外伤性颈动脉海绵窦瘘的综合影像评价

目的 评价各种影像学检查手段在诊断外伤性颈内动脉海绵窦瘘中的作用。资料与方法 回顾性分析15例颈动脉海绵窦瘘患者的各种影像学表现，其中CT、超声检查15例，脑血管造影12例，MRI检查3例。结果 颈内动脉海绵窦瘘CT表现为：眼球突出，眼上静脉扩张和海绵窦增大(15／15)，眶内软组织肿胀(9／15)和眼外肌肥厚(10／15)。MRI表现与CT大致相同，MRA可立体显示扩张的眼上静脉和瘘口(2／3)。脑血管造影于动脉期可见患侧海绵窦扩大显影并眼上静脉逆向充盈显影(12／12)，并可见瘘口显示(11／12)，压迫患侧颈总动脉，健侧颈内动脉造影可见患侧颈内动脉和海绵窦显影(9／12)。经颅多普勒超声检查可显示眼上静脉和海绵窦区的异常血流信号(15／15)，并能准确评价颈内动脉各段血流动力学改变。结论 各种影像学检查手段都有其优势和局限性，各种手段综合应用才能满足临床需要。

Comprehensive Imaging Evaluation of Traumatic Carotid Cavernous Fistula

Objective To evaluate four imaging methods in diagnosing traumatic carotid cavernous fistula (TCCF).Materials and Methods Imaging findings in 15 patients with TCCF were retrospectively analyzed. The imaging materials included CT (n=15), transcranial Doppler (n=15), carotid angiography (n=12) and MRI with MRA (n=3).Results On CT scans, the lesions presented as proptosis, engorged superior ophthalmic vein (SOV) and enlarged cavernous sinus (15/15), as swelling of intraorbital soft tissue (9/15), or as thickening of extraocular muscle (10/15). On MRI, same signs as seen on CT were demonstrated. MRA stereoscopically displayed the engorged SOV and its fistula (2/3). Cranial angiography showed the enlarged cavernous sinus and the retrogradely-dyed SOV during arterial phase (12/12), and it was enable to correctly locate the fistula (11/12). Internal carotid angiography of the normal side with the carotid artery of the affected side being pressed demonstrated that the internal carotid artery and the cavernous sinus at the affected side were retrogradely visualized (9/12). Transcranial Doppler sonography detected abnormal blood flow in SOV and cavernous sinus area, and the velocity of the internal carotid artery was higher in the affected side than that in the normal side (15/15).Conclusion Each imaging means has its own advantage and limitation, a combination or various imaging modalities can provide necessary information about TCCF.