颈内动脉海绵窦段创伤性假性动脉瘤破入蝶窦的CT和MRI诊断

目的评价CT和MRI对颈内动脉海绵窦段创伤性假性动脉瘤（TPA）破入蝶窦的诊断价值.方法对经DSA证实的6例海绵窦段TPA破入蝶窦的CT和MRI资料进行回顾性分析.全部患者均行CT检查,5例行MR检查.结果6例颈内动脉海绵窦段TPA中,CT平扫均显示蝶窦侧壁骨折及其密度增高,2例CT增强扫描均可见蝶窦呈明显均匀强化,强化程度与正常血管一致,海绵窦扩大,1例CT血管成像（CTA）明确显示动脉瘤体与瘤颈.5例行MR SE序列平扫,患者均表现为分层状混杂长T1、混杂长T2信号的血栓,4例尚可见瘤腔内的流空现象;3例增强扫描示蝶窦呈明显均匀强化,强化程度与正常血管一致,其中1例在相位编码方向上流动伪影明显;2例MR血管成像均明确显示瘤体与瘤颈.结论CT和MRI是诊断颈内动脉海绵窦段TPA破入蝶窦的有效非创伤性检查,并可作为手术前后长期随访的良好检查方法.

CT and MRI diagnosis on the rupture of traumatic pseudoaneurysms of the cavernous segment of the internal carotid artery into the sphenoid sinus

Objective To investigate diagnostic value of CT and MRI for traumatic pseudoaneurysms (TPA) of the cavernous segment of the internal carotid artery (ICA) when they rupture into the sphenoid sinus. Methods CT and MRI of 6 patients with TPA in the cavernous ICA verified by DSA were retrospectively analyzed. All patients had CT scan and 5 of them had MRI scan.Results In All 6 foci, fractures of the lateral wall and high density in the sphenoid sinus were showed in precontrast study on CT scan, and obviously enhancement, which was similar to normal vessels, and cavernous sinus enlargement after postcontrast study were found in 2 cases. The neck and body of TPA on computed tomographic angiography was clearly demonstrated in 1 case. Of the 5 foci in precontrast MRI study, all demonstrated onion mixed-high signal intensity on both T_1WI and T_2WI, and flow void effect could be seen in 4 cases. On postcontrast study, obviously homogeneous enhancement, which was similar to normal vessels, were found in 3 cases. one of which had flow artifacts in the phase direction. The neck and body of TPA on magnetic resonance angiography was clearly revealed in 2 cases. Conclusion CT and MRI are the effective non-invasive method of imageology for diagnosing TPA in the cavernous ICA when they rupture into sphenoid sinus, and they can also be used as pre- and post- operative follow-up examination of TPA.