常规腰椎间盘CT扫描——椎管延长征与不典型椎弓峡部裂

目的分析L4和L5常规腰椎间盘CT扫描椎管前后径延长征与腰椎峡部裂的关系;探讨该征象对峡部裂假性椎间盘膨出与真性椎间盘膨出的鉴别诊断价值;验证补充椎弓峡部反机架角扫描的意义。资料与方法对28例椎管延长椎节做上下终板层面椎管前后径测量,并与正常组38例进行对比分析。椎管延长病例全部行反机架角扫描。结果对崩裂组和对照组L5进行P检验:男性:终板上缘为P1=0.21,终板下缘P2<0.01;女性:终板上缘P3<0.05,终板下缘P4<0.01。发现椎体下缘终板层面椎管前后径增大和对照组比较有显著差异。反机架角扫描全部病例均显示双侧椎弓峡部裂。结论当椎节无明显滑移时,腰椎峡部裂极易误诊或漏诊,椎间盘扫描椎管前后径延长征是主要间接征象,补充椎弓峡部反机架角扫描对峡部裂诊断有重要价值。     

甲状腺病变的CT诊断

1　甲状腺的 CT解剖简介甲状腺分左、右两叶 ,中间以峡部相连 ,呈蝴蝶形 ,峡部相当于蝶体 ,两叶相当于蝶翼。甲状腺上缘起自甲状软骨下方或中部 ,下缘约平第 6气管环 ,甲状腺峡部居中 ,位于气管正前方 ,左、右两叶分别居气管左、右两侧。正常甲状腺的前后径 (即厚度 ) 2～ 3cm,左叶或右叶的左右径 (即宽度 ) 2～ 3cm,上下径 (即长度 ) 6～ 7cm。女性的各径略比男性为小。由于正常甲状腺含碘量比周围软组织高 ,故 CT平扫呈高密度 ,密度均匀 ,边缘清楚 ,CT值约 70± 10 HU,增强扫描后甲状腺呈均匀性显著强化。峡部上缘有时出现一个锥状叶 …     

斯氏位改良法(Chausse’Ⅳ位)

颅骨结构中,有关岩椎、内听道的投照方法较多,普遍认为(Shenver's)位显示单例内听道位置较佳。近年来国外学者对内听道投照方法有新的研究,我们查阅了有关资料认为,美国的和causse’Ⅳ     

上颌骨发育不足上颌窦形态的锥形束CT测量研究

目的：应用锥形束CT（CBCT）对上颌骨发育不足患者的上颌窦形态及容积进行测量，分析上颌骨发育不足患者上颌窦的形态及容积特点。方法：根据上颌长（ANS-Ptm），蝶鞍中心、鼻根点及上牙槽座点间的夹角（SNA），蝶鞍中心、鼻根点及下牙槽座点间的夹角（SNB），上牙槽座点、鼻根点及下牙槽座点间的夹角（ANB）大小，选取10例上颌骨发育不足患者及10例上颌骨发育正常者，应用NEWTOM 5G后处理软件分别测量上颌窦前后径、左右径、上下径；Mimics Research 20软件测量上颌窦窦腔容积；采用SPSS 17.0软件对数据进行统计分析。结果：上颌骨发育不足组上颌窦前后径、左右径、上下径、容积与上颌骨发育正常组比较差异均无统计学意义（均P>0.05）。结论：上颌骨发育不足与上颌骨发育正常者的上颌窦形态及容积大小相似，上颌窦的形态及容积并不是造成上颌骨发育不足的因素。     

肺气肿患者的胸廓测量

肺气肿疾病很常见 ,但对其胸廓改变的测量报道不多。我们随机抽取 81份胸部ＣＴ片。分别测量其主动脉弓平面的心前间距值及胸廓前后径与左右径比值。现报道如下。1　材料及方法81例中 ,男 6 0例 ,女 2 1例 ,年龄 18～ 81岁 ,平均 48岁。其中诊断为肺气肿者 44例 ,所有病人均采用德国Ｓｏｍａｔｏｍ ,ＤＲ3 全身ＣＴ机扫描 ,矩阵 5 12× 5 12 ,常规扫描。2　结果在主动脉弓平面测量其心前间距及胸廓前后径与左右径比值见附表。附表　胸廓测量值心前间距(平均值Ｘ　ｃｍ)胸廓 前后径左右径 比值(平均值　ｒ)肺气肿 1.6 32 0 .6 2 5正　常 1.2 …     

