蝶筛外侧壁HRCT影像解剖学研究

目的：探讨蝶筛外侧壁与颈内动脉(ICA)和视神经(ON)的毗邻关系及其临床意义。资料与方法：回顾性分析80例(160侧)颅底高分辨率CT(HRCT)轴位图像。评价ICA和ON在蝶筛外侧壁上形成隆起的形态特征及视神经管(OC)与蝶筛外侧壁的毗邻关系。结果：ICA隆起型27侧(16．88％)，压迹型68侧(42．50％)，远离型65侧(40．62％)；ON隆起型46侧(28．75％)，压迹型95侧(59．38％)，远离型19侧(11.87％)；OC46侧(28．75％)全程与蝶窦外侧壁毗邻，40侧(25％)全程与后组筛窦毗邻，61侧(38.13％)与两者共邻。结论：颅底轴位HRCT扫描能够很好地评价蝶筛外侧壁毗邻的解剖关系，可以在术前为蝶筛区域手术提供精确的解剖信息，不仅能有效地提高手术的安全性，还有助于手术进路的选择及手术方案的确定。     

蝶筛区域解剖结构的CT评价及对功能性内窥镜鼻窦外科的指导意义

目的探讨CT对蝶筛区域解剖结构的评价能力,以期为功能性内窥镜鼻窦外科手术提供帮助。材料和方法冠状和横轴位薄层CT扫描54例无病变的蝶筛区域,并重建矢状位图像。结果CT图像中蝶上筛房出现率13.0％。蝶窦气化CT分型中,甲介型占8.3％,半鞍型占51.9％,全鞍型占39.8％。蝶窦中隔居正中位置占24.1％。蝶窦的其他变异有翼突气化、前床突气化、蝶骨大翼气化和蝶骨小翼气化。视神经管纵轴与蝶筛窦的毗邻关系在CT图像上分为三型,视神经管横轴对蝶筛窦的压迫关系分为四型,并统计出各型的分布情况。结论CT扫描能显示蝶筛区域与功能性内窥镜鼻窦外科手术有关的绝大部分解剖结构及其变异,对手术有很大的指导作用。     

正常筛窦与蝶窦和视神经管毗邻关系的CT表现及临床意义

观察后组筛窦与蝶窦和视神经管的相互关系，为诊断鼻窦疾病及临床手术提供依据。材料与方法对３００例正常人筛，蝶窦进行ＣＴ扫描，其中３４例行横断加冠状扫描，２２１例扫描，４５例行冠状扫描。结果：根据后组筛窦与蝶窦的位置关系，将后组筛窦分为蝶前型，蝶侧型和蝶上型；     

视神经管与蝶筛窦毗邻关系的多层螺旋CT研究

(242侧)、筛旁型26.7%(139侧)、筛蝶型22.3%(116侧);蝶上筛房形成者中,3、4级视神经管及筛旁型、筛蝶型视神经管发生率较蝶前筛房者均明显提高(X2值分别为117.4、201.2,P值均<0.01).前床突气化者89.1%(57/64)为4级视神经管,10.9%(7/64)为3级.结论 鼻窦MSCT容积扫描、结合MPR技术多方位连续、动态观察可准确显示视神经管与周围结构立体关系,为鼻内镜手术安全实施提供可靠依据.     

蝶窦影像解剖学研究进展

随着蝶窦和鞍区经鼻内镜手术的广泛开展．有关蝶窦及其与邻近结构特别是颈内动脉和视神经管等关系的解剖学和影像学研究受到国内外学者的高度重视。研究结果表明．蝶窦的气化发育及其与毗邻结构之间存在复杂的解剖变异，术前蝶窦区域的检查包括X线平片、MRI及CT扫描，尤其是CT扫捕，可清晰揭示蝶实及其毗邻结构的断面解剖与变异。为临床提供详尽的资料，对治疗方案的选择，确定手术路径．评估手术难度及预防术中并发症具有重要的价值。     

