眶颅沟通性病变的CT和MRI研究

目的 研究、探讨眶颅沟通性病变的沟通路径、CT和MRI表现及其影像学特征。方法 51例患者,男28例,女23例,年龄2－68岁,平均41岁,为手术病理和随访结果证实。51例均行 CT扫描,45例行MR扫描,CT和MR增强扫描各44例。结果 通过眶上裂或视神经管沟通的颅眶沟通笥病变31例,占60.8％。其中9例通过视神经管沟通,包括4例视神经和视交叉胶质瘤、3例视神经鞘脑膜瘤,以及2例视网膜母细胞瘤侵犯视神经和视交叉;通过眶上裂沟通者,包括5例脑膜瘤、4例神经源性肿瘤、2例Tolosa-Hunt综合征、3例炎性假瘤、1例眼眶和海绵窦皮样囊肿,以及7例鼻咽癌同时侵犯海绵窦和眼眶,通过眶骨穿支血管间隙沟通的病变或骨质破坏缺损区沟通的眶颅沟通性病变20例,占39.2％,包括5例眶骨扁平性脑膜瘤、10例眶壁转移瘤、1例眶壁软骨肉瘤侵犯筛窦、额窦和额叶、3例泪腺囊腺癌侵犯颅内和1例额底脑膜瘤侵犯眼眶。结论 CT和MRI,尤其是使用脂肪抑制技术和增强扫描的T1WI能明确显示眶颅沟通性病变的沟通路径和病变特征,为制订治疗方案和手术入路提供重要和直接的依据。     

Orbit: initial experience with surface coil spin-echo MR imaging at 1.5 T

Fifty-nine cases in which surface coil MR imaging of the orbit was performed were reviewed. MR imaging was performed with spin-echo techniques at 1.5 T with both short repetition time/echo time (TR/TE) and long TR/TE sequences in all cases. In all patients short TR/TE images were obtained with small-diameter surface coils; long TR/TE images were usually obtained with a standard head coil. Surface coil MR appears to be an important adjunct in state-of-the-art orbital imaging. Orbital MR imaging may be most useful, providing information not available on computed tomography (CT), in identifying lesions in the orbital apex, superior orbital fissure, and optic canal; differentiating inflammatory pseudotumor from malignancy in clinically similar patients; characterizing lesions containing hemorrhage or other paramagnetic material; defining the posterior extent of optic pathway gliomas; and detecting abnormal flow in intraorbital vascular structures. CT seems to be superior to MR imaging in the evaluation of small perioptic meningiomas, especially those that are calcified.     

Artery of the Superior Orbital Fissure: An Undescribed Branch from the Pterygopalatine Segment of the Maxillary Artery to the Orbital Apex Connecting with the Anteromedial Branch of the Inferolateral Trunk

BACKGROUND AND PURPOSE:Some branches of the internal maxillary artery have anastomoses with the inferolateral trunk that are important as intracranial-extracranial collateral pathways and as dangerous anastomoses for transarterial embolization of these branches. We present here an undescribed branch potentially anastomosing with the anteromedial branch of the inferolateral trunk, which is provisionally named the artery of the superior orbital fissure, defined as an arterial branch from the pterygopalatine segment of the maxillary artery to the orbital apex at the superior orbital fissure.MATERIALS AND METHODS:Two neuroradiologists reviewed 3D and MPR images of the external and/or common carotid artery with particular interest paid to the artery of the superior orbital fissure in 54 patients who underwent 3D angiography with a field of view covering the pterygopalatine fossa and the cavernous sinus. The underlying diseases in these patients were 17 parasellar hypervascular lesions (including 13 cavernous sinus dural arteriovenous fistulas and 4 meningiomas), 18 internal carotid artery stenoses/occlusions, and 19 other diseases.RESULTS:The artery of the superior orbital fissure was identified in 20 of 54 patients; it arose at the pterygopalatine segment of the maxillary artery, either singly or from a common trunk with the artery of the foramen rotundum, and ran upward to reach the superior orbital fissure. It anastomosed with the anteromedial branch of the inferolateral trunk at the superior orbital fissure with blood flow toward the cavernous sinus (n = 14) and/or the ophthalmic artery (n = 2). It was more prominent in parasellar hypervascular lesions and internal carotid artery stenoses/occlusions than in other diseases.CONCLUSIONS:The artery of the superior orbital fissure, a remnant of the anastomotic artery, was often identified, especially in patients with parasellar hypervascular lesions.

