多层螺旋CT血管造影后处理技术对颈部神经鞘瘤和颈动脉体瘤的诊断价值

目的:颈动脉三角区肿瘤的准确诊断及明确肿瘤与颈动脉的关系具有重要的临床意义,本研究探索多层螺旋CT血管造影(multi-slice spiral computed tomography angiography,MSCTA)后处理技术对颈动脉体瘤及颈动脉三角区神经鞘瘤的诊断价值以及明确肿瘤与颈动脉关系的价值。方法:分析收治的19例颈动脉三角区神经鞘瘤和4例颈动脉体瘤的MSCTA影像学资料,结合多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR)等图像后处理技术分析其影像学特征。结果:128层螺旋CT血管造影均能提供高分辨率、立体直观的影像学资料,准确显示肿瘤实质情况及其与颈动脉的位置关系。MPR能提供神经鞘瘤瘤体精确的影像,但与血管的关系显示较差;MIP和VR则能直观地显示颈动脉影像及其移位情况。MPR和MIP能从不同观察面显示颈动脉体瘤的实质情况,同时显示血管与肿瘤的关系;VR是颈动脉体瘤最佳的成像方式,能提供精确的瘤体与动脉的关系,如瘤体包膜与血管外膜的关系等。联合应用MPR、MIP和VR技术,能提供敏感精确的影像。结论:MSCTA后处理技术能为神经鞘瘤及颈动脉体瘤提供高质量的诊断信息,有效鉴别肿瘤;同时其能显示肿瘤与颈动脉的三维关系,提高手术的安全性。

Multi-slice spiral computed tomography angiography postprocessing methods for diagnosis of neurilemmoma and carotid body tumor

PURPOSE：At present clinicians still have certain difficulties in diagnosing carotid body tumor and neurilemmoma in carotid triangle and analyzing the relation between the tumor and the adjacent vessels.The purpose of this study was to investigate the usefulness of multi-slice spiral computed tomography angiography postprocessing methods in diagnosis neurilemmoma and carotid body tumor and to identify the positional relation between the tumor and carotid arteries.METHODS：CTA images of 19 patients with neurilemmoma in carotid triangle and 4 patients with carotid body tumor were retrospectively reviewed.Three postprocessing methods,such as multiplanar reformation（MPR）,maximum intensity projection（MIP） and volume rendering（VR）,were obtained for each CTA study,and then the images of them were analyzed and compared.RESULTS：The results demonstrated that high spatial resolution MSCTA images provided valuable accurate information regarding the tumor and carotid artery.MPR provided more precise cross-sectional images of neurilemmoma than MIP and VR,nevertheless MIP and VR provided direct-viewing arterial imaging and displacement.For carotid body tumor,MPR and MIP methods displayed the information of tumor in any view;but VR was the optimal imaging technique for evaluating the accurate connection between the tumor and the artery.Application combined with MIP,MPR and VR offered sensitive and accurate depiction of neurilemmoma and carotid body tumor.CONCLUSIONS：In conclusion,MSCTA postprocessing methods can provide high sensitive and specific diagnostic information of neurilemmoma and carotid body tumor and analyze the relation between the above diseases and carotid arteries effectively.Rational utilization of several reconstruction methods may facilitate operative planning and augment operative security.