骨骼影像诊断血管鞘间隙病变课件

颈血管鞘间隙病变的影像学诊断,李传亭 山东省医学影像学研究所,颈面部间隙的构成,颈浅筋膜：皮下组织内 颈深筋膜：深层位于椎前（椎前筋膜） 中层位于咽粘膜下（内脏筋膜） 浅层包饶颈面部结构（包膜） 颈深筋膜的三层间构成诸间隙,颈面部间隙的分类,舌骨上区和舌骨下区 咽粘膜间隙 咽后间隙 椎前间隙 咽旁间隙 颈血管鞘间隙 颈后间隙 腮腺间隙 咀嚼肌间隙 颊间隙 舌下间隙 颌下间隙,颈血管鞘间隙的解剖,颈血管鞘间隙的病变,原发：颈内动脉、 颈内静脉病变 交感链、 舌咽和 迷走神经来源的 肿瘤 淋巴结转移瘤和淋巴瘤。 周围间隙播散蔓延：,病变来源的鉴别,最大径（病变中心） 血管移位情况,颈动脉病变,动脉粥样硬化 肌纤维发育不良 颈动脉瘤和颈动脉夹层 假性动脉瘤 颈动脉血栓形成,颈动脉粥样硬化,颈动脉粥样硬化,颈动脉粥样硬化,颈动脉粥样硬化,肌纤维发育不良 Fibromuscular Dysplasia,Type 1: a typical string of beads appearance with alternating segments of stricture and dilation. Type 2: a long tubular stenosis can be seen Type 3: characterized by involvement of only one side of an artery. This leads to diverticularizations of the arterial wall.,肌纤维发育不良 Fibromuscular Dysplasia,颈动脉瘤CAROTID ANEURYSM,颈动脉瘤,颈动脉夹层Dissection, Carotid Artery,the cause may be mechanical factors and underlying arteriopathy, such as Marfan syndrome and fibrocystic dysplasia. Dissections are usually subadventitial (between the media and adventitia or within the media), creating a false lumen that can cause stenosis, occlusion, or pseudoaneurysm of the vessel. double lumen and intimal flap. string sign with long tapered narrowing, segmental stenosis or occlusion, membrane or flap, and multiple scalloped narrowings,颈动脉夹层,颈动脉夹层,颈动脉夹层,颈动脉夹层,颈动脉夹层,颈动脉夹层,颈动脉夹层,颈动脉夹层,假性动脉瘤,假性动脉瘤,颈动脉血栓形成 Carotid thrombosis,Care must be exercised in cases of carotid thrombosis. Very slow flow rates may be missed if the timing of the intravenous contrast agent bolus or the peak density of the contrast material is less than optimal,颈动脉血栓形成,颈血管鞘内对比剂积聚,神经源性病变,神经纤维瘤 神经鞘瘤 神经纤维瘤病 恶性神经鞘瘤 副神经节肿瘤,神经纤维瘤,神经纤维瘤病,原始神经外胚层肿瘤,副神经节肿瘤Paragangliomas,originating from the paraganglia or glomus cells within the carotid body, vagal nerve, middle ear, jugular foramen middle-aged, with a painless slow-growing mass. an enhancing soft-tissue mass in the carotid space, jugular foramen a salt-and-pepper appearance at standard spin-echo and an intense blush at angiography Imaging studies depict the location and extent of tumor involvement,颈动脉体瘤,Bilateral carotid body tumors,Bilateral vagal paragangliomas,迷走神经瘤,迷走神经瘤,颈静脉球瘤,颈静脉球瘤,淋巴结病变,转移瘤：最小径10mm 肿瘤细胞取代淋巴结髓质正常结构或引起坏死 皮质不规则强化，形态厚薄不一，髓质相比为不规则低密度 颈动脉受侵：脂肪间隙消失 ，包绕 270 淋巴瘤： 霍奇金病和非霍奇金淋巴瘤两大