【作者】 孙建平；

【导师】 吴恩余；

【作者基本信息】 吉林大学 ， 临床医学， 2011， 硕士

【摘要】 视神经管(optic canal,OC)是眶与颅内沟通的重要渠道之一,也是视神经通向颅内的最狭窄部位,因其管径窄、位置深、骨壁薄,历来是眼眶影像学检查中的难点。视神经管从颅腔向前、外下突向眶尖,位于眶上裂的内上方,由蝶骨小翼构成,穿行于蝶骨小翼前、后两根之间。视神经管可分为上、下、内、外四个壁和两口:眶口和颅口。视神经管内有视神经及眼动脉通过,神经管骨折后可造成视神经管狭窄和视神经损伤,甚至失明,很难保守治愈。早期发现、确定骨折类型对明确视神经管骨折的手术适应证、选择手术方式均有很大帮助,并对临床提高手术成功率、减低由于视神经管骨折而致盲的发生率有重要意义。常规CT由于断层过厚,部分容积效应大,不能清晰显示视神经管的详细情况,此外由于构成视神经管四壁的骨较薄,主要以骨皮质为主,缺乏骨髓组织,故MRI不能直接显示视神经管的骨性构成,因而不能适应迅猛发展的现代临床医学诊断及手术技术的迫切需要。随着螺旋CT在临床上的广泛应用,高分辨率CT (High-Resolution Computed Tomography,HRCT)以其容积数据采集、优良的多轴位和CT三维成像技术,大大拓宽了CT的临床应用范围。既往的研究发现,采用HRCT,以前床突为中心,联合应用横轴位加冠状位扫描,可以较好的显示视神经管骨折的类型和程度[7-9],故HRCT及其多平面重建成像己经成为视神经管病变的常规轴位CT扫描最有益的补充[10],能够为临床判断是否损伤及损伤程度有极其重要的意义。研究目的:应用多层螺旋CT对眼部外伤后视神经管骨折的病人进行视神经管容积扫描及三维重建,对比不同重建方法下骨折的检出率,及同一类型骨折在不同重建方法下的显示情况,为临床提供最佳、早期、准确、直观的影像资料。材料与方法:收集2009-2010年在我院就诊的外伤后视神经管骨折的病人35例,均运用德国SIEMENS公司生产的Sensatianl6型螺旋CT扫描仪及PHILIPS公司生产的极速CT进行眼眶部容积扫描,获取原始数据。扫描后将原始数据分别以5mm及0.8mm的层厚及间隔进行重建,前者作为传统常规扫描进行对照,后者应用三维重建软件进行重建,包括采用MPR技术进行矢状位和冠状位重建、SSD重建以及MIP重建等,重建后将数据传至工作站,对比不同重建方式对视神经管骨折的显示情况。图像分析是在横轴位及冠、矢状位上观察视神经管的骨性构成、正常形态、周围毗邻关系等,对比不同重建方式下视神经管的骨折程度、分型情况。因视神经管为双侧,故本文按“眼”进行分析,运用统计学方法来评价视神经管骨折在常规CT扫描、HRCT多平面重建及三维重建图像上的显示情况。结果:常规CT轴位扫描骨折显示率为34.21%。HRCT轴位结合多平面重建冠、矢状位对视神经管的骨折显示率为100%,同时可明确地显示视神经管区的解剖结构、毗邻关系及骨折类型,准确判断骨碎片的移位方向和程度,测量骨碎片的大小。三维重建SSD结合MIP骨折显示率为65.79%,显示不佳主要为骨碎片移位较小,骨折线较短。结论:MSCT扫描中的HRCT及多平面重建成像技术(MPR技术),能够很好的显示正常的视神经管区的解剖结构、空间毗邻关系,完全的显示视神经管的骨折,并准确判断骨折的类型及程度,所以在视神经管骨折方面具有极大地优势,成为常规轴位CT扫描最有益的补充。三维重建在部分骨折类型显示方面优于常规CT,并且其空间立体感强,能够为临床医师提供立体的接近解剖结构的影像资料,便于制定合理的治疗方案,具有一定的临床价值。总之,随着多层螺旋CT在临床上的广泛应用,HRCT的MPR技术及三维重建技术的联合应用,视神经管骨折的早期发现、及时治疗将会更加完善。更多还原