口服对比剂CT检查下咽环杓后区解剖测量值的临床价值

目的探讨口服对比剂后螺旋CT扫描环杓后区解剖结构的显示及其测量值的临床价值。资料与方法观察43例病人口服对比剂后环杓后区解剖结构的CT影像。分别测量杓状软骨上缘水平、环状软骨上缘水平及环状软骨下缘水平下咽前壁厚度、后壁厚度和前后壁厚度之和。测量数据分别采用配对t检验和独立样本t检验进行统计学分析。结果不同性别病人的杓状软骨上缘水平、环状软骨上缘水平及环状软骨下缘水平下咽前壁、后壁厚度分别比较,差异无统计学意义(P0.05)。男性杓状软骨上缘水平下咽前后壁厚度之和大于女性[男性(9.27±2.51)mm,女性(7.96±1.46)mm;P0.05]。环状软骨上、下缘水平的下咽前后壁厚度之和差异无统计学意义(P0.05)。同性别病人下咽前、后壁厚度比较显示,男性和女性病人环状软骨上、下缘水平的下咽后壁厚度均大于下咽前壁,而杓状软骨上缘水平的下咽后壁厚度均小于下咽前壁(均P0.05)。结论口服对比剂后螺旋CT扫描可以勾画出环杓后区解剖形态,弥补了临床喉镜的不足,并能提供不同层面解剖测量值,为疾病的早期发现和术前分期提供准确的影像学依据。     

听神经瘤的MRI诊断

分析手术和病理证实的７６例７８个听神经瘤的ＭＲＩ表现，其中２例为内听道内微小听神经瘤，１１例作静脉注射Ｇｄ－ＤＴＰＡ后ＭＲ成像。下列特征有助于听神经瘤诊断：（１）肿瘤以第Ⅶ、Ⅷ神经束为中心生长，病侧Ⅶ、Ⅷ神经束明显增粗，与桥小脑角肿瘤多无明确分界。（２）Ｔ＿２加权图像肿瘤呈低信号或低等混合信号，Ｔ＿２加权图像呈高信号或高等混合信号。（３）注射Ｇｄ－ＤＴＰＡ后肿瘤实质多呈不均匀强化，囊变区无强化。（４）绝大多数肿瘤患侧内听道前后径增大，深径缩短。静脉注射Ｇｄ－ＤＴＰＡ对诊断微小听神经启往往甚为有效。     

16层螺旋CT内听道底孔道多平面重建研究

目的采用多层螺旋CT多平面重建研究内听道底孔道的CT表现,为诊断内听道底部的病变及手术操作提供相应的依据。方法对30例(60耳)正常成人颞骨行CT扫描,采用多平面重建(MPR)对内听道底各孔道进行测量。结果内听道底前后径(4.07±0.97)mm,上下径(3.24±0.88)mm;面神经管迷路段长度(3.04±0.52)mm,宽度(0.96±0.31)mm;前庭上神经管长度(2.52±0.48)mm,宽度(0.83±0.30)mm;蜗神经管长度(0.89±0.19)mm,宽度(2.05±0.39)mm;前庭下神经管长度(1.07±0.23)mm,宽度(0.73±0.21)mm;单神经管长度(3.56±0.68)mm,宽度(0.56±0.11)mm。结论多层螺旋CT多平面重建可以明确内听道底形态及各孔道情况,为病变诊断及手术提供依据。     

原发性脾大导致左肾积水及左侧输尿管上段囊状扩张1例

患者女，44岁，间断性腹胀1a，加重10d入院。查体：体温36．2℃，脉搏84次／min，一般状态尚佳，腹稍膨隆，肝肋下未触及，脾大，超声所见：脾厚约8．9cm，肋下：上缘达剑突，下缘平脐水平．右缘于右锁骨中线内侧，脾门处脾静脉内径约1．9cm。左肾大小正常，周边规则，实质回声均质，集合系统可见分离，内为不规则液性暗区，最大厚度约1．2cm，内透声好。     

