翼状韧带的影像解剖学研究

目的 探讨翼状韧带的位置、形态及走行,并深入研究其断面解剖形态及CT和MRI表现.方法 采用经福尔马林固定的正常成人头颅标本12例,其中3例用于大体解剖观察,3例制成5.0 mm厚的冰冻切片,6例制成0.5 mm厚的薄层切片;选取2组各51例健康志愿者分别行CT和MRI检查.结合大体和断面解剖,分析翼状韧带的CT和MRI表现,并对其进行影像学测量.结果 大体和断层解剖均能清晰显示翼状韧带的位置、形态及走行.齿状突上部的横断面和齿状突中部的冠状面是显示翼状韧带的理想层面.翼状韧带在CT和MRI横断面、冠状面及矢状面上的显示率均为100%(51/51).对于翼状韧带结构的显示,MRI优于CT,尤其是质子密度加权成像的显示效果最佳.翼状韧带宽度在男女性别及左右侧别间的差异无统计学意义(P>0.05).结论 CT和MRI均能较好地显示翼状韧带,结合大体和断层解剖进行研究,可为翼状韧带创伤、畸形及感染等病变的诊断提供影像解剖学支持.     

枕大孔区韧带结构的断面解剖和CT、MRI对照研究

目的探讨枕大孔区韧带结构的连续薄层断面形态规律及CT、MRI表现。方法选取经10％甲醛溶液浸泡的正常成人尸体头颈标本6具，全部行CT和MR扫描，其中3例用于冰冻断面标本制作，3例用于生物塑化断面标本制作。对枕大孔区韧带结构的连续断面形态进行观察，并与CT、MR图像对照研究。结果获得层厚3mm的枕大孔区横断面、冠状面和矢状面连续冰冻断面标本各1套。获得层厚1mm的枕大孔区横断面、冠状面和矢状面连续塑化薄层断面标本各1套。断面切片能清楚显示枕大孔区各韧带结构(6例均清楚地显示翼状韧带、横韧带、覆膜，寰枕前膜、寰枕后膜、寰枢前韧带分别在2具矢状面标本上清楚地显示)，并与CT、MRI有良好的对应关系。结论薄层断面切片能良好显示枕大孔区韧带结构，结合CT和MRI进行对照研究，可深入了解枕大孔区韧带结构的连续薄层断面形态规律。     

正常横韧带的影像学研究

目的探讨横韧带的位置、形态及其走行,并深入研究其影像学特点及最佳检查方法。方法各选取51例健康志愿者,分别行CT和MRI检查。分析横韧带的CT和MRI表现,并由2名高年资影像医师比较MRI各序列对横韧带的显示效果。结果CT和MRI能清晰显示出横韧带,显示率均为100%(51/51),其中MRI优于CT,2名医师一致认为质子密度加权成像(PDWI)显示横韧带效果最佳(F医师=0.002,P医师>0.05;F序列=125.638,P序列<0.05)。齿状突中部横断面和齿状突后部冠状面是横韧带的理想显示层面。结论MRI在显示横韧带方面优于CT,PDWI为横韧带的最佳MR成像序列。     

MRI上不同角度斜断面对踝关节外侧韧带显示效果的研究

目的:寻找踝关节外侧韧带于自然体位下MRI显示最佳的斜断面,为临床更好地评价外侧韧带提供依据。方法:解剖15例自然体位的正常踝关节标本,分离出外侧韧带,测出它们的长轴走行角度,据此制定MRI扫描方案;35例自愿者行踝关节MRI扫描,扫描方位包括常规横断面,冠状面及不同角度斜断面,比较不同扫描方位上各韧带的显示效果。结果:ATFL的显示以20°斜断面效果最佳,其次是横断面和30°斜断面,两者显示效果相当,45°斜断面次之。CFL的显示以-15°斜断面效果最佳,其次是-25°斜断面,横断面和-35°斜断面次之,但两者显示效果相当。CFL的整体显示率较ATFL低。冠状面对ATFL和CFL的显示不满意,但可满意显示PTFL。结论:MRI评价踝关节外侧韧带时,选择适当的扫描方位可以达到最佳的显示效果。     

