正常耳部解剖的高分辨CT研究

目的：利用高分辨ＣＴ（ＨＲＣＴ）研究耳部解剖结构，以便术前能了解有无解剖变异和估价病变范围及与邻近结构的关系。材料和方法：选择５０例临床上除外耳部病变的病人，作横断面和冠状面ＨＲＣＴ扫描；将所获图像与干颅扫描图像及将重要结构注入石膏后扫描的图像进行对照。结果：通过上述方法总结出横断扫描（以眶上耳线为基线向上扫描）由下至上８个层面和冠状扫描（由外耳道后缘１ｃｍ处向前扫描）的由后向前７个层面的耳部各结构的解剖所见。结论：耳部ＨＲＣＴ对耳部的精细解剖结构能直观地显示，由于它能清楚显示颞骨岩部的全貌，对术前选择手术入路和术式有很高价值。     

高分辨率CT扫描及重建技术在颞骨岩部检查中的应用

目的：探讨１ｍｍ高分辨率ＣＴ扫描及重建技术对显示耳部结构的实用价值。方法：本文选取５０例正常耳,对其中２７例进行１ｍｍ轴位扫描及二维重建,另２３例进行３ｍｍ轴位扫描及二维重建,部分进行三维重建,并分组对轴位扫描及冠状面重建图像进行比较。结果：统计学处理后表明采用一定的扫描及重建技术,１ｍｍ薄层扫描优于３ｍｍ扫描及重建图像。结论：对１ｍｍ扫描图像进行二维及三维重建,能够有效地减少伪影,立体地了解耳部结构,提供更多的耳部信息。     

颌面部直接矢状位CT扫描方法

颌面部直接矢状位ＣＴ扫描(简称矢扫),能清楚显示颌面部有关矢状面上的解剖结构,弥补了轴位ＣＴ扫描(简称轴扫)及冠状位ＣＴ扫描(简称冠扫)的不足[1,2]。根据诊断要求作者对蝶鞍区、鼻腔、鼻窦、眼眶、口腔等处病变的常规ＣＴ扫描上仍不能明确诊断的患者,加作直接矢扫,获得了满意的效果,现将其方法介绍如下。材料及设备　荷兰ＰｈｉｌｉｐｓＴｏｍｏｓｃａｎ350型全身ＣＴ扫描机,直接矢扫附件及副检查床;多幅照相机摄片。方法　ＣＴ扫描机架向主检查床侧倾斜20°,放下垂直于副检查床的金属板开关,将附加床垫置于机架和副检查床间,患者俯卧其…     

自制胸部冠状面扫描支撑架与螺旋CT配套使用在诊断儿童气道疾病中的价值

气道疾病是儿童常见的呼吸道急症 ,胸部ＣＴ的应用报道较少[1,2 ] ,且多为轴面扫描 ,对气道的显示不及冠状面 ,即使是螺旋ＣＴ的冠状面重建 ,图像质量也不佳[3 ] 。为弥补上述缺陷 ,结合儿童特点 ,笔者自行设计制作了一儿童胸部冠状面扫描支撑架 (专利申请号 :0 12 49894 7) ,与螺旋ＣＴ配套进行直接胸部冠状面螺旋扫描 (简称 :冠扫 ) ,探讨其在儿童气道疾病中的应用价值 ,并与轴面螺旋扫描 (简称 :轴扫 )对比分析。一、材料与方法1 一般资料 :对 113例临床疑为气道疾病患儿行轴扫后不能确定诊断的再进行冠扫 ,选择经支气管内窥镜手术及病理…     

副鼻窦口的HRCT解剖研究及临床意义

冠状位ＨＲＣＴ薄层扫描及保留数据再次重建放大技术显示鼻窦开口的细微结构，分析其正常、变异及病变。材料和方法：头颅标本一个、颅骨标本两个，制成１ｃｍ厚的冠状位切片以显示各窦口，正常人副鼻窦冠状位扫描６例，手术证实的鼻窦慢性炎症７０例，均为冠状位扫描后保留数据重建放大，层厚及层距５ｍｍ。结果：冠状位ＣＴ清晰显示：额窦开口额隐窝，上颌窦及前组筛窦开口筛漏斗及半月裂隙，后组筛窦及蝶窦开口蝶筛隐窝。７０例炎症患者的窦口均有狭窄或阻塞。结论：用ＨＲＣＴ冠状位薄层扫描后保留数据再次重建放大技术可清晰显示各副鼻窦开口，而窦口的通畅与否与炎症的发生密切相关。     