鼻副窦CT表现对鼻内窥镜手术的临床意义（附56例分析）

目的：分析鼻窦CT表现并探讨对内窥镜手术的指导价值。方法：收集分析经手术病理证实的56例鼻窦炎的术前CT片并分析其CT表现。结果：（1）术前CT片可确定病变的程度和范围;（2）中鼻道及鼻窦解剖变异;中鼻甲气化11例,中鼻甲偏曲21例,钩突异常3例,Haller气房9例;（3）筛窦和蝶窦毗邻解剖变异;纸板缺如或破坏3例,视神经管突人后组筛窦1例,双侧颈内动脉与蝶窦毗邻4例。结论：鼻窦CT扫描对功能性鼻内窥镜手术有肯定指导价值,是术前必不可少的检查手段。     

CTVE技术在神经内镜经鼻蝶窦垂体腺瘤手术中的应用价值

目的探讨CTVE技术在神经内镜经鼻蝶窦垂体腺瘤手术中的应用价值。方法在20例行鼻蝶窦垂体腺瘤手术患者中,对常规术前垂体CT检查数据进行CTVE重建,将其用于术前计划以及术中定位。对CTVE显示的鞍底三维图像与术中显微镜所见图像进行对比分析。结果 CTVE能以三维图像的形式对鞍底解剖结构进行显示,对解剖结构：蝶窦内隔、鞍底、颈内动脉隆起、视神经管隆起以及O-C隐窝的显示率分别为100.00%、100.00%、42.50%、40.00%及72.50%,均显著高于术中显微镜显示范围;通过对观察阈值的调高,CTVE可以清楚地显示鞍底深面的颈内动脉、垂体组织、部分视神经管,通过二维图像,可准确地标出肿瘤在CTVE图像上的具体部位。结论 CTVE可显示蝶窦以及鞍底的表面解剖标志同深面结构的三维解剖之间的关系,在经鼻蝶窦垂体腺瘤手术中,CTVE能够很好地指导术前计划以及术中定位。     

视神经管骨折CT分型诊断(附19例分析)

目的　探讨视神经管骨折CT分型。材料与方法　对 19例外伤性视神经管骨折进行CT分型。结果　将视神经管骨折分为 3型 :( 1)管内型 ( 10例 ) ;( 2 )管外型 ( 7例 ) ,又分为颅口型和眶口型 2个亚型 ;( 3)混合型 ( 2例 )。结论　视神经管骨折CT分型诊断有助于临床确定手术适应证和制定手术方案     

视神经管骨折HRCT检查的临床意义

目的：探讨HRCT检查对视神经管骨折的临床意义。方法：对外伤性视神经伤患者12例行视神经管HRCT扫描,骨算法重建,对骨折的CT表现进行分析。结果：12例患者共14只眼视神经管骨折,视神经管内壁骨折8例,其中内壁为蝶窦壁6例、筛窦壁2例。外壁骨折3例,视柱骨折1便,上壁骨折3例,下壁骨折5例。视神经管骨折CT表现可分为4型：（1）线形型骨折;（2）凹陷型骨折;（3）粉碎型骨折;（4）混合型骨折。14只眼视神经管骨折中9只眼视神经管骨折是颅底骨折的一部分。结论：HRCT检查可提高视神经管骨折的诊断水平,为临床选择治疗方案提供影像依据,具有重要临床意义。     

CT在肺中央型类癌诊断和鉴别诊断中的价值

目的:探讨CT在肺中央型类癌诊断和鉴别诊断中的价值。方法:收集18例肺中央型类癌,对其CT表现进行回顾性分析,CT表现包括病变部位、形态、增强后改变、间接征象(阻塞性改变、淋巴结转移、转移征象)。结果:病变完全位于管腔内8例(44.4%),位于管腔外1例(5.6%),同时累及管腔内外者9例(50.0%)。病灶大小:小于2cm者3例(16.7%),2cm~5cm者11例(61.1%),大于5cm者4例(22.2%)。明显强化者10例(55.6%),其中,均匀强化者6例,不均匀强化者4例;没有明显强化者8例(44.4%)。同侧纵隔淋巴结肿大1例,对侧淋巴结也肿大者1例,没有淋巴结肿大者16例。远处器官转移者1例(肝脏)。结论:综合分析CT表现有助于肺中央型类癌的诊断和鉴别诊断。     