上颈椎外伤的多层CT评价

目的研究上颈椎外伤的多层CT扫描技术及其价值。资料与方法回顾性分析27例上颈椎外伤，其中外伤在1个月内者共18例，1个月以上者9例。采用4层螺旋CT扫描仪，1．0mm准直(1．3mm有效层厚)，50％重叠重建，并进行多平面重建(MPR)、三维表面遮盖显示(3D-SSD)和容积显示(VR)成像，分别评价骨折、关节脱位以及韧带损伤等。结果CT清楚显示上颈椎外伤的骨折情况，以原始横断面图像和MPR图像结合显示最佳，并可检出齿状突水平骨折和齿状突先天变异，但陈旧性(1个月以上)外伤单纯横断面显示常不完善，至少需要MPR的补充显示；关节脱位的显示以VR或SSD为佳，寰椎横韧带损伤表现为横断面上齿状突两侧韧带结构不对称，VR横断面薄层块显示更好。结论1．0mm准直扫描结合MPR和VR图像是目前4层CT机作上颈椎外伤检查的上佳技术组合，可以充分显示上颈椎外伤的各种情况。     

正常踝距腓前韧带和跟腓韧带的解剖学观察及其MRI扫描方法 学的研究

目的 寻找踝节外侧韧带于自然体位下MRI显示最佳的扫描方位.资料与方法 首先解剖6例(12个踝节)自然体位的正常踝节标本,分离出外侧韧带,测量其走行角度,据此制定MRI扫描方案;然后对25名自愿者(50个踝节)行不同方位MRI扫描,比较不同扫描方位上各韧带的显示效果.结果 距腓前韧带(ATFL),在-20°斜断面显示效果最佳,评分最高;-15°和-25°斜断面显示效果次之;横断面和-30°斜断面显示效果不及上述断面;冠状面和矢状面显示效果最差.跟腓韧带(CFL)在15°斜断面显示效果最佳,评分最高;20°和25°斜断面显示效果次之;30°斜断面显示效果不及上述断面;横断面、冠状面和矢状面显示效果最差.结论 MRI评价踝节外侧韧带时,选择适当的扫描方位可以达到最佳的显示效果.     

CT图像后处理及MR诊断在寰枢关节半脱位的临床分析

目的探讨CT图像后处理及MR扫描在寰枢关节半脱位患者中诊断价值。方法 2010年1月~2013年12月在我院及温州医学院附属第二医院放射科检查的寰枢关节半脱位患者24例,观察X线、CT及后处理、MRI对于24例寰枢关节半脱位患者齿状突是否居中、齿状突断裂、横韧带及脊髓损伤等表现的显示情况。结果 X线检查发现12例患者寰枢关节齿状突不居中,CT扫描、CT图像后重建处理、MRI分别发现22例、24例、20例,CT图像重建及MRI显示齿状突断裂情况较X线及CT扫描更加明显,24例患者寰枢关节处未见骨折征象,脊髓未见明显受压征象;横韧带位于双侧侧块内侧和齿状突后方,T_2WI显示均匀低信号影,MRI显示3例横韧带损伤。结论单纯依靠CT显示寰枢关节齿状突不居中并不能明确诊断寰枢关节半脱位,MRI可以良好的显示横韧带等软组织结构损伤等情况,对寰枢关节半脱位具有重要的诊断价值。     

