颞骨内鼓乳段面神经的斜矢状位断层及MRI影像解剖学研究
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摘要
第一部分:国人颞骨内鼓乳段面神经的MR应用影像解剖学研究
研究背景:
面神经的神经解剖和影像学表现较为复杂,而颞骨内鼓乳段面神经由于其位置重叠,结构细小,走行曲折,更是人体最复杂的解剖区域之一。目前我国耳显微外科的整体水平还不高,有关颞骨内鼓乳段面神经的基础和临床研究的深度和广度还不够,因此在鼓乳段面神经疾病的诊断、治疗、预后及手术适应症、手术时机选择、手术效果评价等方面的认识还未完全统一。如何通过有效的方法或手段良好地显示该段面神经的走行及形态,一直是国内外众多学者研究的目标。
普通X线对面神经检查十分有限,随着医学影像技术的发展,对颞骨内鼓乳段面神经的影像学检查及显示技术有了长足进展。尤其是近年来,采用先进的CT及MR技术进行颞骨内鼓乳段面神经的研究,为临床提供有参考价值的影像解剖学信息,受到越来越多的关注与重视。CT和MR对于面神经病变的诊断各有优势和不足。CT对骨质结构显示较好,薄层高分辨率颞骨CT扫描可以清晰地显示面神经管颞骨内段。随着螺旋CT的应用,其三维重建技术使良好显示耳部细微结构成为可能,特别是多层螺旋CT曲面重建技术(curved-planar reconstruction,CPR)在这方面显示出了明显的技术优势。CPR技术可以沿着“兴趣曲线”显示曲面结构,利用多层面CT扫描及其后处理技术,可以完整地显示双侧颞骨内面神经管的结构,为研究面神经管的影像解剖特征提供了一个良好的方法,所获影像可对面神经管进行详细的形态观察和解剖测量,是迄今为止研究面神经管影像解剖特征的最佳方法。但是CPR技术是利用计算机特殊软件将原始轴面数据在不同层面重新排列、组合为新的层面图像,亦即把走行曲折的面神经管拉直伸展开后,展示在一幅平面图像上,其图像质量不如直接扫描的图像真实,且与实际面神经管的解剖形态亦有差别,是“虚拟”面神经管解剖形态结构。不仅如此,CPR技术还高度依赖于描绘者的技术水平及其所绘曲线的准确性,不准确的定位线可以导致兴趣结构的曲线偏移,从而造成图像的偏差。由于CT具有对骨质结构显像好的特点,故其所获影像是面神经骨管的影像而并非面神经良好显示的影像,因而无法观察面神经的真实状况。由于MRI具有非侵袭性、多平面直接成像、高清的组织分辨率及无骨骼伪影等特点,可以直接观察面神经的影像,因而日益成为面神经疾病的重要影像学检查方法。
但是目前有关颞骨内鼓乳段面神经MR成像的文献报道较少,未见较为详尽、完整的有关颞骨内鼓乳段面神经MR成像研究的文献报道。本研究应用先进的3.0T MR设备,进行国人颞骨内鼓乳段面神经的斜矢状位MR扫描成像研究,以期获取能良好显示鼓乳段面神经全程的MR斜矢状位扫描基线,并观测所获面神经的MR斜矢状位影像学形态和相关技术参数,分析其影像解剖学表现特征,以探讨国人颞骨内鼓乳段面神经的最佳MR斜矢状位成像方法,从而为临床面神经疾病的影像学诊断、治疗、手术及预后等提供可靠参考。
目的:
1、探讨国人颞骨内鼓乳段面神经MR斜矢状位扫描的最佳扫描平面及扫描基线。
2、探讨国人颞骨内鼓乳段面神经的MR斜矢状位扫描影像的解剖学形态特征。
3、对国人颞骨内鼓乳段面神经MR斜矢状位扫描影像进行解剖观察和测量。
方法:
1、标本来源
选择经福尔马林固定的成人无明显颅底病变的颞骨标本20例(40侧),其中男11例,女9例。所有标本均来源于青岛大学医学院解剖学教研室。
2、扫描参数及方法
2.1扫描参数
应用GE 3.0T MR扫描机,头部线圈,采用稳态采集的快速成像序列(Fast Image Employing Steady-state Acquisition;3D-FIESTA),扫描参数如下:重复时间(TR:ms):4.4,回波时间(TE:ms):Min,翻转角(FA,Flip Angle):55,扫描野(FOV):20带宽(Bandwidth):62.50,层厚1.6mm,矩阵:320×320,激励次数:2,每层位置数:30。