先天性外耳道狭窄的CT分析（附30例报告）

目的：分析先天性外耳道狭窄合并鼓室，听小骨畸形的ＣＴ表现，材料与方法，对经过电镜检查诊断为传时性耳聋者３０例４０耳进行横断及冠状位ＣＴ扫描，结果：４０耳中有３４耳呈骨性外耳道狭窄，６耳呈膜性外耳道狭窄，２６耳合并有鼓室狭窄，１９耳合并有面神经管乳突段前位２９耳合并有听小骨畸形。结论：经高分辨率ＣＴ对颞骨进行横断及冠状位扫描综合分析后即可获得外。内耳的三维造影资料，为临床提供影像学依据，     

体部直接冠状位CT扫描

体部直接冠状位ＣＴ扫描 (以下简称冠扫 )是利用现代ＣＴ机孔径大、扫描速度快的特性 ,采用特定的体位 ,根据检查部位分段进行体部冠扫 ,以弥补体部ＣＴ轴位扫描 (以下简称轴扫 )的不足。1　材料与方法搜集我院 1993年 5月～ 1999年 10月行常规轴扫后辅以冠扫的胸、腹部占位性病变 2 6例。男 15例 ,女 11例。年龄 9～ 46岁 ,平均 3 1岁。病变包括肝脏 7例 ,肾脏 3例 ,肾上腺 2例 ,盆腔 5例 ,胸部 9例。使用ＰｉｃｋｅｒＩＱＸｔｒａ型ＣＴ机。扫描孔径 70ｃｍ ,重建矩阵 5 12× 5 12 ,常规扫描时间 2、3、4ｓ ,层厚 2、5、10ｍｍ ,最大扫描…     

256层螺旋CT轴位与冠状位重建对窦口-鼻道复合体正常解剖及变异的对比观察

目的：探讨多层螺旋CT（MSCT）轴位和冠状位重建对窦口-鼻道复合体（OMC）区域的正常解剖结构和变异显示能力及差异。方法：利用32例健康体检者和23例因非鼻及副鼻窦疾病而行头颈部CT扫描者,常规扫描后进行轴位和冠状位标准重建,分别对比观察OMC区域的正常解剖结构和变异及显示能力。结果：轴位和冠状位重建图像对双侧额窦开口、中鼻甲和中鼻道的显示能力无明显差异。但轴位图像在显示筛漏斗、前中组筛窦、上颌窦开口及钩突等的显示能力明显较冠状位差。结论：对OMC区域的正常结构和变异的显示冠状位明显优于轴位,冠状位重建可以代替冠状位扫描,以消除冠状位扫描给患者带来的不便。     

颞骨的HRCT技术及临床应用

本文报告５９例耳疾病ＨＲＣＴ表现，结果表明ＨＲＣＴ不仅能够显示细微耳病变及与周围复杂结构的关系，还能提供丰富软组织信息，为目前耳疾病最有价值的影象学检查方法，同时对颞骨的ＨＲＣＴ扫描技术进行了讨论。     

耳部疾病的双螺旋CT评价

目的确定耳部疾病的双螺旋ＣＴ扫描价值。材料与方法分析经临床、手术及病理证实的１４５例１８３耳的各种疾病的ＣＴ征象及其特征。结果中耳炎８１耳,先天性耳畸形５６耳,颞骨骨折３４耳,中耳癌５耳,外耳道胆脂瘤４耳,耵聍３耳。结论双螺旋ＣＴ扫描对各种耳部疾病的诊断与鉴别诊断具有可靠的价值,可为临床制定治疗方案提供依据。     

高分辨率CT显示听小骨能力的研究

目的 探讨高分辨率CT（HRCT）单侧密集骨重建技术对听小骨细微结构的显示能力及对疾病的诊断价值。方法：收集45人，81只耳的资料，全部病例行HRCT扫描，后进行单侧局部密集骨重建，观察轴冠位的正常及异常HRCT图像对听小骨（包括砧骨豆状突，砧镫关节，镫骨前后脚、脚板）的显示情况。结果：慢性中耳乳突炎31只，外耳道先天性闭锁伴中耳发育畸形2只，颞骨骨折波及中耳1只。HRCT密集骨重建，轴冠位结合扫描，能清晰显示听小骨炎症的微小破坏，骨折等病变；结合中耳仿真内镜可清晰地显示发育畸形的听小骨。结论：HRCT能清晰，准确地显示听小骨细微结构。优于传统的CT图像，可为临床诊断和治疗提供可靠的依据。     