跗骨窦区断层解剖与影像学表现对照

目的研究跗骨窦结构及颈韧带在断层解剖与CT、MRI表现,并进行对照,为影像学诊断提供解剖学依据。方法解剖1例尸体跗骨窦标本,颈韧带表面涂抹对比剂后CT扫描,图像后处理观察颈韧带;对17例标本行MRI扫描,40例正常人行CT容积扫描与MRI扫描,并将标本制作成不同典型断层标本,分别通过测量观察跗骨窦特征及颈韧带走行特征。辨认跗骨窦内部结构及周围结构,对测量结果进行统计学分析。结果跗骨窦及颈韧带径线测量在断层解剖上与MRI对比、MRI与CT图像对比无显著性差异。跗骨窦内部结构及周围结构在CT、MRI均可清晰显示。结论 MRI图像与断层解剖标本测量结果基本一致,能够清晰显示跗骨窦局部结构,跗骨窦软组织的CT容积扫描多平面重组图像与MRI图像无明显差异。     

骶丛及坐骨神经的MR评价与尸体断面解剖对照研究

目的：通过对骶丛和坐骨神经的不同断而图像与尸体解剖断而的对照分析，来选择与判断最佳MRI扫描断而以清楚显示骶丛和坐骨神经近段，为临床治疗原发性或／和继发性骶丛及坐骨神经病变提供影像解剖学资料。方法：选择5具尸体分别行MRI 3个冠状、2个横断面扫描后，冰冻尸体进行相对应性切片断层。对30个成年自愿者骶丛神经采用5个MR影像断面扫描，采用一种四等级评分标准方法对每一种断面影像中骶丛神经解剖的显示程度进行分级并进行统计学分析，确定出显示骶丛神经解剖特征的最佳影像扫描断面。结果：对于评估骶丛神经和坐骨神经的解剖状况至少需要2个扫描断面；垂直冠状位和水平轴位扫描层而的显示能力较其它所有的冠状和轴位层面都好。结论：①采用MR扫描可清楚地显示骶丛及其周围组织结构特征；②MRI垂直冠状位和水平轴位对显示骶丛及坐骨神经最为有用；③MRI SE序列T1WI对显示正常骶丛或坐骨神经最有价值。     

髂腰韧带的MRI形态研究及其在腰骶部椎体节段定位中的临床意义

目的：利用MRI对髂腰韧带的形态学特点进行初步研究,探讨其对于腰骶部椎体节段定位的临床意义。方法：回顾性研究接受腰椎MRI检查的495例成年患者的影像资料。利用横断面及冠状面扫描图像观察髂腰韧带的形态、走行。研究其与腰椎节段的关系。结果：985侧髂腰韧带,其髂腰韧带主要部分均起自L5横突。研究发现髂腰韧带形态学特点及走行等方面差异均相当显著。通过观察髂腰韧带水平,将其作为椎体分段定位标志,所有46例移行椎病例均能准确定位。结论：髂腰韧带的形态和走行尽管变异明显,但其解剖定位相对恒定,MRI横断面及冠状面扫描能清晰显示其形态。临床利用其进行腰骶部移行椎节段定位是较为有效的手段。     

正常颅颈交界区韧带结构的影像研究

目的 探讨颅颈交界区(CCJ)韧带结构的影像特点,优化该区域韧带的检查方法 及序列.方法 各选取51名健康志愿者,分别行CT和MR检查.分析CCJ韧带结构的CT和MRI表现,并由2名高年资影像医师比较T1WI、T2WI、质子密度加权像(PDWI)、T2*WI、短时反转恢复序列(STIR)及质子密度加权脂肪饱和序列(PDFSAT)对CCJ韧带的显示效果.对原始数据进行标准正态秩变换,然后进行重复测量方差分析.结果 CT和MRI均能清晰显示除寰枕前膜(仅在MRI上显示)以外的CCJ韧带结构及其毗邻结构,其中MRI更具优势.寰枕前膜在MRI上显示率为100%(51/51),齿突尖韧带在CT和MRI上显示率分别为29.4%(15/51)、43.1%(22/51),寰枕后膜-硬膜复合体、覆膜-硬膜复合体、横韧带及翼状韧带在CT和MRI上的显示率均为100%(51/51).2名医师对于PDWI的评分结果 M均为5.0分,差异无统计学意义(F=0.000 P>0.05);PDWI明显高于T1WI(M=3.0分)、T2WI(M=3.0分)、T2*WI(M=1.0分)、STIR(M=1.0分)及PDFSAT(M=3.0分),P值均<0.01.结论 MRI在显示CCJ韧带结构方面优于CT,PDWI为CCJ韧带的最佳MR成像序列.通过对正常CCJ韧带的影像学研究,能够为该区各韧带病变的诊断和治疗提供客观依据.     