The maxillary artery is a major terminal branch of the external carotid artery, which is divided into 3 segments. The first segment originates anterosuperiorly in the deep parotid gland, and the second segment runs anteriorly to reach the pterygomaxillary fissure. It then turns medially to enter the pterygopalatine fossa (PPF) through the pterygomaxillary fissure, becoming the third segment.¹ The third segment, the terminal part of the maxillary artery, runs transversely in the PPF, which is a narrow space bounded by multiple bony structures. The maxillary arterial branches from the third segment run through various fissures, canals, and foramina to supply various tissues and organs of the surrounding areas.^1–7 The artery of the foramen rotundum is thought to be the sole arterial branch of the third segment of the internal maxillary artery to enter the cavernous sinus through the foramen rotundum.^1,5,6 It can supply skull base tumors and dural arteriovenous fistulas, and it has a potential anastomosis with the anterolateral branch of the inferolateral trunk (ILT).There are 2 communication pathways between the PPF and orbita. The uppermost part of the PPF communicates directly with the orbital apex at the superior orbital fissure (SOF), and the PPF communicates anterolaterally with the inferolateral part of the orbita through the inferior orbital fissure (Fig 1).^8,9 The upward communication can be a potential pathway communicating between the PPF and the orbita as well as the middle cranial fossa. Similarly, we found an undescribed branch via the direct communicating pathway between the uppermost part of the PPF and orbital apex, which is provisionally named the artery of the SOF, which originates from the pterygopalatine segment of the maxillary artery and runs upward to reach the orbital apex at the SOF. It frequently anastomoses with the anteromedial branch of the ILT to supply parasellar hypervascular lesions through the SOF. In this study, we investigated the presence and course of the artery of the SOF in various pathologic conditions by using 3D rotational angiography.Open in a separate windowFig 1.MPR images of rotational angiography in patients with left cavernous sinus dural arteriovenous fistulas. The coronal plane at the level of the inferior orbital fissure (IOF) shows the infraorbital artery (IOA) running through the inferior orbital fissure, through which the pterygopalatine fossa communicates anteriorly with the orbita. The third segment of the maxillary artery (Max A) is located in the pterygopalatine fossa. The coronal plane at the level of the medial part of the PPF shows the pterygopalatine fossa communicating superiorly with the orbital apex (arrowheads) at the SOF. Note a small arterial branch (artery of the SOF) running from the PPF to the SOF through this communication pathway. The PPF communicates medially with the nasal cavity via the sphenopalatine canal containing the sphenopalatine artery (SPA). The PPF communicates posteriorly with the middle cranial fossa via the foramen rotundum (FR), which contains the artery of the foramen rotundum (AFR). The superior orbital fissure continues to the cavernous sinus (CS). MMA indicates middle meningeal artery.     

Orbital apex: correlative anatomic and CT study

A detailed analysis of the coronal anatomic and CT appearances of the orbital apex is presented. In cadavers, coronal CT 9800 scans of the orbital apex and precisely corresponding cryomicrotomic sections were obtained. The CT appearance of the optic nerve, anulus of Zinn, and cranial nerves III-VI at the superior orbital fissure and orbital apex were determined. These anatomic structures were also demonstrated in clinical CT studies. Practical applications of the anatomic landmarks in evaluating orbital apex tumors are illustrated.     

Superior orbital fissure syndrome and its mimics: What the radiologist should know?

