颅底环枢部影像解剖学特点及诊断价值

Anatomic imaging features of bases of skull and atlantoepistrophic articulation and diagnostic value

目的探讨环枢部的影像解剖学特点及其诊断价值。方法收集确诊和资料完整的颅底病变21例,其中男性14人,女性7人。平片摄颈椎正、侧位X线平片,必要时加拍颈椎过伸过屈位片及张口位片。CT行颅底横断位薄层扫描,并作多平面和三维重建。MRI行后颅凹颈段脊髓矢状位、横轴位及冠状位扫描检查。结果21例中,颅底凹陷为7例,寰枢椎脱位9例,Chiari畸形5例。X线平片主要表现为寰椎、枢椎形态构异常,并且能显示Chamberlain线,借此可作出颅底凹陷的诊断。颅底凹陷和Chiari畸形可同时并存,MRI不但能诊断出颅底凹陷,而且能够诊断出X线片和CT不能显示的Chiari畸形。寰枢椎脱位主要通过测量寰枢椎间距离(ADI)诊断,主要依靠X线平片和CT测量诊断。结论学习和掌握环枢部的影像解剖学特点,X线平片、CT、MRI不同检查方法的价值和限度,有利于提高颅底寰枢部病变的诊断和鉴别诊断水平。

Methods Collected 21 definite diagnosis cases of diseases of bases of skull which had completely data,including 14 males and 7 females. Collected imagings with DR of normotopia and lateral projection, got the imagings of hyperextension and hyperbending if it were necessary.The lamellar scanning ilnagings of CT were collected. Took multiplanar reconstruction and three-dimensional reconstruction. Got the anteroposterior axes, axial view and coronal imagings of the cervical segments of spinal cord in the posterior cranial fossa with MRI. Results Seven cases were basilar impression,nine cases were dearticulation of atlantoepistrophic articulation,and five cares were Chiari abnormity.In the X-ray pictures,it showed the abnormal form of tile atlas and axis,it also showed the Chamberlain line, according to which we could diagnose the basitar impression.The basilar impression were always simultaneous with tile Chiari abnormity. MRI not only diagnosed the basilar impression,but also diagnosed the Chiari abnormity. The diagnosis of dearticulation of atlantoepistrophic articulation mainly according to measure the ADI. The X-ray pictures and CT were important. Conclusion Study and prehension the anatomic imaging features of bases of skull and atlantoepistrophic articulation,study the value and limitation of X-ray pictures, CT and MRI in favour of increasing the level of diagnosis of diseases in bases of skull and atlantoepistrophic articulation.