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目的对64层螺旋CT轴位像上显示的颅底颈内动脉及基底动脉腔内线状低密度影形成的原因进行初步研究探讨,并结合文献分析其临床意义。方法采用64层螺旋CT对本科室2009年9月14日至2009年10月15日收治的270例非外伤患者行头颈部血管成像检查,在ADW 4.4后处理机上进行后处理后传入PACS系统,并将得到的颅底血管轴位图像也传入PACS系统,由2位后处理经验丰富的医师进行观察,统计基底动脉及颅底颈内动脉各段出现线样低密度影的例数并进行分析,且分别测量基底动脉末端CT值及颈内动脉海绵窦段管腔直径、基底动脉垂直走行处直径,得到的数据进行统计学分析。结果纳入研究的270例患者中,不存在血管腔内线样低密度影的40例,而存在的230例,占总研究人数的85%(230/270)。线样低密度影在横轴位上分为3型,Ⅰ型440根,表现为血管腔内1条线状低密度影;Ⅱ型64根,表现为血管腔内从中心发出2条线状低密度影到达血管壁,形如“鱼叉”状;Ⅲ型137根,表现为血管腔内线样低密度影呈星芒状分布。统计各部位存在线状低密度影的例数,基底动脉108根,颈内动脉虹吸部341根,颈动脉孔前23根,颈动脉孔143根,眼动脉段19根,颈动脉海绵窦段7根,基底动脉及颈内动脉虹吸部出现线样低密度影的概率最大。分别测量基底动脉末端CT值,不存在线样低密度影血管腔内的CT值(421.68±65.26)Hu比存在其的CT值(390.81±73.78)Hu高(P=0.014)。将不存在线样低密度影与存在线样低密度影的血管腔直径进行分析,基底动脉不存在线样低密度影的血管腔比存在的血管腔管径小,而左侧颈内动脉不存在线样低密度影的血管比存在的血管管径大(P<0.01),右侧则无明显区别(P>0.05)。结论血管腔内线样低密度影的影像与血管腔内CT值、血管解剖因素及伪影的影响有关,与血管管径无明显关系,对外伤性血管损伤合并内膜瓣形成的鉴别诊断有重要的临床意义。
Objective To study the causes of linear low-density intracavity arteries in the skull base internal carotid artery and the basilar artery displayed on 64-slice spiral CT axial images, and to analyze the clinical significance based on the literature. Methods A total of 270 cases of non-traumatic patients underwent head-and-neck neck angiography with 64-slice spiral CT in the department between September 14, 2009 and October 15, 2009 and post-treatment on the ADW 4.4 post-processor. The data were then sent to the PACS system, The axial cranial basement images were also transmitted to the PACS system. Two post-treatment experienced physicians observed the incidence of linear low-density images of the basilar and intracranial arteries of the skull base The CT values at the end of the basilar artery, the diameter of the lumen of the cavernous sinus segment and the diameter of the basilar artery in the vertical direction were measured and statistically analyzed. Results Of the 270 patients enrolled in the study, there were no 40 cases of intracavitary linear low-density contrast and 230 were present, accounting for 85% (230/270) of the total. Line-like low-density film in the horizontal axis is divided into 3 types, type I 440, manifested as a linear low-density intraluminal lumen; type II 64, the performance of the vascular cavity emitted from the center of two linear Low-density shadow reaches the vascular wall, shaped like a “harpoon” -like; type 137, manifested as linear low-density intraluminal blood vessel shadow was star-shaped distribution. The number of cases with linear low-density shadow in each site was calculated. 108 basilar artery, 341 internal carotid artery siphon part, 23 anterior carotid artery hole, 143 carotid artery hole, 19 ophthalmic artery segment and carotid cavernous sinus segment 7, the basilar artery and internal carotid artery siphon appeared linear low density of the greatest probability. CT values of the basilar artery were measured respectively. CT values (421.68 ± 65.26) in the absence of line-like low-density intracavities were higher than those in CTs (390.81 ± 73.78) Hu (P = 0.014). The absence of line-like low-density and presence of line-like low-density shadow of the vessel lumen diameter analysis, the basilar artery without line-like low-density blood vessel lumen than the presence of small, while the left internal carotid artery Blood vessels with line-like low-density shadow had a larger diameter than the existing ones (P <0.01), while there was no significant difference between the right and left sides (P> 0.05). Conclusions The image of intracavitary linear low-density contrast is related to the value of intracavitary CT, vascular anatomy and artifacts, and has no significant relationship with the vascular diameter. It is important for the differential diagnosis of traumatic vascular injury with intimal flap formation The clinical significance.