Aim of this study

The aim of this study was to assess the rule of imaging in the superior orbital fissure syndrome (SOFS) and to identify the rule of the radiologist in guidance of the management.

Material and methods

This study was conducted on 7 patients with clinical diagnosis of SOFS. Contrast enhanced MRI was used in examination of all patients. With exception of metastatic lesions, follow up MRI study was performed to all lesions. Final diagnosis was reached either by dramatic response to cortico-steroid therapy, tissue biopsy or by correlation with clinical and other imaging data.

Results

In all patients enhancing abnormal T1 and T2 intermediate intensities are seen localized to the anatomical site of the superior orbital fissure (SOF). Four patients presented with sheet like enhancement casting the SOF. Nodular enhancement is noted along the medial aspect of the SOF in one case. Two patients presented with sizable destructive space occupying lesions at SOF.

Conclusion

In management of SOFS, if there is a dramatic clinical and radiological response to corticosteroid therapy, we recommend MRI follow-up study after 6 week interval. As the symptoms were resolving, the potential risks associated with tissue biopsy from that area will be unacceptable.     

Neuroradiology of the sphenoidal region.

The neuroradiological techniques employed in diagnosing a series of 54 lesions involving the superior orbital fissure and cavernous sinus (sphenoidal region) were reviewed in order to compare the value of sphenoidal tomography, pneumoencephalography, cerebral arteriography and sphenoidal venography. The patients included in the series exhibited clinical syndromes of sphenoidal region cranial nerve deficits. Confirmation of the sphenoidal region disorder was obtained in all cases. Of the four procedures, sphenoidal venography and basal tomography yielded the highest rate of positive studies.     

Color Doppler flow imaging of the normal and abnormal orbit

Twenty-six normal orbits (16 subjects) and seven patients with suspected orbital disease were studied with color Doppler flow imaging CDFI). Arterial structures consistently identified included the ophthalmic artery, central retinal artery, and posterior ciliary branches. The terminal lacrimal branch was seen in the majority of orbits (n = 19). Venous structures consistently seen included the central retinal vein and venae vorticosae; the superior ophthalmic vein was identified in the majority of normal orbits (n = 22). Response of the superior ophthalmic vein to the Valsalva maneuver was assessed in six of the normal subjects (12 orbits). Retrograde flow was typically seen during the maneuver and accentuated antegrade flow after cessation of the maneuver. Pathologic entities correctly diagnosed with CDFI included a dural arteriovenous malformation (AVM) with spontaneous carotid-cavernous fistula, an orbital AVM, and superior ophthalmic vein thrombosis. Vascular lesions were excluded in two patients with orbital masses. Bilaterally enlarged superior ophthalmic veins were identified in a patient with unilateral symptoms suggestive of a varix; CDFI results were confirmed with computed tomography, but orbital venograms were interpreted as normal. These findings suggest that CDFI may be helpful in the evaluation of suspected vascular orbital disease.     

眼眶神经纤维瘤病的CT表现

目的:探讨眼眶CT扫描诊断神经纤维瘤病 I 型(NF1)的应用.材料和方法:回顾性分析17例具有完整临床资料的NF1眼眶CT征象,全部病例均经手术病理和/或临床证实.结果:NF1眼眶CT的主要表现为:上睑肥厚,眶周及颞、颧部丛状神经纤维瘤;蝶骨发育不良,蝶骨大小翼或额骨眶板缺失;颅眶骨畸形,眶腔不对称性扩大,眶上、下裂及视神经孔扩大;眼球突出,体积增大;眶内软组织肿块;泪腺肿大,眼外肌肥厚,视神经增粗.结论:眼眶CT扫描对NF1病变侵犯范围、能否手术和手术方式选择具有重要的应用价值.     

