CT血管成像直窦近端影像解剖学研究

Anatomy of the proximal straight sinus under CT angiography

目的:探讨直窦近端解剖形态的CTA表现。方法:采用64层螺旋CT行头部及头颈部CTA,回顾性三维重建100例直窦近端影像。观察大脑大静脉汇入直窦处形态、直窦顶的形态、下矢状窦形态、大脑永存镰状窦显示率及形态。结果:①根据大脑大静脉末端形态及其管腔是否变细,将大脑大静脉汇入直窦处形态分为3型,I型-管腔变细,占46%;II型-管腔无变细,中间无间隙,占32%;III型-管腔内充盈缺损,占22%。②直窦顶可为:弧形35例,"一"字形28例,倒"V"字形24例,不规则形8例,柱形3例,T形1例,双峰形1例等七种类型。③下矢状窦显示占65%,缺如占35%;其形态可呈向上凸起弧状或弯曲状;管腔可粗细不均。④大脑永存镰状窦显示率为9%,形态多样,其中4例伴有其他静脉窦发育变异。结论:直窦近端解剖学特征复杂,利用MSCTA可以个体化、完整、有效、充分地显示其活体解剖特点,可为临床上静脉窦病变的诊断和治疗提供依据。

Objective： To explore the CT angiography （CTA） features of the proximal straight sinus. Methods： Retrospective three-dimensional reconstruction of the proximal straight sinus was carried on 100 cases of head or head-and-neck CTA （64-slice CT） data. The anatomic characteristics of the straight sinus, involving its confluence site with the galea vein, the top of the straight sinus, the inferior sagittal sinus, and the persistent faleial sinus were observed and analyzed. Results： ① According to the shape and lumen of the distal end of the galea vein, the confluence site with the galea vein was divided into three types： type Ⅰ with the thin lumen （46%）, type Ⅱ with the same lumen as the main trunk of the galea vein （32%）, and type Ⅲ with filling defect（22%）. ② The straight sinus top showed the arc shape（35 cases）, ＂-＂ shape（28 cases）, inverted ＂V＂ shape （24 cases）, irregular shape（8 cases）, column shape（3 cases）, T shape（1 ease） and the double-peak shape（1 case） respectively. ③65% of cases disclosed the inferior sagittal sinus, with the arc or curved shapes and irregular lumens. ④ The display rate of the persistent falcial sinus was about 9%, including 4 cases of other developmental variations. Conclusions： The anatomic features of the proximal straight sinus are complicated. MSCTA can be used to display it individually, sufficiently, completely and effectively, which is valuable for diagnosing and treating diseases of this area.