【Abstract】 Optic canal is one of the important channels the orbital with intracranial communication,but also to the optic nerve intracranial stenosis site,because of its diameter is narrow,the position is deep,bone wall is thin,it always is the difficulty in the eye socket imaging examination. Optic canal from cranial cavity forward,outside to orbit tip,located within the supraorbital cracked above,by sphenoid small winglets constitute,through the sphenoid small winglets,between the two roots. Optic canal can be divided up,down,inside and outside four walls and two mouths: orbital mouth and cranial mouth. Optic canal had optic nerve and ophthalmic artery through,optic canal after fracturing can cause its stenosis ,optic nerve damage and even blindness,it is hard to conservative cure. Inchoate discovery,determine fracture type for specific optic canal fracture operated indication and select the surgical approaches have help,so as to improve the success rate, reduce the incidence of blindness because of optic canalclinical fractures will help.Conventional CT because the faults are too thick,part of volume effect is big,can not display optic canal details clearly,moreover due to optic canal walls of bone is thin,mainly with the bone cortex primarily,lack of bone marrow tissue , therefore MRI can not directly display optic canal of osteoarthritis constitutes and therefore can not adapt to the rapid development of modern clinical medical diagnosis and surgical technique of urgent need. With spiral CT in clinical application,High-Resolution Computed Tomography (HRCT) with its volume data acquisition,excellent multiaxial bits and 3D imaging technology,greatly widened CT of the clinical application of scope. Past studies has found that adopts HRCT,anterior clinoid process as the center,the combined use of the horizontal axis of the bit add coronal scan,can display optic canal fractures of the type and extent well,so HRCT and Multiplanar reconstruction imaging have become the most beneficial supplement of after optic canal lesions of conventional shaft a CT scan,can for clinical judgment whether injury and damage degree have very important significance.Objective: Application of ocular trauma in multislice CT after fractures of the optic canal patients were optic canal volume scanning and 3d reconstruction, Comparing the fracture detection under different reconstruction methods, and the display of the same type of fracture under different reconstruction methods,provide best, early, accurate and intuitive image data for clinical.Materials and methods: Collect 2009-2010 in our hospital 35 cases optic canal fracture patients,all use Germany SIEMENS company produce the Sensatian16 type spiral CT and UltraFast CT that PHILIPS company produce for orbital department volume scanning, obtain raw data. After a scan 5mm respectively based on 0.8 mm thick and intervals reconstruction,the former as traditional regular scans were compared , the latter application of 3D reconstruction software more planar reconstruction and 3D reconstruction,including MPR technology reconstruction sagittal bits,coronal reconstruction,SSD reconstruction and MIP reconstruction,reconstruction after the data to the workstation,Comparing the different ways of optic canal reconstruction under fracture degree, classification. Image analysis is in the horizontal axis of the throne observation optic canal of osseous composition,the normal form,around adjacent relation and fracture degree,parting. For optic canal for bilateral,in the paper according to the "eye" carries on the analysis.Use statistical methods to evaluate optic canal fractures in conventional CT scan, HRCT many plane image reconstruction and the display of 3D reconstruction.Results: Conventional CT scan showed a shaft fracture rate of 34.21%. HRCT shaft bits with coronal, planar reconstruction sagittal bits of visual display fracture rate of 100% ,and optic nerve can be clearly shows the archdiocese of anatomical structure, relations with neighbours and fracture type, accurate judgement of the bone fragment displacement direction and degree, the size of the bone fragments measurement.3D reconstruction SSD and MIP fractures showed rate was 65.79%,show not beautiful mainly for fracture displacement is lesser,fracture line is relatively short.Conclusion: The HRCT and many plane reconstruction imaging (MPR technology),can very good showed normal optic canal of the anatomical structure,spatial relations with neighbours,fully display optic canal of fracture,and accurate judgement of the fracture type and degree,so in optic canal fracture has greatly superiority , has become the most beneficial supplement for conventional shaft a CT scan. 3D reconstruction in optic canal fracture shows better than conventional CT ,and its space stereo sense is stronger,can provides stereo close to anatomical image data for clinicians,easy to formulate rational treatment,has certain clinical value. Anyhow,with MSCT clinical application, MPR technology and the 3D reconstruction technique combined application, optic canal fractures of the inchoate discovery,inchoate cure will be more perfect.更多还原