计算机辅助三维CT重建椎动脉横突段的走行及解剖变异

背景：目前不同影像学方法对椎动脉的检查仍然存在差异和争论，计算机断层扫描血管造影技术的发展，为血管及骨关节结构的解剖观察及疾病诊断提供了新的手段。 目的：评价三维CT血管造影显示椎动脉横突段的效果，明确其走行及变异。 方法：从2009-12-01/2010-05-31头颈部联合CT血管造影检查的三维影像资料中，去除椎动脉不显影或显影不清楚的资料，选出无明显异常病变者250例，在三维图像上观察椎动脉在横突段的走行及血管管径的变异。获得原始断层图像后，通过容积重建、多层面重建、表面遮盖成像来显示椎动脉。 结果与结论：椎动脉经C6横突孔进入占所有样本的92.6%，经异常横突孔进入占所有样本的7.4%(37条)，经C4，C5，C7横突孔进入的发生率分别为2.2%(n=11，占不正常的29.7%)，4.6%(n=23，占不正常的62.2%)，0.6%(n=3，占不正常的8.1%)。20例为右侧异常(54.1%)，17例为左侧异常(45.9%)。所有患者中27例为单侧异常(10.8%)，5例为双侧异常(2%)。比较椎动脉管腔直径，左侧直径明显大于右侧53例，右侧直径明显大于左侧30例，左右侧差异具有显著性意义(P < 0.01)。提示椎动脉在横突段的解剖变异发生率较高，三维CT血管造影能客观地反映椎动脉的病理改变，并清晰显示椎动脉与骨性结构的关系。

Computer-assisted three-dimensional CT angiography for reconstruction of course and variations of the second segment of vertebral artery

BACKGROUND: Different imaging detections for vertebral artery are still varied and controversial. The development of CT angiography has provided a new method for the anatomic observation and disease diagnosis about vessels and joints. OBJECTIVE: To evaluate the three-dimensional CT angiography (3DCTA) in displaying the second (V2) segment of the vertebral artery, and to identify its course and variation. METHODS: Totally 250 cases without obvious pathological lesions were selected from the 3D data of head-neck CT angiography examination. On the 3D images, the courses of the V2 segment of the vertebral artery and the variations of the vascular diameter were observed. RESULTS AND CONCLUSION: The vertebral artery entered the C6 transverse foramen in 92.6% of all specimens. An abnormal level of entrance was observed in 7.4% of specimens (37 courses), with a level of entrance into the C4, C5, or C7 transverse foramen, respectively, in 2.2% (n=11; 29.7% of all anomalies), 4.6% (n=23; 62.2% of all anomalies) and 0.6% (n =3; 8.1% of all anomalies) of all specimens. 20 (54.1%) abnormalities were right-sided and 17 (45.9%) were left-sided. 27 out of 250 patients (10.8%) had a unilateral anomaly and 5 had a bilateral anomaly (2%). To compare the vascular diameter of the vertebral artery, the size in the left were larger than that in the right in 53 cases, and the size in the right were larger than in the left in 30 cases, which was of significant difference between left and right (P < 0.01). The incidence of anatomic variations of the vertebral artery V2 segment is high. 3D-CTA, which can objectively reflect the pathology of the vertebral artery, has important clinical value.