2.2扫描方法
所有标本均先行MR常规轴位扫描,在轴位扫描图像中选取耳蜗、水平半规管显示较为清晰、完整的层面为轴位基础层面。在轴位基础层面上,以膝状神经节和水平半规管为标志,与正中矢状轴斜矢状成角确定斜矢状位扫描基线,再将已确定的斜矢状平面内倾适当角度进行MR扫描。比较不同扫描基线和内倾角度所获取的鼓乳段面神经影像,选取鼓乳段面神经全程显示最完整、连续的影像,记录该影像所对应的扫描基线和内倾角。
3、测量方法
采用3D-FIESTA序列采集图像数据,利用磁共振机上相应软件直接测量我们所确定的每侧鼓乳段面神经斜矢状最佳扫描平面的扫描基线与正中矢状轴之间的“夹角”,斜矢状扫描平面的“内倾角”以及各段面神经的长度、直径及各种相关技术参数等指标的测量,所有数据均连续测量三次,取平均值。
4、统计学处理
测量结果以均数±标准差表示。用SPSS 12.0统计软件包对所得数据进行统计学处理,获取各指标的均数及正常范围。对左、右两侧斜矢状位扫描相关角度的测量结果进行单因素方差分析(One-way ANOVA),以明确左、右两侧所获结果统计学有无显著性意义。
结果:
1、20例(40侧耳)颞骨标本鼓乳段面神经MR斜矢状位扫描均得到良好显示,可以清楚地观察到颞骨内鼓乳段面神经的全程完整影像,其形态及走行连续。鼓室段、锥段、乳突段等各段面神经显示清晰,可以进行细致解剖观测。
2、我们分别测量颞骨内鼓乳段面神经全程显示最佳的MR斜矢状位扫描平面其扫描基线与正中矢状轴所成夹角角度,斜矢状平面内倾角的角度,以确定每侧的最佳斜矢状位扫描平面,并在该平面上进行鼓乳段面神经相关长度和径线的测量,均得到满意结果。
结论:
1、MR斜矢状位扫描可良好显示颞骨内鼓乳段面神经的全程影像。
2、本研究测得20例(40侧)颞骨标本鼓乳段面神经的MR斜矢状位最佳扫描平面的扫描基线与正中矢状轴所成夹角角度为24.54°±4.59°,斜矢状位扫描平面内倾角角度为5.97°±2.32°,且左、右侧测量结果统计学无显著性意义。
3、本研究中颞骨内鼓乳段面神经的相关径线测量结果和大体解剖及文献报道结果基本符合,可以为临床面神经疾病的诊断、治疗、手术及预后等提供影像解剖学参考。
第二部分:国人颞骨内鼓乳段面神经的斜矢状位断层解剖学研究
研究背景:
颞骨结构体积微小、位置重叠,方向各异,是人体最复杂的解剖区域之一。长期以来,该区域一直是临床应用解剖学和医学影像学领域中的研究热点。近年来,先进的MR设备及图像后处理技术的迅速发展,能进行薄层扫描、多平面重建和三维成像,从而为展示颞骨内鼓乳段面神经的复杂结构提供了良好工具。但是要正确识别和分析颞骨内鼓乳段面神经的MR影像,尚需借助于相应的薄层断面标本进行详尽的相关解剖定位和对比、鉴别研究。
近年来,断层解剖学研究继常规轴位、冠状位、矢状位之外,又提出第“四维”的概念,即斜矢状位。但有关斜矢状位断层解剖研究的报道较少,未见国内外关于颞骨内鼓乳段面神经的斜矢状位薄层断面解剖研究,国内仅见段菊如,王韶玉等对成人颞骨标本面神经颞骨内段的横断面断层图像和CT图像进行对比,以探讨面神经及其周围结构在高分辨率CT上的定位,为面神经颞骨内段病变及耳科其他病变的影像诊断及手术治疗提供解剖学依据。未见有关颞骨内鼓乳段面神经的斜矢状位断层图像与斜矢状位MR扫描图像进行对比的研究。
本研究先应用先进的3.0T MR设备对所有颞骨标本先行斜矢状位扫描成像,获取颞骨内鼓乳段面神经全程显示良好的影像,记录每侧的扫描基线和内倾角度,然后应用先进的冷冻数控铣削技术,采用和MR斜矢状位扫描相同的基线和角度,对20例颞骨标本进行斜矢状位薄层连续切片,层厚0.4mm,数码相机摄影,计算机保存数据,最后将所获断层图像与同一标本相应层面的MR图像进行对比、观察,以获取颞骨内鼓乳段面神经的更为详尽的信息,进一步验证MR斜矢状位扫描成像的可行性及所获最佳扫描基线和角度的准确性,为颞骨内鼓乳段面神经的MR成像提供断层解剖学基础和依据,从而为临床面神经疾病的影像学诊断、治疗以及手术提供可靠参考。