Variations of sphenoid and related structures

The aim of this study was to delineate the precise relationship between the sphenoid sinus and internal carotid artery and the optic nerve, as well as to assess incidence of the anatomic variations of these structures. A review of 92 paranasal sinus tomographic scans was made for anatomic variations of the sphenoid sinus and related bony and neurovascular structures. Coronal and axial tomographic sections were obtained with 2.5-mm section thickness. We assessed the protrusion of the internal carotid artery (ICA) and the optic nerve (ON) into the sphenoid sinus, bone dehiscence of these structures, and pneumatization of the anterior clinoid process (ACP) and pterygoid recess (PR), as well as the variations of the sphenoid sinus septum. The protrusion of the ICA into the sphenoid sinus was found in 24 (26.1 %) patients. An ON protrusion was present in 29 (31.5 %) patients. Pneumatization of the PR was encountered in 27 (29.3 %) patients. There was not a statistically significant relationship between the pneumatization of the PR and ICA protrusion into the sphenoid sinus (χ ² = 0.258, p = 0.168). A significant relationship between the ACP pneumatization and protrusion of the ON into the sphenoid sinus was found (χ ² = 0.481, p = 0.007). Preoperative recognition of the anatomic variations by the radiologist is beneficial for identification of the limits of dissection. This is particularly important in the sphenoid sinus area where extensive pneumatization of the skull base bones may distort the anatomic configuration. Therefore, axial and coronal CT sections should always be obtained prior to any surgery in the sphenoid sinus area. Received: 27 January 1999; Revised: 12 August 1999; Accepted: 1 September 1999     

The unprotected parasphenoidal carotid artery studied by high- resolution computed tomography

A retrospective review was made of 500 consecutive thin-section axial CT scans of the adult sphenoid sinus using contrast enhancement and the bone algorithm to determine whether there was exposure of the cavernous sinus and the carotid arteries along their parasphenoidal course. At least one cavernous-carotid complex that could be considered at risk during sphenoid sinus surgery was seen in 31.4% of the patients. Of this group, 14.4% of the patients had no bony covering on one or both sides at some point along the parasphenoidal course. In 17% the bony covering was so thin it would give minimal, if any, protection from surgical trauma. A patient who had laceration of an unprotected carotid artery with development of post-traumatic aneurysm is discussed.     

Dynamic CT of the laterosellar extradural venous spaces

We evaluated the ability of dynamic CT scanning to accurately demonstrate the laterosellar extradural venous spaces. Careful examination of 680 consecutive patients with this technique has permitted us to describe four main venous groups: the veins of the lateral wall (present in 98% of cases), the vein of the inferolateral group located beneath cranial nerve VI (present in 92% of cases), the medial vein located between the internal carotid artery and the pituitary gland (present in 20-30% of cases), and the vein of the carotid sulcus located between the intracavernous internal carotid artery and the lateral wall of the sphenoid bone (present in 65% of cases). The vein of the carotid sulcus is absent only when the internal carotid artery lies close to the sphenoid bone. In 12 patients with suspected cavernous sinus invasion, dynamic CT scanning demonstrated obliteration of the vein of the carotid sulcus. In five patients with huge tumors of the temporal region, dynamic CT scanning of the cavernous sinus permitted demonstration of normal laterosellar extradural venous spaces, thus permitting exclusion of intracavernous sinus invasion. We believe dynamic CT is the imaging technique best suited for studying the laterosellar extradural venous spaces. Its spatial resolution and dynamic capacity make it superior to MR, and it should be the first procedure when invasion of the cavernous sinus by a pituitary tumor is suspected.     

Evaluation of variations in sinonasal region with computed tomography

AIM: To investigate the frequency of anatomical variations in sinonasal region and association of these variations with mucosal diseases.METHODS: The study included 400 cases (191 female and 209 male) who were considered to have preliminary diagnoses of sinonasal pathology and who had paranasal sinus computed tomography (CT) examination in axial plane. Reformatted CT images were studied in all planes.RESULTS: Age range of the patients was 20-83 (mean 40.26 ± 14.85). Most commonly detected anatomical variation was Agger nasi cell (74.8%). There was a significant association between clinoid process pneumatization and protrusion of internal carotid arteries and optic nerves into sphenoid sinus (P < 0.001). Besides, the relationships between pterygoid process pneumatization and protrusion of vidian nerve into sphenoid sinus, and between pneumatization of large sphenoid wing and protrusion of maxillary nerves into sphenoid sinus were also significant (P < 0.001). Uncinate bulla and giant ethmoid bulla were found to be significantly associated with sinonasal mucosal diseases (P = 0.004 and P = 0.002, respectively).CONCLUSION: Sinonasal region has a great number of variations, and some of them have been determined to be associated with sinonasal mucosal disease. It is necessary to know that some of these variations are associated with protrusion of significant structures such as carotid artery or optic nerve into the sinus and care should be observed in surgeries on patients carrying these variations.     