内耳化脓坏死性迷路炎的影像学表现

目的：探讨内耳化脓坏死性迷路炎影像学诊断价值。方法：回顾性分析6例经手术病理和临床诊断的化脓坏死性迷路炎的CT和MRI表现,总结分析其影像学特点。结果：6例行颞骨高分辨力CT扫描（HRCT）,轴面和冠状面CT均显示有不同程度内耳骨迷路的破坏,并伴软组织增生,其中4例有高密度死骨形成;MRI检查6例,显示膜迷路部分或全部为软组织病变充填,增强后不均质明显强化,死骨在T1WI、T2WI均显示为小片低信号或无信号,增强后无强化。结论：HRCT可显示骨迷路结构的破坏范围及死骨的存在,有诊断价值;MRI显示颅内并发症明显优于CT,两者结合可诊断内耳化脓坏死性迷路炎。     

正常中内耳结构的HRCT扫描

目的探讨较全面显示中内耳各细微结构的最佳扫描技术。方法对90例受试者行30°轴位、105°冠状位、层厚与间距都为1mm的HRCT扫描。观察中内耳各结构在轴位和冠状位上的表现,统计显示率;评判不同结构在两扫描方位上的显示情况,比较优显率。结果（1）30°轴位、105°冠状位扫描平面与中内耳某些结构的排列走行方向一致,能较全面显示中内耳的细微结构。（2）轴位与冠状位显示中内耳某些细微结构各有优势。结论中内耳HRCT检查,采用30°轴位、105°冠状位扫描技术,较好地显示包括神经、关节、韧带等细微结构及其毗邻关系,能为耳部显微外科手术方案的制定提供较多的依据。     

多平面重建在弥漫性肺疾病中的应用价值

目的评价多层螺旋CT(MDCT)多平面重建(MPR)对肺弥漫性病变的诊断价值。资料与方法对67例经临床确诊表现为肺内弥漫性病变的病例进行MDCT扫描和薄层冠状位MPR,并与轴位高分辨率CT(HRCT)比较。图像分析共分3组,2人3次完成阅片。结果轴位HRCT和冠状位MPR评价磨玻璃密度影、气腔样实变和小结节等高密度病灶和含气病灶的敏感度分别是100%和87%～100%,特异性分别为100%和97%～100%,差别无显著性。HRCT和MPR图像在显示肺内细网状影、线样影和牵张性细支气管扩张的敏感度分别为92%～100%和71%～100%,特异性分别为88%～100%和90%～100%,差别无显著性。HRCT和MPR图像在评价肺弥漫性病变的分布上无显著性差别。观察者对MPR评价磨玻璃密度影、气腔样实变和蜂窝影、肺气肿、肺大泡的满意度较高(95%～100%);对线样影、细网状影、小结节或微结节、牵张性支气管扩张等的满意度较低(10%～68%),差别有显著性(P<0.05)。结论目前采用1.25mm准直的MDCT扫描所得的MPR图像在评价磨玻璃密度影、肺实变、蜂窝影和肺气肿、肺大泡等病变的能力等同于轴位HRCT;评价线样影、细网状影及牵张性支气管扩张和微结节等病变的能力不及轴位HRCT。     

Computed tomography and magnetic resonance tomography of the normal temporal bone

The normal anatomy of the temporal bone and the inner ear will be described in detail on high resolution computed tomography (HRCT) and magnetic resonance images. The imaging technique of computer tomography--either single detector or multi detector CT--is normally obtained in an axial plane without the intravenous application of contrast material. The images are reconstructed in a high resolution bone window level setting. The coronal images are reconstructed either if used single detector or multi detector CT. Only in some cases a scan in the coronal plane is directly obtained using a single detector CT. MR imaging of temporal bone is usually performed in a head coil. Axial high resolution 3D-T2-weighted sequences either in fast spin echo technique or gradient echo technique--for example CISS-sequence--are obtained, then an axial high resolution T1-weighted sequence before and after the application of gadopentate dimiglumine is performed. HRCT excellently demonstrates the osseous structures of the temporal bone as well as of the inner ear, while MRI excellently depicts soft tissue structures especially those of the inner ear. Due to the susceptibility artifacts MRI is not very suitable for imaging the external auditory canal or the middle ear or the pneumatic system. In conclusion HRCT is so far excellent to delineate the osseous structures of the temporal bone and inner ear while MRI excellently depicts the soft tissue structures of the inner ear, the internal auditory canal and the cerebellopontine angle. Reissner's membrane, the cochlear duct, and the organ of Corti cannot be visualized even using high-resolution MRI. HRCT and MRI are therefore used as complementary methods for imaging the temporal bone.     

