28例颈动脉海绵窦瘘影像诊断分析

目的探讨超声、CT、MRI和数字减影血管造影(DSA)等各种影像学检查在颈动脉海绵窦瘘(CCF)诊断中的价值。方法收集我院经DSA证实诊断的CCF共28例,所有患者行眼科标准化A／B超声、DSA检查,部分患者行彩色多普勒超声、CT及MRI检查中的一项或多项。结果超声检查可发现眼上静脉增粗与脉搏同周期的搏动等,并能检测血流频谱。CT和MRI检查可发现海绵窦扩大及异常表现。DSA检查显示CCF分为颈内动脉海绵窦段直接供血和颈动脉的供应硬膜的动脉供血,供血动脉包括：颈内动脉海绵窦区细小脑膜分支;颈外动脉来源的脑膜中动脉、副脑膜动脉、咽升动脉、圆孔动脉等;瘘血向眼静脉、岩下窦、海绵问窦、侧裂静脉及皮层引流等。结论超声、CT、MRI等影像学检查对CCF的诊断各有所长,联合应用多可做出正确的临床诊断;DSA是诊断CCF的“金标准”,可明确瘘的大小、瘘血来源及引流方向。（中华眼科杂志,2004,40：674-678)

Imaging diagnosis of carotid cavernous fistula

Objective To evaluate the value of ultrasonography, CT, MRI and digital subtrac tion angiography (DSA) in the diagnosis of carotid cavernous fistula (CCF). Methods Twenty-eight cases of CCF patients were examined with ophthalmologic A/B echogr aphy and DSA, part of them were examined by one or several items among color Dop pler imaging, CT and MRI. Results Ultrasonography could determine the enlarged ophthalmic vein with signal of bloo d stream and could detect the pulsation synchronizing with the pulse. CT and MR I could display the enlargement and abnormality of cavernous sinus. DSA could r eveal fistulas supplied by internal carotid artery directly or by the dual branc hes of the carotid artery. The latter included meningohypophyseal trunk, capsul ar artery, middle meningeal artery, accessory meningeal artery, ascending pharyn geal artery and the artery of the foramen rotundum, etc. The drainage pathway o f fistula included ophthalmic vein, inferior petrosal sinus, intercavernous sinu s, sylvian vein and cortical drainage, etc. Conclusions Each method of examination has its own advantages, combining of various methods can lead to an accurate diagnosis of CCF. DSA is the "golden standard" which can display supplying artery and the drainage pathway.(Chin J Ophthalmol, 2004, 40:674-678)