Invasive orbital pseudotumor — CT demonstration of extension beyond orbit

Summary Two cases of orbital pseudotumor are described with computed tomographic (CT) studies showing extension of the pseudotumor beyond the confines of the bony orbit. In one patient with orbital pseudotumor involving the medial rectus muscle, the pseudotumor extended through the medial wall of the orbit into the ethmoid sinus. A second patient had extension of orbital pseudotumor into the infraorbital fissure causing enlargement of the infraorbital fissure and foramen. Both lesions were confirmed by biopsy.     

颅脑创伤合并创伤性眶上裂综合征的手术治疗

目的 比较颅脑创伤合并创伤性眶上裂综合征手术治疗与保守治疗的效果,探讨适应证及手术时机.方法 对12例(男7例、女5例)14侧创伤性眶上裂综合征患者的临床资料进行比较,比较手术治疗与保守治疗的效果,形成创伤性眶上裂综合征的初步治疗方案.结果 患者平均年龄28岁,平均随访6个月,所有患者均出现了以下症状中的一项或几项:眼球固定、眼睑下垂、眼球突出、角膜反射迟钝或消失、瞳孔散大,以及瞳孔对光反射迟钝或消失.其中1例患者合并眶尖综合征.CT三维重建显示:7例患者眶上裂区有骨折线、骨折片压迫或眶上裂出现变形.7例行手术治疗,其中6例有不同程度恢复.在行保守治疗的5例患者中,3例有不同程度恢复.结论 颅脑创伤合并创伤性眶上裂综合征患者年龄普遍较轻,如不及时治疗,将严重影响患者的神经功能.经扩大颧弓入路行眶上裂减压术能改善患者症状,降低致残率,提高患者生存质量.     

MR Imaging of Orbital Inflammatory Pseudotumors with Extraorbital Extension

Objective

To demonstrate a variety of MR imaging findings of orbital inflammatory pseudotumors with extraorbital extension.

Materials and Methods

We retrospectively reviewed the MR features of five patients, who were diagnosed clinically and radiologically as having an orbital inflammatory pseudotumor with extraorbital extension.

Results

The types of orbital pseudotumors were a mass in the orbital apex (n = 3), diffuse form (n = 2), and myositis (n = 1). The extraorbital extension of the orbital pseudotumor passed through the superior orbital fissure in all cases, through the inferior orbital fissure in two cases, and through the optic canal in one case. The orbital lesions extended into the following areas: the cavernous sinus (n = 4), the middle cranial fossa (n = 4), Meckel''s cave (n = 2), the petrous apex (n = 2), the clivus (n = 2), the pterygopalatine fossa and infratemporal fossa (n = 2), the foramen rotundum (n = 1), the paranasal sinus (n = 1), and the infraorbital foramen (n = 1). On MR imaging, the lesions appeared as an isosignal intensity with gray matter on the T1-weighted images, as a low signal intensity on the T2-weighted images and showed a marked enhancement on the post-gadolinium-diethylene triamine pentaacetic acid (post-Gd-DTPA) T1-sequences. The symptoms of all of the patients improved when they were given high doses of steroids. Three of the five patients experienced a recurrence.

Conclusion

MR imaging is useful for demonstrating the presence of a variety of extraorbital extensions of orbital inflammatory pseudotumors.     

泪腺腺样囊性癌的CT诊断

目的：评价泪腺腺样囊性癌（ACC）的CT影像表现。方法：回顾性分析经手术和病理证实的23例泪腺腺样囊性癌,结合临床和病理,观察CT表现。结果：全部肿瘤均发生在泪腺眶部,扁椭圆形11例,不规则形8例,梭型4例;肿瘤边界清楚15例,边缘不规则8例,其中肿瘤沿肌锥外间隙向眶尖生长10例,肿瘤部分包附眼球1例;肿瘤部分与外直肌和或上直肌和上睑提肌分界不清14例,蔓延到眶上裂和海绵窦1例,颞窝和中颅窝受累2例。11例（包括平扫和增强4例中的平扫）行平扫,显示肿瘤均为较高密度,其中4例密度较均匀,7例病灶内部分见小囊状、斑点状低密度改变;16例（包括平扫和增强4例中的增强）增强扫描大多为中到高度强化,其中10例强化不均匀,5例强化较均匀,1例未见强化;瘤内钙化3例。眶骨受压凹陷变薄13例,其中伴眶上裂扩大1裂;骨质吸收破坏10例。结论：泪腺腺样囊性癌的CT影像表现具有一定的特征,能为诊断定性和临床治疗提供重要依据。     