内听道摄片架的制作与应用

目前内听道的检查方法较多，如内听道摄片、CT、MRI等。但内听道的常规摄影仍为首选，既经济又实用。但在传统投照方法中，由于内听道的大小、形状存在个体差异，对同一个病人必须双侧对比摄片，病人仰卧，头颅矢状面垂直于台面，听眦线垂直于台面，这种姿势对颈粗短与偏胖病人要求高且固定方法不方便，使两侧内听道准确对称投照难度大。为此，我们设计了内听道摄片架。     

体表乳突面积的测量方法

目的:探讨体表乳突面积的测量方法,测量正常乳突面积。方法:①评价CT影像测量相关结构的正确性,采用64层螺旋CT对4具干颅标本进行扫描,在矢状位乳突显示最大截面分别测量乳突厚度(即外耳道下壁最低点至乳突后缘水平距离)和乳突高度(即外耳道下壁最低点至乳突尖的垂直距离);按影像层面对上述距离行实体测量。影像测量均值与实体测量均值的差异行显著性检验;②在体研究:随机入选无耳部疾患的118人(236侧),其中女性63例(126侧),男性55例(110侧),在体表上测量乳突厚度(设外耳门后缘最凸点为A点,自A点向后方引水平线与乳突后缘相交于B点,A、B两点间的直线距离代表乳突厚度)和乳突高度(以乳突尖为C点,自C点向AB线引垂直线,相交于D点,则CD两点间的直线距离代表乳突的高度),然后行颌面部扫描面CT扫描。以研究第一部分的方法选择层面,并测量乳突厚度和乳突高度,以乳突厚度与高度乘积的1/2定义乳突面积,同时在体表乳突测量值与影像乳突测量值之间行直线相关和回归分析。结果:①实验部分:各项指标的影像测量值与实体测量值差异无统计学意义(P0.05);②在体研究:各项指标测量结果侧别差异无统计学意义(P0.05),性别差异有统计学意义(P0.05)。体表乳突测量值和影像乳突测量值之间呈正相关,且相关有统计学意义(P0.001)。结论:此测量方法简单、可重复性强,可利用体表乳突面积评估颞骨内部乳突面积。     

进驻海拔5000m以上地区一年青年心脏体积X线观察

本文对进驻海拔５０００ｍ以上地区一年的５８名青年在现场拍摄正、侧位Ｘ线胸片并与平原时相比较，结果：心脏长径及心胸比率显著较小（Ｐ〈０．００１）；心脏面积缩小，但相关不显著（Ｐ〉０．０５）；心脏宽径，心脏深径、心脏体积及心脏体积指数显著增加（Ｐ〈０．００１或Ｐ〈０．０１）；右心房宽径、右心房高径、左室壁厚度、肺面积、升主动脉模径、主动脉结构横径、肺动脉干横径、肺动脉段突度，右肺下动脉横径及右肺下动脉     

Detection of acoustic schwannoma: use of constructive interference in the steady state three-dimensional MR.

PURPOSETo compare constructive interference in the steady state (CISS) three-dimensional Fourier transform (3DFT) MR imaging with contrast-enhanced T1-weighted spin-echo MR imaging for accuracy in detecting acoustic schwannoma.METHODSOne hundred twenty-five consecutive patients with possible acoustic schwannoma were examined. The accuracy of CISS-3DFT MR imaging in detecting abnormalities of the cerebellopontine angle, the internal auditory canal, and the inner ear was compared with T1-weighted contrast-enhanced spin-echo MR imaging by independent assessment of both image sets by two observers.RESULTSThe postcontrast T1-weighted MR images revealed 18 cases of unilateral disease of the cerebellopontine angle and/or the internal auditory canal and no case of an abnormal bilateral cerebellopontine angle and/or internal auditory canal. Twelve cases were pathologically proved acoustic schwannomas. One meningioma of the cerebellopontine angle and one metastatic ependymoma to the cerebellopontine angle and the internal auditory canal was encountered. The four remaining cases had a provisional diagnosis of acoustic schwannoma and were scheduled for follow-up imaging and clinical review. Analysis of whether contrast material would have been administered to the appropriate patients (ie, those with disease of the cerebellopontine angle and/or internal auditory canal) according to CISS MR imaging findings revealed a sensitivity of 100% and a specificity of 98% for observer 1 and a sensitivity of 94% and a specificity of 94% for observer 2.CONCLUSIONCISS-3DFT MR imaging, in this patient population, provided high sensitivity and specificity in detecting lesions of the cerebellopontine angle and internal auditory canal; however, further experience is required before a definitive statement regarding the suitability of this technique as a screening procedure can be made. When contrast material cannot be administered, CISS MR imaging may be considered an adequate examination for the evaluation of possible acoustic schwannoma.     

