颈内动脉床突段的MSCT分型及其临床意义

Classifications of clinoid segment of internal carotid artery with MSCT and its clinical significance

目的:利用多层螺旋CT(MSCT)三维重建在活体个性化进行颈内动脉(ICA)床突段分型并了解其周的解剖关系,为术中磨除前床突提供有用的影像学信息。方法:对210例受检者(420侧)常规进行容积再现(volume rendering,VR)重建颅骨和ICA,沿眶截骨平面和矢状正中平面分别模拟切除颅盖骨和左右分开,同时分别距前床突左右外侧缘和后床突后侧缘1cm处模拟矢状位和冠状位切除左右外侧及后侧颅骨,并与不同颜色的ICA图像融合,分别从左右侧位及后侧冠状位观察ICA与前床突之间的关系并进行分型。结果:根据ICA床突段与前床突的关系,在侧位相上分全ICA型351侧(83.57%)、半ICA型61侧(14.52%)和无ICA型8侧(1.90%)3型;于冠状位上分为ICA内侧型407侧(96.9%)和ICA外侧型13侧(3.10%)2型。结论:MSCT三维重建技术能清楚的显示ICA床突段与前床突的关系并分型,为制定个体化手术方案提供重要影像学参考。

Objective. To observe the anatomy relationship between the anterior clinoid process （ACP） and the anterior clinoid segment of internal carotid artery （ICA） with multisliced computed tomography （MSCT） three-dimensional reconstruction technology in order to provide useful imaging information for ACP removal surgery. Methods. A total of 210 patients （420 sides） underwent volume rendering reconstruction of skull which was removed along with superorbital （1. 5 cm） superoccipital tuberosity （1.0 cm）plane. The left or right lateral sagittal planes to the lateral rim of the ACP and coronal planes to the rim of the posterior clinoid process （PCP） were cut in simulation. Then the rest skull of volume rendering reconstruction of ICA was integrated with images in different colors. The anatomy relationships between the ACP and the clinoid segment of ICA were observed. Results. According to the relationships of ACP and ICA, the clinoid segment of ICA were classified into three types in lateral view： namely the whole ICA 351 （83.57%）, half ICA 61 （14.52%） and non-ICA 8 （1.90%）, there were 2 types of clinoid segment of ICA in coronal view. namely medial ICA 407 （96.90%） and lateral ICA 13 （3.10%）. Conclusion： MSCT three-dimensional reconstruction techniques can clearly show the relationship between ACP and the anterior clinoid segment of ICA and ensure its types, and can provide an important imaging reference for the individualized surgical plan.