眼眶单纯内侧壁骨折的CT诊断

目的 分析和评价CT、特别是高分辨率CT（HRCT）扫描对眼眶单纯内侧壁骨折的诊断价值。材料与方法 回顾性分析30例眼眶单纯内侧壁骨折患者的CT资料。男27例,女3例。轴位扫描22例,冠状位和冠状位加轴位扫描各4例,其中25例行HRCT扫描。结果 骨折发生在眶内缘1例,筛骨眶板29例。结果 CT特别是HRCT能细致地显示眼眶内侧壁的解剖结构,能精确地显示眼眶单纯内侧壁骨折的直接、间接征象和并发症,是最重要和有价值的检查方法。     

Value of high-resolution MR in patients scheduled for cochlear implantation

Objective: To determine sensitivity and specificity of high-resolution MR imaging and of high-resolution axial CT (HRCT) and to compare the two modalities in predicting the surgical and functional success of cochlear implantation.Material and Methods: The presurgical MR images (2D T2W TSE, 3D T2*W CISS, plain and contrast-enhanced 3D T1W MP-RAGE) and axial HRCT findings of 26 patients were evaluated with regard to the predictive value concerning the success of cochlear implantation.Results: We found a high correlation between MR and HRCT and the success of cochlear implantation. In all 26 patients, the MR-based predictions concerning the success of cochlear implantation were correct. In 10 patients, MR gave additional information to HRCT. In all patients, MR gave sufficient information about the status of the inner ear, inner auditory canal and cochlear nerve to aid the surgeon during the operation.Conclusion: A high-resolution MR protocol consisting of coronal 2D T2W TSE, 3D T2*W axial CISS, plain and contrast-enhanced sagittal T1W 3D MP-RAGE is recommended for the evaluation of candidates scheduled for cochlear implantation. It provides information which cannot be obtained by HRCT.     

翼管部位病变的HRCT表现

目的　探讨翼管部位病变的HRCT表现及诊断价值。方法　回顾性分析经临床或病理证实 10 0例翼管部位的病变 ,皆行HRCT水平和冠状位扫描。结果　翼管均为继发性改变 ,分三种类型 :扩大 2 0例 (2 0 .0 % )、变窄 2 7例 (2 7.0 % )和消失 5 3例 (5 3 .0 % ) ,72例伴软组织肿块。结论　HRCT可清楚、直观显示翼管骨性结构 ,能发现翼管早期病变及准确判断病变范围 ,帮助选择最佳临床治疗方案     

中下鼓室内结节的影像学研究

目的：探讨中、下部鼓室内结节的影像学诊断价值。方法：回顾性分析23例中、下鼓室内结节的影像学表现和影像鉴别诊断,23例病例均行横断面和冠状面高分辨力CT（HRCT）及MRI平扫和增强扫描。结果：23例病例在横断面和冠状面HRCT扫描中均能显示中、下鼓室内软组织结节,除4例血管变异CT能明确诊断外,其他病例HRCT均无特征性表现。23例行MRI平扫和增强扫描,其中19例中下鼓室结节显示为实质性占位,不同病例其MRI信号有差异;4例血管变异MRI显示血管的流空征,增强后显示变异的血管影。结论：横断面和冠状面HRCT可显示中下鼓室软组织结节,但对于软组织结节的性质CT难以明确诊断,MRI对中下鼓室结节性质的诊断优于CT。     

The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas

The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas will be described in this paper. The pre- and postoperative imaging of the temporal bone was performed with HRCT and MRI.HRCT and MRI were performed in the axial and coronal plane. MRI was done with T2 weighted and T1 weighted sequences both before and after the intravenous application of contrast material. All imaging findings were confirmed clinically or surgically. The preoperative cholesteatoma-caused complications depicted by HRCT included bony erosions of the ossicles, scutum, facial canal in the middle ear, tympanic walls including the tegmen tympani, and of the labyrinth. The preoperative cholesteatoma-caused complications depicted by MRI included signs indicative for labyrinthitis, and brain abscess. Postoperative HRCT depicted bony erosions caused by recurrent cholesteatoma,bony defects of the facial nerve and of the labyrinth, and a defect of the tegmen tympani with a soft tissue mass in the middle ear. Postoperative MRI delineated neuritis of the facial nerve, labyrinthitis, and a meningo-encephalocele protruding into the middle ear. HRCT and MRI are excellent imaging tools to depict either bony or soft tissue complications or both if caused by acquired cholesteatomas. According to our findings and to the literature HRCT and MRI are complementary imaging methods to depict pre- or postoperative complications of acquired cholesteatomas if these are suspected by clinical examination.