岩下窦多层螺旋CT成像与薄层断面影像解剖学研究

发布时间：2018-02-15 22:20

本文关键词： 岩下窦颈内静脉断层解剖三维重建 MSCT　出处：《第三军医大学》2009年硕士论文　论文类型：学位论文

【摘要】： 岩下窦(IPS)起自海绵窦后端,走行在斜坡两侧的IPS沟内,通常经颈静脉孔(JF)出颅,最终汇入颈静脉球(JB)或颈内静脉(IJV),沿途接收多条静脉的注入,与颅神经Ⅵ、Ⅸ、Ⅹ、Ⅺ关系密切。随着岩斜区及颈静脉孔区肿瘤切除等显微外科手术的开展以及经颈内静脉诊断和介入治疗颅底和海绵窦病变的逐渐应用,有必要对IPS的影像解剖学、重要神经毗邻及其与相关静脉的吻合情况进行详尽研究。本课题从断层解剖、三维重建、正常CT表现及颅内压增高状态下IPS的影像学改变等方面对IPS的走行、正常形态、变异和出颅后与JB或IJV的汇合形式进行较为系统的研究。目的: 研究IPS及周围结构的超薄层断面解剖和影像学表现,为此区域的临床手术和相关疾病的诊断和治疗提供形态学依据和影像学参考。材料与方法: 1.选取6例中国数字化可视人体(CVH)数据集中相关IPS的连续薄层横断面图像(铣切层厚为0.1mm~0.5mm),在连续薄层横断面图像上对IPS及周围解剖结构进行观察,将IPS进行分段描述和测量,主要结构进行手工分割、三维重建,建立IPS的三维立体模型。 2.临床收集头颈CTA检查的成年患者120例(颅内肿瘤和其它原因引起的颅内压增高患者以及心脏大血管疾病患者不纳入研究范围),将源图像传至AW4.3后处理工作站进行逐层观察和相应指标的测量,采用多平面重建(MPR)、曲面重建(CPR)和容积再现(VR)技术显示IPS的走行、相关径线以及与其它静脉的吻合情况,结合连续薄层断面,观察IPS在多层螺旋CT(MSCT)图像上的形态学表现。 3.收集颅内肿瘤或其它原因引起的颅内压增高患者8例,行头颈CTA检查。观察IPS的断面形态学表现并测量相关径线,初步探讨颅内压增高对IPS的影响和程度。结果: 1.IPS为一完整的静脉结构,始于海绵窦后部,在IPS沟内向外下方走行,两侧借后海绵间窦或基底静脉丛相互交通,出颅时可为1~3支改变,多数经JF出颅,出颅后以不同形式与周围静脉属支吻合并再分支后汇入JB或IJV。根据汇入平面的不同以及与乙状窦(SS)末端的吻合是否存在,本实验将IPS-IJV汇合作了进一步的亚型分类描述和统计,对IPS-IJV的分类进行了补充。 2.IPS起始部、垂直部和水平部、出颅部以及颅外段在解剖横断面上均得到连续显示,起始部宽度左侧为5.94mm±1.34mm,右侧6.78mm±1.07mm,深度左侧为3.30mm±0.33mm,右侧3.23mm±0.39mm;垂直部宽度左侧为4.92mm±0.65mm,右侧5.02mm±0.75mm,深度左侧为2.96mm±0.42mm,右侧2.67mm±0.65mm;出颅处宽度左侧为4.09mm±0.77mm,右侧4.25mm±0.57mm,深度左侧为2.95mm±0.72mm,右侧2.92mm±0.46mm;汇入JB或IJV处直径左侧为2.37mm±0.93mm,右侧3.35mm±1.38mm。 3.MSCT图像5个典型层面中的各结构与解剖断面对应良好,IPS相关测量结果为:起始部宽度左侧为7.88mm±1.83mm ,右侧8.42mm±1.87mm ,深度左侧为2.90mm±0.83mm,右侧2.90mm±0.71mm;IPS垂直段直径左侧为1.87mm±0.82mm,右侧2.08mm±0.60mm;出颅处左侧为1.96mm±0.74mm,右侧1.95mm±0.68mm;汇入JB或IJV处直径左侧为2.36mm±0.82mm,右侧为2.65mm±0.85mm。 4.颅内压增高时IPS的相关测量结果:起始部宽度为9.56mm±2.31mm,深度为2.39mm±0.55mm;垂直部直径为1.76mm±0.60mm;出颅处直径为2.28mm±0.44mm;汇入JB或IJV处的直径为2.46mm±0.59mm。结论: 1.在解剖薄层断面图像上能够准确显示并追踪IPS的行程和变异,颅底微小静脉及神经结构亦得到清晰显示,基于断面的三维重建图像真实立体,可为该重要结构的断层影像学研究提供参考。 2.MSCT连续薄层断面与解剖断面对应良好,结合MPR、CPR和VR,能够详细显示IPS的行程以及与相关静脉的汇合,是评价IPS形态学变化的准确影像学技术。 3.MSCT有较高的空间分辨率,能够更清晰的显示静脉血管细节,本研究依据IPS汇入IJV的平面以及与SS末端有无交通支,对IPS-IJV的汇合形式进行了补充,同时,发现低位IPS也是一种常见形式。总之,MSCT薄层断面及重建技术能够详细显示IPS的行程和汇合形式以及特殊的低位IPS,能够为介入术前对IPS的有效评价提供依据。 4.IPS在颅内压增高时存在一定程度的形态学改变,尽管本实验样本量不足,不能全面反映颅内压增高患者的IPS改变,但其结果具有一定的临床意义,对后续研究具有启示作用。
[Abstract]:The inferior petrosal sinus (IPS) from the cavernous sinus back, walking on a slope on both sides of the IPS trench, usually by the jugular foramen (JF) cranium, then into the jugular bulb (JB) or the internal jugular vein (IJV), receiving multiple intravenous injection along the way, and cranial nerve VI, IX, x, Xi is closely related. With the petroclival region and jugular foramen area microsurgery and carrying out the gradual application of internal jugular vein diagnosis and interventional therapy of cavernous sinus and skull base lesions, necessary imaging anatomy of the IPS, and with important adjacent nerves anastomosis of vein, a detailed study of this topic from. Sectional anatomy, three-dimensional reconstruction, normal CT and increased intracranial pressure under the condition of IPS imaging changes and other aspects of IPS walking, normal morphology, variation and posterior cranial JB or IJV confluence forms are more systematic research.
Objective:
Objective to study the sectional anatomy and imaging findings of ultrathin section of IPS and its surrounding structures, so as to provide morphological evidence and imaging reference for clinical operation and diagnosis and treatment of related diseases.
Materials and methods:
1. a total of 6 cases of China visible human (CVH) thin serial image data set IPS (milling thickness 0.1mm~0.5mm), in the continuous thin-layer cross-sectional images of IPS and surrounding anatomic structures were observed in the IPS segment measurement and description, the main structure of the manual segmentation, 3D reconstruction, 3D the three-dimensional model of the IPS.
120 adult patients in 2. clinical cases (collecting head CTA examination in patients and patients with cardiovascular disease are not included in the scope of the study of intracranial tumors and other reasons caused by intracranial pressure), measurement of the source image to the AW4.3 postprocessing workstation by layer observation and the corresponding index, using multi planar reconstruction (MPR), surface reconstruction (CPR) and volume rendering (VR) technique showed that IPS for anastomosis related diameter and other veins, combined with continuous thin sections of IPS were observed in multi-slice spiral CT (MSCT) morphological features of the images.
