. The distinctive radiographic characteristics of this entity obviate unnecessary investigation and surgery. Encroachment on the internal auditory canal may possibly contribute to neurosensory hearing deficit.     

Anatomic variations of the human cochlear aqueduct. A radioanatomic investigation

The cochlear aqueduct follows a course through the petrous pyramid that varies from straight and steeply vertical to a curvilinear and horizontal. Its course and length are correlated to the pneumatization of the pyramid and also to the volume of the jugular fossa. These two factors influence the radiographic reproduction of the cochlear aqueduct, especially in computed tomography in the axial transverse projection but to a far lesser degree in multidirectional tomography.     

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.     

Computed tomography of temporal bone pneumatization: 2. Petrosquamosal suture and septum

The degree of visualization of the petrosquamosal (K?rner's) septum on high-resolution axial computed tomography (CT) in 141 temporal bones (100 subjects) was analyzed. The superior and inferior parts of the septum were assessed separately and were seen in 75% and 41% of cases, respectively. There was no relation between the size of K?rner's septum and pneumatization. The clinical relevance of this finding is discussed. The CT features of the ventral petrosquamosal suture also were investigated. The crista tegmentalis, a contribution of the petrosal tegmen to the mandibular fossa, was seen on CT as a polypoid excrescence projecting from the ventrolateral petrous pyramid. This knowledge is useful in the radiographic analysis of the course of longitudinal fractures of the petrous bone.