目的:
1、将所有标本先经3.0T MR扫描机进行斜矢状位扫描,获取层厚为1.6mm的鼓乳段面神经全程显示良好的MR斜矢状位图像。
2、应用先进的冷冻铣削技术获取层厚为0.4mm的与MR斜矢状位扫描成像相同基线和内倾角度条件下的颞骨标本鼓乳段面神经的斜矢状位薄层断面解剖数据。
3、将斜矢状位断层图像和同一标本相对应的MR图像分别进行对照研究,以期获得颞骨内鼓乳段面神经准确、详尽的解剖信息,并进一步验证MR斜矢状位扫描成像的可行性和实用性,从而为鼓乳段面神经的MR影像学研究提供断层解剖学基础。
方法:
1、标本来源
选择经福尔马林固定的成人无明显颅底病变的颞骨标本20例(40侧),其中男11例,女9例。标本均来源于青岛大学医学院解剖学教研室。
2、MR扫描方法
2.1扫描参数
应用GE 3.0T MR扫描机,头部线圈,采用稳态采集的快速成像序列(Fast Image Employing Steady-state Acquisition;3D-FIESTA),扫描参数如下:重复时间(TR:ms):4.4,回波时间(TE:ms):Min,翻转角(FA,Flip Angle):55,扫描野(FOV):20带宽(Bandwidth):62.50,层厚1.6mm,矩阵:320×320,激励次数:2,每层位置数:30。
2.2扫描方法
所有标本均先行MR常规轴位扫描,在轴位扫描图像中选取耳蜗、水平半规管显示较为清晰、完整的层面为轴位基础层面,在轴位基础层面上,以膝状神经节和水平半规管为标志,与正中矢状轴斜矢状成角确定斜矢状位扫描基线,再将已确定的斜矢状平面内倾适当角度进行MR扫描。比较不同扫描基线和内倾角度所获取的鼓乳段面神经影像,选取鼓乳段面神经全程显示最完整、连续的影像,记录该影像所对应的扫描基线和内倾角,以备断层解剖之用。
3、冷冻数控铣削
3.1冷冻、包埋和固定
将经MR扫描后的标本放入低温冷冻室内,经过-20℃,-30℃,-40℃依次冷冻两天,然后采用不锈钢包埋箱包埋,标本固定角度及位置与该标本MR斜矢状位扫描基线位置及角度均相同。固定定位杆,填充3%蓝色明胶溶液至距离包埋箱底7cm处,并冷冻至使其凝固变硬。24h后,将标本用自制固定架固定定位,放入包埋容器中,依次向包埋箱内加入第二、三、四层明胶,其间隔时间为24h。
3.2数控铣削
在恒温-15℃铣削室内,把标本块放在铣削精度为0.001mm SKC500型数控机床的工作台上,固定标本块后,调整铣床Z轴每次进给距离为0.4mm,主轴转速900次/分,X轴方向上每转进给距离为0.4mm。每执行完一层,铣头停在X轴的最大负端,此时带有计数器、比例尺和比色卡的采集框走到合适的位置,此时根据情况对标本面进行适当的技术处理准备照相。
3.3断面图像的采集与保存
使用Canon EOS 20D相机,820万像素,加装遮光罩,调整镜头前缘距离标本断面垂直距离95cm。当铣床执行完一个完整程序后,铣头停留在X轴的最大负端,通过Canon Utilities EOS Capture软件控制相机,采集图像数据,图像采集结束后,备份原始数据。
4、解剖断层与MR图像的对照研究
将应用冷冻数控铣削技术获得的颞骨标本的0.4 mm薄层斜矢状位连续断层解剖图像在Photoshop上进行相应处理,使处理后图像的色彩、对比度、清晰度及背景都达到最佳水平,最后保存。观察鼓乳段面神经的断面解剖结构特征,并将其与相应的MR斜矢状位扫描图像层面进行对比研究,以观察其一致性。
结果:
1、应用先进的冷冻数控铣削技术,采用与MR斜矢状位扫描成像相同基线和内倾角度条件进行连续切片,所获颞骨内鼓乳段面神经斜矢状位连续薄层断面图像清晰,易于观察。颞骨内鼓乳段面神经的形态及走行得到良好显示。
