多层螺旋CT三维血管成像在鞍结节脑膜瘤诊治中的应用

Application of multi-slice spiral computerized three-dimensional tomographic angiography in diagnosis and treatment of tuberculum sellae meningioma

目的探讨多层螺旋CT三维血管成像对鞍结节脑膜瘤及其周围组织的显示能力,评价其在鞍结节脑膜瘤诊断中的应用价值。方法21例鞍结节脑膜瘤病人均行CT平扫和增强扫描。图像送至AW 4.2工作站进行最大密度投影、容积再现、表面遮蔽法后处理,对三维图像进行旋转、切割及相关测量,模拟最佳手术入路,将其影像学特点与手术中所见进行对比研究。结果重建图像显示瘤体充分强化,颅骨、血管、肿瘤三者立体关系显示清楚,血管受压或被肿瘤包绕、肿瘤周围组织移位等征象均显示清晰。结论多层螺旋CT三维血管成像可以充分显示鞍结节脑膜瘤的影像特征,使血管充分强化,重建后可清楚显示肿瘤、血管及肿瘤与邻近组织的关系,可以从多角度模拟手术路径,选择最佳手术入路,有助于鞍结节脑膜瘤的诊断及治疗方案的制定,提高手术的安全性。

Objective To study the application and value of multi-slice spiral computerized threedimensional tomographic angiography in diagnosis and treatment of tuberculum sellae meningioma. Methods CT plain scan and contrast-enhanced scan were performed in 21 cases with tuberculum sellae meningioma. All image data were analyzed with the software of maximum intensity projection, volume rendering, and shaded surface display on the advantaged workstation. Three dimensional images were applied to imitate the approach of operation. Surgery was performed according to the images of three dimensional imaging CT arteriography. Results The tumors were enhanced evidently in reconstruction images. The relationship among skull, tumor and blood vessels could be simultaneously clearly revealed by three dimensional imaging CT arteriography, and the main CT appearances included blood vessels pressed or surrounded by the tumors, and peripheral constructions deviated from their normal positions. Conclusion Three dimensional imaging CT arteriography can show the imaging characteristics of tuberculum sellae meningioma and the correlations of tumor, blood vessels and the peripheral constructions. It can supply the vital information for choosing the proper surgical approach and provide the useful message for managing the sinus during the operation. It is useful in diagnosis and treatment of tuberculum sellae meningioma.