Direct sagittal CT in the evaluation of temporal bone disease

The human temporal bone is an extremely complex structure. Direct axial and coronal CT sections are quite satisfactory for imaging the anatomy of the temporal bone; however, many relationships of the normal and pathologic anatomic detail of the temporal bone are better seen with direct sagittal CT sections. The sagittal projection is of interest to surgeons, as it has the advantage of following the plane of surgical approach. This article describes the advantages of using direct sagittal sections for studying various diseases of the temporal bone. The CT sections were obtained with the aid of a new head holder added to our GE CT 9800 scanner. The direct sagittal projection was found to be extremely useful for evaluating diseases involving the vertical segment of the facial nerve canal, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, sinodural angle, carotid canal, jugular fossa, external auditory canal, middle ear cavity, infra- and supralabyrinthine air cells, and temporomandibular joint.     

A radiologico-anatomical comparative study of the cochlear aqueduct

AIM: A comparative radiologico-anatomical study of the cochlear aqueduct (CA) was performed. MATERIALS AND METHODS: Eight cadavers and 23 dry temporal bones were studied. High-resolution computed tomography (HRCT) was carried out on each cadaver before microdissection. Microdissection was carried out in a plane parallel to the HRCT sections. RESULTS: The CA was found to be located an average of 7 mm inferior to the internal acoustic meatus and at the superior edge of the jugular foramen. The external aperture of the CA was triangular in shape in 18 bones (78.3%). The petrosal fossa was located just inferior to the external aperture and housed the glossopharyngeal nerve, which had an incomplete bony canal in four bones (17.4%) and a complete bony canal in three bones (13%). It was possible to demonstrate the petrosal portion of the CA on both coronal and axial HRCT. The otic capsule segment of the CA was impossible to demonstrate on coronal sections. CONCLUSION: The CA cannot be visualized in only one section of the plane in HRCT. Both the otic capsule and petrosal segments can be demonstrated on axial HRCT.     

The current state of the radiological diagnosis of acoustic neuroma

Summary Thin, overlapping section, contrast-enhanced, axial and coronal CT, with additional highresulution (HR) treatment of the sections through the internal auditory canal, was performed on 31 patients clinically suspected of acoustic neuroma. With this technique 13 acoustic neuromas protruding more than 10 mm and eight acoustic neuromas protruding between 2 and 10 mm outside the internal auditory canal were unequivocally diagnosed. O₂CT cisternography was performed on ten patients. An intracanalicular neuroma was diagnosed in three cases with this technique, also a small extracanalicular neuroma in one case, and an acoustic neuroma was definitely excluded in six cases. It is concluded that O₂CT cisternography is the diagnostic procedure of choice for the detection of purely intracanalicular neuromas and the definite exclusion of acoustic neuroma. HR CT proved superior to polytomography for the evaluation of the internal auditory canal and should be performed in every case suspected of acoustic neuroma. A protocol for the radiological investigation of patients suspected of acoustic neuroma is given     

胸椎经椎弓根内固定器的研制与生物力学的测试

为设计一种胸椎经椎弓根内固定器 ,同时与Dick钉进行生物力学对比研究 ,用游标卡尺对 10具成人胸1～ 11椎体干燥标本、2 0份MRI和CT片的椎弓根高度、宽度、长度、进钉点及椎弓根轴线的角度、椎弓根之间的宽度、椎弓根的毗邻等进行观测 ,并将 10具新鲜成人尸胸2 ～胸11椎体标本制成屈曲压缩骨折模型和屈曲牵张型损伤模型 ,用Dick钉和ARRIF Ⅱ型分别固定在胸7和胸10 及胸4 和胸6的椎弓根内 ,进行三维方向上的生物力学测试。结果确定进钉点在上位椎体下关节突下缘的外缘线上 3mm处 ,与矢状线的夹角在 15°～ 2 0°。胸4 以上椎体可容纳直径 4 0mm、长度 3 0～ 3 5cm的椎弓根螺钉 ,胸4 以下椎体可容纳直径 5 0mm、长度 3 5～ 4 0cm的椎弓根螺钉。ARRIF Ⅱ型在三维方向上具有较好的应力遮挡 ,抗扭转力矩较Dick钉大 ,ARRIF Ⅱ型椎弓根螺钉均在椎弓根内。说明胸椎经椎弓根螺钉可较安全地置入椎弓根 ,内固定器能很好地复位骨折椎体 ,间接减压椎管。     

