三维重建CT血管造影在C1-2水平椎动脉变异诊断中的价值

The diagnostic value of three-dimensional reconstruction CT angiography for vertebral artery variations at the C1-2 level

中文关键词:  三维CT血管造影  椎动脉变异  C1-2内固定  C2椎动脉高跨  椎动脉损伤

英文关键词:Three-dimensional CT angiography  Vertebral artery variation  C1-2 internal fixation  High-riding vertebral artery  Vertebral artery injury

中文摘要:

  【摘要】 目的：探讨三维重建CT血管造影（computed tomographic angiography，CTA）对C1-2水平椎动脉变异的诊断价值。方法：回顾性分析171例因脑出血、脑肿瘤等明确与椎动脉变异无关的疾病而行头颈部CTA检查的患者的影像学资料，其中男性108例，女性63例，平均年龄为59.5±14.7岁（20~88岁）。对原始图像进行三维重建，明确是否存在C2椎动脉高跨、节段型椎动脉、窗口型椎动脉、小脑后下动脉起点下移及寰椎骨桥形成等椎动脉变异情况及发生率。结果：171例患者中共有78例（45.6%）患者在C1-2水平椎动脉存在变异，部分患者存在两种或两种以上变异。C2椎动脉高跨有58例（33.9%），其中19例位于左侧，15例位于右侧，24例双侧存在；节段型椎动脉有2例（1.2%），均位于左侧；窗口型椎动脉有4例（2.3%），2例位于左侧，2例位于右侧；未发现小脑后下动脉从C1-2水平的椎动脉发出，但有16例（9.4%）患者小脑后下动脉的起点位于寰椎与枕骨大孔之间，其中13例位于左侧，3例位于右侧；此外，寰椎骨桥形成有32例（18.7%），其中11例位于左侧，5例位于右侧，16例双侧都存在。结论：C2椎动脉高跨是C1-2水平最常见的椎动脉变异，其发生率女性高于男性；三维重建CTA检查可清楚显示C1-2水平各种类型的椎动脉变异，对椎动脉变异的诊断具有重要意义。

英文摘要:

  【Abstract】 Objectives: To investigate the diagnostic value of three-dimensional reconstruction CT angiography (CTA) for vertebral artery variations at the C1-2 level. Methods: Imaging data of 171 patients with head and neck examination were retrospective analyzed, most of whom were due to diseases, such as cerebral hemorrhage and brain tumor unrelated to variation of vertebral artery(VA). The subjects of this study included 108 males and 63 females. The average age was 59.5±14.7 years old(from 20 to 88 years old). The three-dimensional reconstruction of the original image was performed to confirm whether there existed high-riding VA(HRVA), a persistent first intersegmental artery(FIA), fenestration of the VA above and below C1(FEN), posterior inferior cerebellar artery(PICA), and ponticulus posticus(PP). Results: There were 78 patients(45.6%) having variations at the C1-2 level, and there were two or more variations in some patients. HRVA was observed in 58 patients(33.9%), of which 19 cases were on the left side, 15 cases were on the right side, and 24 cases were bilateral. There were 2 cases(1.2%) of FIA, which located on the left side. There were 4 cases(2.3%) of FEN, 2 cases on the left side, and 2 cases on the right side. PICA did not originate at C1-2 in any of these cases, but PICA was observed in 16 patients(9.4%) who originated between the atlas and the foramen magnum, 13 of them were located on the left side, and 3 cases on the right side. In addition, there were 32 cases(18.7%) of PP, of which 11 were located on the left side, 5 on the right and 16 on both sides. Conclusions: The most common variation of the vertebral artery at the C1-2 is the HRVA of C2, and its incidence is higher in women than in men. The three-dimensional reconstruction CTA can show clearly the variation of each type of vertebral artery in the level of C1-2, which is of great significance for the diagnosis of vertebral artery variation.