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MSCT图像后处理在显示翼腭窝结构中的价值

发布时间:2018-03-31 16:36

  本文选题:翼腭窝 切入点:各向同性 出处:《山东大学》2010年硕士论文


【摘要】: 目的 探讨多层螺旋CT的各向同性扫描对于翼腭窝结构及其相关通道的完整显示,多平面重组(MPR)步骤,容积显示(VR)、最大密度投影(MIP)技术在显示翼腭窝上的应用,及其临床应用价值。 方法 应用Siemens sensation 16CT扫描仪行螺旋CT检查,筛选100名无翼腭窝及其通道病变的成人,将其数据由工作站进行容积显示(VR)、最大密度投影(MIP)及多平面重组(MPR)等图像后处理,观察翼腭窝结构及其通道的形态、走行,并测量具体大小。 结果 圆孔、翼管、蝶腭孔、翼腭管、腭鞘管、犁鞘管在其最佳辨认方位上显示率分别为99%、98%、99%、96%、96%、85%。 结论 多层螺旋CT扫描结合图像后处理技术,能多方位而且直观地显示翼腭窝骨性结构及其通道,能为早期发现相关病变以及为制订临床治疗方案提供影像学依据。 意义 翼腭窝及其相关结构解剖复杂、细微、形态不规则,为感染及肿瘤扩散的重要通道,因为部位深在,又有重要的血管、神经穿行,常规临床鼻窦检查难以进入小的孔道发现病变,活检困难,影像学检查成为疾病诊断的重要手段。由于CT检查对骨骼微细结构的高显示能力,易于观察病变引起的骨皮质硬化及密度降低现象,可以早期发现病变通过各管道向其他部位的侵犯,对治疗方案的选择及对病人预后的评估也有重要意义。随着鼻窦内窥镜技术的不断进步,国内外学者逐渐开始由鼻内窥镜处理包括翼腭窝病变在内的侧颅底病变的探索,于圆孔处高位切断上颌神经治疗三叉神经痛,于翼管处作翼管神经切断术治疗顽固性血管运动性鼻炎、过敏性鼻炎、复发性鼻息肉,于蝶腭孔处夹闭蝶腭动脉治疗严重鼻后部出血及相关部位肿瘤的切除,已经得到较好的成果。术前详细了解解剖变异和病变累及范围成为必需,这样对于影像学检查检查提出了更高的要求。以往由于CT扫描和后处理技术的泄后,要显示多个方向常需多方位扫描,但是即使加上常规的正冠状位及矢状位也无法完整显示翼腭窝结构及其交通,限制了CT在手术方案制定中的应用价值,远远无法满足现今鼻窦内窥镜新技术的需要。多层螺旋CT各向同性扫描,所有后处理图像的质量可以保证与原始横断图像完全一致,在此基础上通过调整观察平面可以选择最佳角度和方位来显示翼腭窝的各个结构,克服了常规图像的局限性。MPR、VR、MIP等重建技术可随时矫正体位不正带来的问题,在任意平面重组,完整显示翼腭窝各结构及其与周围结构的毗邻关系,更加有利于临床医生们观察、测量表面结构和骨性结构,并由此成为经鼻腔内镜手术的路径图对于术前诊断和制定介入方案提供了必要的影像学信息。
[Abstract]:Purpose. To investigate the application of isotropic multi-slice spiral CT in the display of pterygopalatine fossa and its related channels, the steps of multiplanar recombination MPRs, the volumetric display of VRV and the maximum density projection of the pterygopalatine fossa, and its clinical value. Method. Siemens sensation 16CT scanner was used to screen 100 adults with pterygopalatine fossa and its channel lesions. The data were processed by workstation for volume display, maximum density projection (MIP) and multiplanar recombination. The structure and channel of pterygopalatine fossa were observed. Results. The display rates of round foramen, pterygoid canal, sphenopalatine foramen, pterygopalatine canal, palatopalatine sheath canal and plough sheath canal in their optimum identification positions were 990.98 / 99g / 9696 / 9695, respectively. Conclusion. Multi-slice spiral CT scan combined with image post-processing technology can display the pterygopalatine fossa bone structure and its channels in many directions and intuitively. It can provide the imaging basis for early detection of related lesions and for the formulation of clinical treatment plan. Meaning. The pterygopalatine fossa and its associated structures are complex, subtle, and irregular in shape. They are important channels for infection and tumor diffusion, because of the depth of the site and the passage of important blood vessels and nerves through the pterygopalatine fossa. It is difficult for the routine clinical sinus examination to enter into the small pore to find the lesion, the biopsy is difficult, the imaging examination becomes the disease diagnosis important means. Because CT examination to the bone fine structure high display ability, It is easy to observe the phenomenon of cortical sclerosis and decrease of density caused by the lesion, and can detect the invasion of the lesion to other parts through each duct at an early stage. With the development of endoscopic sinus technique, researchers at home and abroad began to explore the treatment of lateral skull base lesions, including pterygopalatine fossa lesions. To treat trigeminal neuralgia by cutting maxillary nerve at the foramen roundus, and to treat refractory vasomotor rhinitis, allergic rhinitis, recurrent nasal polyps by pterygotomy at the pterygotomy. The removal of severe posterior epistaxis and tumor of related sites by clipping the sphenopalatine artery at the sphenopalatine foramen has achieved good results. It is necessary to understand the anatomical variation and the extent of lesion before operation. This puts forward higher requirements for imaging examination. In the past, because of the release of CT scanning and post-processing techniques, multi-directional scanning was often required to display multiple directions. However, the pterygopalatine fossa structure and its communication could not be completely displayed in normal coronal and sagittal images, which limited the application value of CT in surgical planning. Multislice spiral CT isotropic scanning, all post-processing images can be guaranteed to be consistent with the original transection image. On this basis, the optimal angle and orientation can be chosen to display the structures of pterygopalatine fossa by adjusting the observation plane, which overcomes the limitation of conventional image. The complete display of the structures of the pterygopalatine fossa and its adjacent relationship with the surrounding structures is more convenient for clinicians to observe and measure the surface structure and bone structure. Therefore, the path map of transnasal endoscopic surgery provides the necessary imaging information for preoperative diagnosis and interventional planning.
【学位授予单位】:山东大学
【学位级别】:硕士
【学位授予年份】:2010
【分类号】:R322

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