2D time-of-flight MR venography in neonates: anatomy and pitfalls

BACKGROUND AND PURPOSE: The dural venous sinuses in neonates differ from those in adults or older children in that the caliber of venous sinuses is smaller and there is skull molding. The aim of this retrospective study is to evaluate the presence of flow gaps in venous sinuses in neonates on 2D time-of-flight (TOF) MR venography (MRV). METHODS: Fifty-one neonates underwent coronal 2D TOF MRV. Nine also had CT venography (CTV) for comparison. In 1 neonate, a further 2D TOF MRV was performed in the sagittal plane; in another neonate, images were captured in the axial plane; and in another, a further coronal TOF MRV with shorter echo time was performed. RESULTS: Flow gap was seen in the posterior aspect of the superior sagittal sinus in 35 of 51 (69%). Focal narrowing of the superior sagittal sinus, in the region of convergence of lambdoid sutures, was detected in 7 of 51 (14%). The right and left transverse sinuses demonstrated flow gap in 13 of 51 (25%) and 32 of 51 (63%) respectively. There was normal filling of contrast on CTV in the superior sagittal sinus, transverse sinus and sigmoid sinus in those cases with flow gap detected on coronal 2D TOF MRV. Right, left, and codominance of the transverse sinuses are as follows: 32 of 51 (63%), 5 of 51 (10%), and 14 of 51 (27%), respectively. The right and left sigmoid sinuses demonstrated flow gap in 7 of 51 (14%) and 8 of 51 (16%), respectively, and the left sigmoid sinus was absent in 1 of 51 (2%). CONCLUSION: The high proportion of flow gap in the venous sinuses of neonates, particularly of the superior sagittal sinus, could be attributed to the smaller caliber venous sinuses, slower venous flow, and skull molding.     

Plain radiography and tomography of the internal auditory canal for the diagnosis of acoustic neuroma

In the series of 50 acoustic neurinomas (AN) the internal auditory canal (IAC) diameter and the diameter difference between the tumor and non-tumor side are compared with the sizes of the AN. No correlation is found. About 50% of the AN cases had normal ipsilateral IAC in plain and tomographic radiographies. A pathological IAC finding strongly favours AN, but the border between a normal and pathological finding is not an exact one. A normal plain and tomographic radiography does not exclude AN and further investigations cannot be avoided. Our conclusion is that plain radiograms and tomograms have no place in the modern diagnosis of AN.     

High-resolution MR cisternography of the cerebellopontine angle, obtained with a three-dimensional fast asymmetric spin-echo sequence in a 0.35-T open MR imaging unit.

High-resolution MR cisternography performed with 3D fast asymmetric spin-echo imaging (3D fast spin-echo with an ultra-long echo train length and asymmetric Fourier imaging) was optimized in a 0.35-T open MR imaging unit. The 0.35- and 1.5-T images of the two volunteers and three patients with acoustic schwannomas were then compared. The optimal parameters for images obtained by 3D fast asymmetric spin-echo imaging at 0.35 T were as follows: field of view, 15 cm; matrix, 256 x 256 x 40; section thickness, 1 mm; echo train length, 76; and imaging time, 10 minutes 44 seconds. Scans obtained from both normal volunteers showed the facial, cochlear, and superior and inferior vestibular nerves separately in the internal auditory canal on both 0.35- and 1.5-T images. All three acoustic schwannomas were depicted on both 0.35- and 1.5-T images. Screening for disease at the cerebellopontine angle and in the internal auditory canal, without the administration of contrast material on a low-field open MR imaging unit and within a clinically acceptable imaging time, may be possible. Further controlled prospective studies are required, however, before implementation on a wide basis. If proved effective, this may be of particular value for reducing healthcare costs and for imaging claustrophobic and pediatric patients in an open system.