真菌性蝶窦炎的影像诊断和鉴别诊断

目的:探讨蝶窦真菌感染的影像学特征、诊断和鉴别诊断。方法:回顾性分析11例经病理证实的真菌性蝶窦炎的临床和影像学检查资料。结果:CT与MRI表现为窦腔内结节样软组织密度影8例(73%);伴有沙粒状、小条片状、团块状的钙化6(45%)例;累及后组筛窦5例(45%),伴窦腔扩大7例(64%);局限性骨质增生和破坏4例(36%)。结论:真菌性蝶窦炎具有较特征性影像学表现,鉴别诊断要考虑一般性炎症、息肉、粘液囊肿和肿瘤。     

非创伤性视神经管病变的CT、MRI表现

目的:探讨非创伤性视神经管病变的CT、MRI表现。方法:回顾性分析21例非创伤性视神经管病变的CT、MRI表现。结果:非创伤性神经管病变可引起视神经管狭窄、扩大和视神经管骨质吸收、破坏,其中引起视神经管狭窄的病变有:骨纤维异常增殖症(12例)、骨瘤(1例)、石骨症(2例)、脑膜瘤(2例);引起视神经管扩大的病变有血管畸形(1例);引起视神经管骨质吸收、破坏的病变有转移瘤(3例)。结论:CT、MRI检查对非创伤性视神经管病变引起视神经管改变的诊断起着重要作用。     

64层螺旋CT颈部动脉成像的临床应用

目的：探讨64层螺旋CT颈部动脉成像技术的临床应用。方法：回顾性分析65例经64层螺旋CT颈部动脉造影检查病例,使用对比剂跟踪技术,后处理使用容积再现技术（VRT）、最大密度投影（MIP）、多平面重建（MPR）、曲面重建（CPR）、仿真内窥镜（CTVE）等技术重建,分析其发育变异、斑块性质、狭窄程度等情况,并结合临床进行分析。结果：65例130条颈动脉中,34条无异常,颈内动脉瘤8条,粥样斑块并狭窄88条。88条狭窄的颈动脉中,轻度狭窄59条（67.0%）,中度狭窄22条（25.0%）,重度狭窄5条（5.7%）,闭塞2（2.3%）条;130条椎动脉中,正常52条,先天性变异27条,粥样斑块并狭窄46条,椎动脉受增生骨质压迫5条。51条狭窄的椎动脉中,轻度狭窄40条（78.4%）,中度狭窄8条（15.7%）,重度狭窄3条（5.9%）。结论：应用64层螺旋CT颈部CTA检查,可同时完成颈动脉与椎动脉血管成像,准确显示血管病变的类型、程度,为临床治疗提供科学的依据。     

脑CTA与CT灌注成像在TIA病因诊断中的价值

目的:探讨脑CT血管造影与CT灌注成像在短暂性脑缺血发作(transient ischemic attack,TIA)病因诊断中的价值。方法:对20例临床诊断为TIA的患者行64-SCTP检查及头颈部64层CT血管造影(64-SCTA)检查,前循环TIA11例,后循环TIA9例,测定兴趣区及对侧相应区域局部脑血流量(rCBF),局部脑血容量(rCBV),平均通过时间(MTT)和达峰时间(TTP)。结果:20例患者头颅CT平扫均未发现与临床症状相对应的病灶,但有13例CT脑灌注成像发现与临床症状相对应的异常灌注区,其中10例前循环TIA患者发现灌注异常区,TTP、rCBF、MTT值与健侧对照区差异均有显著性意义(P0.05),rCBV与健侧对照区差异无显著性意义(P0.055);3例后循环TIA患者发现枕叶有灌注异常;CTA发现10例前循环血管狭窄,6例后循环血管狭窄。结论:脑64-SCTP成像可以多参数评估TIA患者血流动力学改变,以TTP及MTT最敏感,CBF次之;脑64-SCTP结合头颈部CTA,对TIA病因诊断有着重要的临床价值。