本文選題：翼腭窩　切入點：各向同性　出處：《山東大學(xué)》2010年碩士論文

【摘要】： 目的 探討多層螺旋CT的各向同性掃描對于翼腭窩結(jié)構(gòu)及其相關(guān)通道的完整顯示,多平面重組(MPR)步驟,容積顯示(VR)、最大密度投影(MIP)技術(shù)在顯示翼腭窩上的應(yīng)用,及其臨床應(yīng)用價值。 方法 應(yīng)用Siemens sensation 16CT掃描儀行螺旋CT檢查,篩選100名無翼腭窩及其通道病變的成人,將其數(shù)據(jù)由工作站進行容積顯示(VR)、最大密度投影(MIP)及多平面重組(MPR)等圖像后處理,觀察翼腭窩結(jié)構(gòu)及其通道的形態(tài)、走行,并測量具體大小。 結(jié)果 圓孔、翼管、蝶腭孔、翼腭管、腭鞘管、犁鞘管在其最佳辨認(rèn)方位上顯示率分別為99%、98%、99%、96%、96%、85%。 結(jié)論 多層螺旋CT掃描結(jié)合圖像后處理技術(shù),能多方位而且直觀地顯示翼腭窩骨性結(jié)構(gòu)及其通道,能為早期發(fā)現(xiàn)相關(guān)病變以及為制訂臨床治療方案提供影像學(xué)依據(jù)。 意義 翼腭窩及其相關(guān)結(jié)構(gòu)解剖復(fù)雜、細微、形態(tài)不規(guī)則,為感染及腫瘤擴散的重要通道,因為部位深在,又有重要的血管、神經(jīng)穿行,常規(guī)臨床鼻竇檢查難以進入小的孔道發(fā)現(xiàn)病變,活檢困難,影像學(xué)檢查成為疾病診斷的重要手段。由于CT檢查對骨骼微細結(jié)構(gòu)的高顯示能力,易于觀察病變引起的骨皮質(zhì)硬化及密度降低現(xiàn)象,可以早期發(fā)現(xiàn)病變通過各管道向其他部位的侵犯,對治療方案的選擇及對病人預(yù)后的評估也有重要意義。隨著鼻竇內(nèi)窺鏡技術(shù)的不斷進步,國內(nèi)外學(xué)者逐漸開始由鼻內(nèi)窺鏡處理包括翼腭窩病變在內(nèi)的側(cè)顱底病變的探索,于圓孔處高位切斷上頜神經(jīng)治療三叉神經(jīng)痛,于翼管處作翼管神經(jīng)切斷術(shù)治療頑固性血管運動性鼻炎、過敏性鼻炎、復(fù)發(fā)性鼻息肉,于蝶腭孔處夾閉蝶腭動脈治療嚴(yán)重鼻后部出血及相關(guān)部位腫瘤的切除,已經(jīng)得到較好的成果。術(shù)前詳細了解解剖變異和病變累及范圍成為必需,這樣對于影像學(xué)檢查檢查提出了更高的要求。以往由于CT掃描和后處理技術(shù)的泄后,要顯示多個方向常需多方位掃描,但是即使加上常規(guī)的正冠狀位及矢狀位也無法完整顯示翼腭窩結(jié)構(gòu)及其交通,限制了CT在手術(shù)方案制定中的應(yīng)用價值,遠遠無法滿足現(xiàn)今鼻竇內(nèi)窺鏡新技術(shù)的需要。多層螺旋CT各向同性掃描,所有后處理圖像的質(zhì)量可以保證與原始橫斷圖像完全一致,在此基礎(chǔ)上通過調(diào)整觀察平面可以選擇最佳角度和方位來顯示翼腭窩的各個結(jié)構(gòu),克服了常規(guī)圖像的局限性。MPR、VR、MIP等重建技術(shù)可隨時矯正體位不正帶來的問題,在任意平面重組,完整顯示翼腭窩各結(jié)構(gòu)及其與周圍結(jié)構(gòu)的毗鄰關(guān)系,更加有利于臨床醫(yī)生們觀察、測量表面結(jié)構(gòu)和骨性結(jié)構(gòu),并由此成為經(jīng)鼻腔內(nèi)鏡手術(shù)的路徑圖對于術(shù)前診斷和制定介入方案提供了必要的影像學(xué)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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R322

【參考文獻】

中國期刊全文數(shù)據(jù)庫 前10條

1 馬力學(xué),趙波,姜海燕;鼻內(nèi)窺鏡下翼管神經(jīng)切斷術(shù)治療過敏性鼻炎[J];海軍醫(yī)學(xué)雜志;2001年04期

2 姜曉鐘,趙云富,鄒愛萍,高宏,苗林,周潔;經(jīng)圓孔外口神經(jīng)切斷術(shù)治療上頜神經(jīng)痛的臨床應(yīng)用(附48例報告)[J];口腔醫(yī)學(xué)縱橫;2000年02期

3 石慧敏,王平仲,余強,羅濟程;頜面部病變侵犯中顱窩底的CT表現(xiàn)[J];臨床放射學(xué)雜志;2002年03期

4 楊本濤 ,王振常 ,鮮軍舫 ,常青林 ,田其昌 ,蘭寶森 ,劉莎;翼腭窩及其通道的HRCT研究[J];臨床放射學(xué)雜志;2002年09期

5 肖恩華，李德泰，沈樹斌，劉顧崗;翼腭窩正常解剖和病變的CT研究[J];臨床放射學(xué)雜志;1995年03期

6 謝毓芝,林濤;69例鼻咽癌侵犯顱面部解剖結(jié)構(gòu)的CT影像分析[J];上�？谇会t(yī)學(xué);2005年03期

7 朱光第，，汪維健;翼腭窩原發(fā)腫瘤的CT診斷探討（附4例報告）[J];實用口腔醫(yī)學(xué)雜志;1994年01期

8 楊廣夫,楊健,王欣璐,魚博浪,王澤忠;翼腭窩病變CT、MRI診斷[J];現(xiàn)代醫(yī)用影像學(xué);1996年01期

9 柳澄;;充分發(fā)揮各向同性掃描的優(yōu)勢,開拓多層CT新的應(yīng)用領(lǐng)域[J];醫(yī)學(xué)影像學(xué)雜志;2007年01期

10 王中亮;居富年;管晏茹;于愛民;馬偉;薛普翼;王保珍;;鼻內(nèi)鏡下行翼腭窩上頜神經(jīng)和眶下神經(jīng)全長切除治療三叉神經(jīng)痛22例報告[J];中國耳鼻咽喉顱底外科雜志;2007年02期

本文編號：1691553