MR imaging of the alar ligament: morphologic changes during axial rotation of the head in asymptomatic young adults

OBJECTIVE:. The alar ligament plays a critical role in limiting the axial rotation of the head, the left alar ligament being stretched on rotation to the right and vice versa. The purposes of this study were to assess the usefulness of MR imaging in demonstrating the alar ligament and also to identify its morphologic changes during axial rotation of the head in asymptomatic young volunteers. DESIGN AND PATIENTS:. Twenty-two healthy volunteers participated in this study. All subjects underwent four series of contiguous fast spin echo density-weighted MR images with a 2 mm slice thickness including axial and coronal images with the head in neutral position, and coronal images with alternate head rotation to the right and left. The alar ligaments seen on each series of MR images were visually graded 0-2, and grade comparisons were performed between the four series of MR images. We also assessed the morphologic changes of the alar ligament on coronal images during axial rotation of the head. RESULTS:. Grade comparisons for the demonstration of the alar ligament revealed that each of three series of coronal images was statistically significantly better in grade than axial images. During axial rotation of the head, MR images showed rather constant morphologic changes of the alar ligament: elevation and wrapping of the contralateral alar ligament around the dens, associated with slightly upward movement of C1-C2 on that side. This wrap-around effect of the contralateral alar ligament in relation to the dens sometimes caused the apparent shortening of the alar ligament on that side. CONCLUSION:. Reliable assessment of the anatomy and function of the alar ligament can be achieved with MR imaging, preferably in coronal planes. MR imaging with the aid of a functional study may be a valuable imaging modality in the evaluation of alar ligament failure.     

膝关节侧副韧带MRI显示方法分析

目的 探讨正常人膝关节侧副韧带MRI检查方法及表现. 方法 对55例成人选择矢状面、冠状面、后斜冠状面进行MR扫描,观察侧副韧带显示的情况,测量内、外侧副韧带的有关数据,并与解剖文献大体测量结果进行比较. 结果 (1)矢状面上内侧副韧带的定位线与胫骨干长轴的夹角为0.55°±0.25°;外侧副韧带的定位线与腓骨颈长轴的夹角为11.47°±1.61°.(2)内侧副韧带在常规冠状位1个层面上完整显示占96%,同时外侧副韧带在1个层面上完整显示占82%;外侧副韧带在11°后斜冠状位1个层面上完整显示占90%.(3)正常内、外侧副韧带在T1WI和PDWI上均呈扁平条状低信号,平均长度分别为11.53 cm和5.31 cm.结论选择完全显示胫骨干、腓骨颈的矢状面为基准面,层厚3 mm MR扫描能很好地显示内、外侧副韧带的解剖结构.     