3., we collected 8 cases of intracranial hypertension or intracranial hypertension caused by other reasons, neck and neck CTA examination. We observed the cross-sectional morphology of IPS and measured related diameter lines, and initially discussed the impact and degree of intracranial hypertension on IPS.
Result:
1.IPS is a complete vein structure, began in the posterior part of the cavernous sinus, walking in the IPS trench below, on both sides of Houhai by the intercavernous sinus or basilar venous plexus are traffic, cranial can change to 1~3, most of the cranial JF, posterior cranial and peripheral vein in different branches with kiss again branch into the JB or IJV. according to the different import plane and sigmoid sinus (SS) at the end of the agreement exists, this experiment will be IPS-IJV to cooperate further subtype classification description and statistics, on the classification of IPS-IJV were added.
The origin of 2.IPS, the vertical and horizontal portion, a cranial and extracranial segment were continuously displayed in anatomical cross section, the width of the starting left for 5.94mm + 1.34mm, 6.78mm + 1.07mm on the right side, left for the depth of 3.30mm + 0.33mm, 3.23mm + 0.39mm on the right side of the width of the vertical; left for 4.92mm + 0.65mm, 5.02mm + right 0.75mm, the depth on the left side was 2.96mm + 0.42mm, 2.67mm + 0.65mm on the right side of the skull at the left side; the width of 4.09mm + 0.77mm, 4.25mm + 0.57mm on the right side, left for the depth of 2.95mm + 0.72mm, 2.92mm + 0.46mm right into the JB or IJV; the diameter of left 2.37mm + 0.93mm, 3.35mm + 1.38mm. on the right side
The structure of the 5 typical aspects in 3.MSCT images and anatomy of broken face should be good, IPS measurement results: initial width of the left 7.88mm + 1.83mm, 8.42mm + 1.87mm on the right side, left for the depth of 2.90mm + 0.83mM, 2.90mm + 0.71mm IPS on the right side; vertical section diameter of the left 1.87mm + 0.82mm, 2.08mm + 0.60mm on the right side; cranial left 1.96mm + 0.74mm, 1.95mm + 0.68mm right into the JB or IJV; the diameter of left 2.36mm + 0.82mm, 2.65mm + 0.85mm. on the right side
4., when IPS increased, the width of the initial part was 9.56mm + 2.31mm, the depth was 2.39mm + 0.55mm, the diameter of the vertical part was 1.76mm + 0.60mm, the diameter of the cranium was 2.28mm + 0.44mm, and the diameter of the entry was JB + or IJV.
Conclusion:
1., we can accurately display and track the stroke and variation of IPS on the anatomical thin section image. The cranial base micro vein and nerve structure are also clearly displayed. The 3D reconstruction image based on the real three-dimensional can provide reference for the important structure's sectional imaging research.
2.MSCT continuous thin section and anatomical face should be good. Combined with MPR, CPR and VR, it can show the travel of IPS and the confluence with related veins in detail, it is an accurate imaging technology to evaluate IPS morphological changes.
3.MSCT has a higher spatial resolution, can display the vein details more clearly, on the basis of the plane IPS into the IJV and SS terminal without traffic branch of IPS-IJV confluence forms were added, at the same time, found that low IPS is a common form. In short, thin section and MSCT reconstruction can show in detail IPS route and variation as well as the special low IPS, which can provide the basis for effective evaluation of IPS intervention before operation.
4.IPS has a certain degree of morphological changes in the increase of intracranial pressure. Although the sample size is not enough, it can not fully reflect the IPS changes in patients with intracranial hypertension, but the results have certain clinical significance, which has implications for future research.

【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R322

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