椎动脉V3各亚段分支显示率及排列方式的CTA研究

The assessment of the frequency and arrangement of subsegmental branches of V3 using computed tomography angiography

目的应用椎动脉CTA评估V3各亚段动脉分支的显示率及排列方式,并对其是否存在性别、侧别统计学差异进行分析。方法选取符合纳入标准的颈部或头颈部CTA联合扫描的患者668例,应用解剖学对V3的三亚段分法,首先在CT图像中确定垂直段(V3v)、水平段(V3h)及硬脑膜外段(V3e)各亚段起止点;然后由3位诊断医师进行图像分析、记录双侧V3各亚段动脉分支的数目;再进行各亚段分支的显示率及排列方式以及性别、侧别统计学分析;最后进行观测者之间的一致性检验分析。结果统计显示左侧V3v、V3h、V3e各亚段具有1支动脉分支的显示率分别为25.07%、20.21%、6.59%;具有2支动脉分支的显示率分别为1.05%、0.00%、0.45%。右侧V3v、V3h、V3e各亚段具有1支动脉分支的显示率依次为25.00%、17.07%、6.44%;显示为2支亚段动脉分支的分别为1.05%、0.30%、0.15%。应用t检验得出V3各亚段分支数目无侧别及性别差异。V3各亚段动脉分支八种排列方式(0,0,0;1,0,0;1,1,0;1,1,1;0,1,0;0,1,1;0,0,1;1,0,1),采用双样本KS检验证明V3各亚段分支排列方式无侧别及性别差异。结论CTA源图像能够显示椎动脉V3各亚段动脉分支的显示率和排列方式,且二者与侧别及性别无统计学差异;明确椎动脉V3段动脉分支情况对于颅颈交界区的手术,可以有助于临床确定手术入路,减少术中出血等并发症的发生。

Objective To reveal the frequency and arrangement of subsegmental branches of V3 on CTA and to analyze the inter-relationships among frequency and arrangement,gender,and side-to-side.Methods First,a retrospective search of radiology records identified 668 consecutive patients who underwent cervical or craniocervical CTA scan from.Second,the four demarcation points were ascertained to define the three subsegments by reviewing the resource images,namely vertical portion of V3(V3v),horizontal portion of V3(V3h),and extradural portion of V3(V3e).Then,the numerical value and the location of the bifurcating branch in each subsegment of V3 were recorded.Third,the frequency and arrangement of the branches was assessed,and the relationships between gender,laterality and frequency and arrangement were analyzed.Results Among our research,25.07%,20.21%or 6.59%was the frequency of one branch in the V3v,V3h,V3e in the left,and 1.05%,0.00%,0.45%was the frequency of two branches respectively.25.00%,17.07%,6.44%was the frequency of one branch in the V3v,V3h,V3e in the right,and 1.05%,0.30%,0.15%was the frequency of two branches respectively.There was no difference between side-to-side as well as gender and numerical value of branch by using t-test.There was no difference between side-to-side as well as gender and eight arrangements(permutation of 0,0,0;1,0,0;1,1,0;1,1,1;0,1,0;0,1,1;0,0,1;1,0,1)by using two-sample KS test.Conclusion The frequency and arrangement of V3 sub-segmental branches could be displayed by the source imaging of CTA,and there were no significant differences among the gender or sides.It was imperative to acquaint the sub-segmental branches before the operation involving V3 in craniocervical junction so as to determine the surgical approach and to reduce the bleeding in the surgical procedures.