眼眶神经鞘瘤的CT和MRI研究

目的 研究眼眶神经鞘瘤的ＣＴ和ＭＲＩ表现,提高其诊断准确率。方法 １９例手术病理证实的眼眶神经鞘瘤,其中１５例行ＣＴ扫描,１０例行ＭＲ扫描,对照手术病理结果,比较分析ＣＴ和ＭＲＩ的诊断准确率。结果 ８例位于肌锥内,８例位于肌锥外,３例位于眼眶和海绵窦,为颅眶沟通性神经鞘瘤;１５例呈椭圆形,４例呈哑铃形。１１例神经鞘瘤ＣＴ平扫呈等密度,密度均匀,９例行增强扫描均呈均匀强化;３例呈等密度,密度不均匀,     

眼眶病变的SPIR磁共振成像

目的：评价SPIR（用于化学位移脂肪抑制的频谱预饱和反转复位技术)与造影增强联合应用在眼眶病变判断中的作用。材料和方法：20例眼眶病变患者在Gd—DTPA增强前后，分别采用T1加权SPIR技术(飞利浦ACS Gyroscan)．以四级评分系统与常规T1加权和T2加权图像作比较．5例无眼眶病变者用来研究正常眼眶解剖。结果：由于高信号脂肪和正常结构的平均容积加上化学性位移伪影在常规MRI图像上难以清楚地勾画出眼眶解剖结构．SPIR图像能清晰显示不能增强的视神经和能显著强化的眼直肌群和泪腺。SPIR技术在眼眶病变的判断中较常规MRI图像为优。结论：SPIR技术与Gd-DTPA注射联合应用．在显示眼眶解剖上要优于常规MRI．它增强了强化病变的显著性，应常规应用于眼眶病变检查。因此，增强后的SPIR能替代增强后的T1加权图像，SPIR的不利是由于气-骨界面信号衰减伪影的出现。     

Direct and CT measurements of canals and foramina of the skull base.

This investigation is based on measurements of 60 macerated adult European skulls from the Alexander-Ecker Collection at the Anatomy Department of the University of Freiburg. Computer tomographical (CT) and anatomical measurements were compared to assess the accuracy of the CT representation of osseous structures. Nine structures were examined: the optic canal; the superior orbital fissure; the foramen rotundum; the foramen ovale; the foramen spinosum; the foramen Vesalii (venosum); the carotid canal; the internal auditory canal, and the hypoglossal canal. The results show a good and even excellent correlation if the cranial opening is approximately at a right angle to the scanline. For this reason, the results of the coronal examination of the internal auditory canal are less satisfactory, and the coronal and axial measurements of the hypoglossal canal show only a moderately good correlation.     

Fissures of the posterior labrum and associated lesions: CT arthrogram evaluation

PURPOSE: To describe osseous, chondral and tendinous lesions associated with fissures of the posterior labrum. To better understand the pathological processes leading to fissure of the posterior labrum. Materials and methods. Retrospective study of 43 CT arthrograms performed in 43 patients that showed a fissure of the posterior labrum. The following associated lesions were noted: osseous and chondral remodeling of the humeral head and/or glenoid and articular surface fissures of the rotator cuff. Based on type of associated lesions, patients were separated into one of four pathological subgroups: posterior instability, posterosuperior or internal impingement, anterior instability and isolated fissure of the posterior labrum. RESULTS: Sixteen patients (37.2%) of patients showed posterior instability, 12 (27.9%) showed lesions of internal impingement, and 11 (25.6%) showed lesions of anterior instability. Only 4 patients (9.3%) had an isolated fissure of the posterior labrum. CONCLUSION: Posterior instability, internal impingement and anterior instability are the main pathologies leading to fissure of the posterior labrum, which seldom occurs in isolation. Evaluation of these associated lesions allows understanding of the underlying pathological processes leading to fissure of the posterior labrum.     