前交叉韧带斜冠状面薄层解剖断面与MRI表现对照研究

目的对冰冻膝关节前交叉韧带（ACL）斜冠状面薄层解剖断面与正常人膝关节MRI特点进行对照研究，为ACL损伤分级诊断建立基础。方法1例（1只）膝关节标本行斜冠状面MRI确定角度，冰冻后沿斜冠状面1mm层厚铣切，观察ACL薄层解剖特点。选择50名正常人对其ACL进行MR斜冠状面扫描，观察ACL的MRI特点。结果1只膝关节标本的ACL在斜冠状面薄层断面清晰显示其全程走行，清晰地显示ACL前内束与后外束，前内束从股骨髁附着点后上方区自后向外侧及前内侧走行，止于髁间棘附着区前内侧方，后外侧束从股骨髁附着点前下方区，自后外侧及外下走行，止于髁间棘附着区后外侧方。斜冠状面MRI能够显示50名正常人ACL全程，显示率为100％。MRI能够区分ACL前内束与后外束结构，显示前内束自后外侧向前内走行，止于髁间棘附着区前内侧方，后外束自后外侧向外下走行，止于髁间棘附着区后外侧方。MRI显示ACL走行与薄层断面显示的走行一致。结论斜冠状面是观察ACL的最佳方位，临床对怀疑ACL损伤的患者必要时行MR斜冠状面扫描。     

MR imaging,MR arthrography,and specimen correlation of the posterolateral corner of the knee: an anatomic study

OBJECTIVE: We sought to evaluate the anatomy of the posterolateral aspect of the knee with anatomic dissection, MR imaging, MR arthrography, and sectional anatomy. MATERIALS AND METHODS: We assessed the posterolateral corner of the knee during dissection of one gross anatomic specimen. MR imaging and MR arthrography were performed in seven additional knee specimens. T1-weighted spin-echo MR images were obtained in the standard imaging planes as well as in the coronal oblique plane. The specimens underwent T1-weighted spin-echo MR imaging after administration of intraarticular contrast material and were sectioned into planes corresponding to those of the MR images. RESULTS: At anatomic dissection, the following posterolateral structures were identified: the arcuate ligament (medial and lateral limbs), fabellofibular ligament, popliteofibular ligament, popliteus tendon and its two posterior attachments to the lateral meniscus, fibular collateral ligament, direct and anterior arms of the tendon of the long head of the biceps femoris muscle, and direct and anterior arms of the tendon of the short head of the biceps femoris muscle. Correlation of MR imaging and anatomic findings showed that the popliteofibular ligament and oblique popliteal ligament were found in 57% and 100% of specimens, respectively. At least one of the two limbs of the arcuate ligament was identified in 71% of specimens. The fabellofibular ligament was not identified on MR images in any of the specimens. The anteroinferior and posterosuperior popliteomeniscal fascicles were identified in all specimens. CONCLUSION: The posterolateral corner of the knee comprises complex and variable anatomic structures. Recognition of these variations is important in the assessment of MR images of the knee.     

MR imaging of alar ligament in whiplash-associated disorders: an observer study

Rotational CT studies have been previously used in whiplash-associated disorders (WAD) to document rotatory instability of the upper cervical spine thought to be due to alar ligamentous injury. More recently MR imaging has been employed to image such injury more directly. Our study aimed to assess the reliability and reproducibility of such MRI findings. In 12 WAD patients and six asymptomatic controls the alar ligaments were imaged in the coronal plane with an 0.5-T MRI system using a quadrature neck coil and applying a fast spin echo proton density/T2-weighted sequence ¶(TR/TE/ETL 2,500/18 ms/16, FOV 140 mm, matrix 200 × 256, 16 × 3 mm slices, scan time 25 min). Images were graded for symmetry of imaging plane using a 3-point scale and also for presence of ligamentous injury with a 4-point scale, by two independent observers on two separate occasions. The alar ligaments could be identified in all cases. Asymmetry of the imaging plane was found to some degree in over half of the cases. Such images were much more likely to be graded as indicating injury. Of a total of 72 assessments, clearly and probably normal grades were given in 75 %, and clearly or probably abnormal grades in 25 %. Kappa values for intra- and inter-observer agreement were moderate to very poor, however, and the grading system could not reliably distinguish between patients and controls. It was concluded that with MRI techniques presently employed, alar ligamentous damage as a causative factor in WAD has not been proven.     