Tolosa-Hunt syndrome with sellar erosion: case report

The so-called Tolosa-Hunt syndrome consists of painful ophthalmoplegia caused by chronic nonspecific inflammation of the cavernous sinus and/or superior orbital fissure, responsive to steroid therapy. We present a case with the unusual feature of sellar erosion, in which angiography. CT and MRI suggested this idiopathic condition.     

Normal radiographic anatomy of thoracic structures: analysis of 316 lateral chest radiographs

PURPOSE: To study the frequency of visualization and characteristics of normal thoracic structures on lateral chest radiographs in the Japanese population. MATERIALS AND METHODS: We reviewed 316 lateral chest radiographs of men and women ranging in age from 20 to 90 years. The frequency of visualization and configuration of structures including major, minor, superior and inferior accessory fissures, and orifices of the right and left upper lobe bronchi were reviewed. RESULTS: On lateral chest radiographs, major fissure and minor fissure were visualized in 99.4% and 87.3%, respectively. Superior accessory fissure and inferior accessory fissure were visualized in 1.9% and 9.5%, respectively. Orifices of the right and left upper bronchi were seen in 92.4% and 98.4%, respectively. CONCLUSION: Frequency of visualization and characteristics of various normal anatomic structures on lateral chest radiographs in the Japanese population differ from those reported previously from the West. Familiarity with these normal thoracic structures and variations is important for daily image interpretation.     

Categorization and characterization of lesions of the orbital apex

Introduction  

The apex of the orbit is formed by the union of the lesser and greater wings of the sphenoid bone and acts as an osseous tunnel for numerous neurovascular structures entering the orbit from the cranial vault. Lesions of the orbital apex are clinically important as they can have an adverse effect on vision. A broad range of lesions can occur here, and our purpose is to organize the pathologic processes which occur in the orbital apex into logical imaging differentials, establish an organized approach to image analysis, and present examples of representative lesions.     

Normal radiographic anatomy of thoracic structures: analysis of 1000 chest radiographs in Japanese population

The purpose of this paper was to study the frequency of visualization and characteristics of normal thoracic structures on posteroanterior (PA) chest radiographs in Japanese population. 1000 consecutive normal PA chest radiographs of men and women ranging in age from 20 years to 90 years were reviewed. Frequency of visualization and configuration of structures including (1) fissure lines such as major, minor, vertical fissure line, and accessory fissures, (2) vascular structures including normal apical opacity, aortic nipple, and descending aortic interface, and (3) other structures including air in the oesophagus, aortic pulmonary stripe, and diaphragm were studied. On PA chest radiographs: (1) minor fissure, superolateral major fissure, superomedial major fissure, vertical fissure line, superior accessory fissure, and inferior accessory fissure were visualized in 74.7%, 19.7%, 15.4%, 1.6%, 2.9% and 13.1%, respectively. (2) Normal apical opacity was seen in 3.7%, while aortic nipple was seen in 0.9%. Descending aortic interface was obliterated in 13.7%. (3) Air in the oesophagus and aortic pulmonary stripe were seen in 8.9% and 17.7%, respectively. Hemidiaphragm was obliterated in 10.3% on the right, and in 32.4% on the left. Scalloping of the diaphragm was seen in 10.6% on the right, 6.5% on the left, and 4.3% bilaterally. Frequency of visualization and characteristics of various normal anatomical structures on chest radiographs in Japanese population differ from those reported previously from the West. Familiarity with these normal thoracic structures and variations is important for our daily image interpretation.