MRI assessment of normal ligamentous structures in the craniovertebral junction

We have established an imaging protocol in order to characterise the normal ligamentous structures in the craniovertebral junction. Thirty volunteers without a history of car accident or head or neck trauma underwent MR imaging with 2-mm-thick proton-density-weighted sections in three orthogonal planes. The alar ligaments were clearly seen in every case and had three different configurations in cross-section: round, ovoid or wing-like. A broadening from lateral to medial in the coronal plane was observed in all cases. The transverse ligament was clearly demonstrated in 26 out of 30 cases. The ligament was flattened where it arched across the dens. Towards the insertions the ligament twisted into an oblique-horizontal orientation. The lower tectorial membrane had a median portion merging with the dura, and a lateral portion separated from it. Between the dens and clivus this membrane either merged totally with dura or was partly separated from it by a thin layer of fat. The posterior atlanto-occipital membrane was clearly demonstrated. It either merged with the dura or was partly or totally separated from it by a fat layer. The anterior atlanto-occipital membrane was inconsistently seen and could not be evaluated. Our refined MR protocol improves the visualisation of the craniovertebral ligamentous structures, and may in the future give new insight into post-traumatic neck disorders up to now poorly understood.     

适于磁共振检测播散性皮层抑制的猫脑解剖研究

目的 寻找适于研究播散性皮层抑制的猫脑表面脑回及磁共振功能成像(fMRI)平面.材料与方法 成年雌性家猫6只,行垂直相交的高分辨力横断面、矢状面、水平面T1WI及T2WI,研究各方位图像显示脑回的解剖特点.灌注固定后取猫脑标本进行大体表面解剖观察,分析各脑回的位置及形态特点.结果 猫脑具有多脑回结构.边缘回内侧紧邻上矢状窦;上侧裂回位置相对表浅,与相邻脑回以脑沟相隔,周围无大血管相邻;外侧裂回位置偏外,长度短,形态复杂.在MRI上每个横断面仅能显示嘴尾侧走行脑回的一个断面,矢状面不能显示相邻脑回间的关系,包括双侧上侧裂回和边缘回的水平面图像既能显示脑回的长轴,又能显示相邻脑回的关系且能提供对侧大脑半球作为对照.结论 上侧裂回是研究播散性皮层抑制最合适的皮层结构;包括双侧上侧裂回和边缘回的水平面是fMRI研究播散性皮层抑制的理想成像层面.     

Interstitial brachytherapy in the head and neck region: when has imaging for treatment planning to be performed?

BACKGROUND AND PURPOSE: The relation of real and virtual anatomy in 3D treatment planning is influencing the quality of a brachytherapy treatment. Aim of this study was to evaluate how far prior to plastic tube implantation for fractionated interstitial brachytherapy performed imaging is appropriate for treatment planning purposes in regard to iatrogenic, morphologic changes of anatomy. MATERIAL AND METHODS: Until April 1, 2001, 51 patients were included in this examination. Primary tumor sites were in the base of tongue (35), oro-/hypopharynx (9), floor of the mouth (4) as well as soft palate (3). Cross section imaging (MRI) in all the patients was performed before and three to six days after implantation of plastic tubes. To evaluate the morphologic alterations due to implant procedure and postimplant edema, distances were measured between two anatomically clearly defined landmarks of whom one had to be invariant to applicator implantation. RESULTS: Between two anatomical landmarks initially mean standard distances were measured: Vertebra-pharyngeal mucosa 1.46 cm, mandibular-pharyngeal wall 3.14 cm, mandibular tip-base of tongue 5.12 cm, tongue width 4.77 cm. The comparison of pre- and postimplant MRI then revealed mean distance alterations: Vertebra-pharyngeal mucosa 3.1 mm, mandibular-pharyngeal wall 4.2 mm, mandibular tip-base of tongue 5.9 mm, tongue width 6.0 mm. CONCLUSIONS: Mean applicator induced anatomic deviations between 3.1 and 6.0 mm compared to pre-implant anatomy, can severely change the target dose distribution. Basis of 3D-treatment planning therefore has to be always postimplant cross sectional imaging with adequate soft tissue depiction.