2、将斜矢状位断层图像和同一标本相对应的MR图像分别进行对照研究,结果表明颞骨内鼓乳段面神经斜矢状位连续薄层断面图像和相应层面的MR图像结构对应良好。
结论:
1、应用冷冻数控铣削技术对颞骨内鼓乳段面神经进行斜矢状位连续薄层断面解剖研究结果表明MR斜矢状位扫描成像方法有效、可行,亦说明我们通过MR斜矢状位扫描获取的有关斜矢状位的扫描基线及角度准确、可靠。
2、通过断层图像与MR图像的对比研究可获取颞骨内鼓乳段面神经的详尽解剖信息,为颞骨内鼓乳段面神经的MR成像提供断层解剖学基础和依据,从而为临床颞骨内鼓乳段面神经的研究提供可靠参考。
第三部分:正常人颞骨内鼓乳段面神经的MR斜矢状位应用影像解剖学观测
研究背景:
面神经是人体内居于颅底骨管中最长的神经,且走行曲折,为了良好地显示其走行,多年来国内外众多学者对此进行了不懈的研究和探讨。研究颞骨内面神经行程及其与周围结构的毗邻关系对颞骨内病变所致的面神经损伤及相关面神经疾病的诊断和治疗具有重要意义。不仅如此,临床上面神经手术各种术式的选择以及耳科某些手术的成功进行都需要对面神经的行程及毗邻关系有清晰的了解和定位。因此熟悉面神经的正常与变异,对避免造成耳科及颅底等手术时的意外损害亦具有极其重要的临床价值。
长期以来,传统的影像学检查方法均不能充分显示颞骨内鼓乳段面神经的影像。因此,面神经曾一度是影像检查的盲区。随着医学影像技术的发展,颞骨内段面神经的影像学检查及显示技术有了长足进展。磁共振(MR)检查凭借其良好的软组织分辨力和任意方向扫描成像等优势,日益成为面神经的重要影像学检查方法。面神经MR的常规扫描层面有轴位、冠状位及矢状位。轴位MR扫描只能在同一扫描层面显示膝状神经节段及面神经鼓室段。冠状位MR扫描仅可显示面神经乳突段的全程。因而常规的MR轴位、冠状位及正中矢状位扫描均不能使面神经鼓室段和乳突段显示最佳,导致难以全面、直观地观察面神经的行程、毗邻及管径大小的改变等,不利于发现该段面神经早期及微小的病变。
近年来,应用CT及MPR技术可以观察到颞骨内鼓乳段面神经骨管的完整形态,但该方法无法反映面神经的真实状况。有文献报道斜矢状位扫描可同层显示膝状神经节段、鼓室段、乳突段并且可以充分显示面神经与前庭、耳蜗、半规管的关系。Theodora Dailiana等曾提出斜矢状位MR扫描的设想,但未详尽描述。张晓宏等报道应用1.5T MR技术得到3侧尸头标本和15侧健康人的颞骨内鼓乳段面神经的影像,但是例数较少且扫描层厚为3mm,所获图像质量欠佳而且未对扫描条件作详细描述。目前尚未见国内外关于颞骨内鼓乳段面神经MR成像的较为详尽、全面的报道。我们通过20例颞骨标本的MR斜矢状位扫描成像和斜矢状位断层解剖研究,亦认为斜矢状位更有利于观察颞骨内鼓乳段面神经的真实走行。
本研究中我们应用先进的3.0T MR扫描设备,探讨正常人颞骨内鼓乳段面神经的MR斜矢状位扫描的最佳扫描基线和角度,观察其斜矢状位影像形态学表现和解剖特征,并进行相关的解剖测量,从而为临床面神经疾病的影像学检查提供可靠参考,为临床面神经疾病的诊断、治疗及手术提供可靠的影像学依据。
目的:
1、对正常人颞骨内鼓乳段面神经进行MR斜矢状位扫描成像,获取正常人MR斜矢状位扫描的最佳扫描基线、角度和颞骨内鼓乳段面神经完整、连续的影像。
2、对所获颞骨内鼓乳段面神经的斜矢状位MR影像进行形态观察和解剖测量,获取颞骨内鼓乳段面神经斜矢状位MR详细的影像解剖学数据,以期为临床面神经的影像学研究提供参考,为面神经疾病的诊断、治疗及手术提供解剖学数据标准和参考。
3、将本组测量所得结果与颞骨标本MR斜矢状位扫描成像所获结果进行统计学分析,进一步验证颞骨内鼓乳段面神经MR斜矢状位成像的临床可行性和实用性。
方法:
1、实验对象
50例(100侧耳)无任何耳部疾患的成年志愿者,男26例,女24例,平均年龄45.3岁。所有志愿者均来源于青岛大学医学院附属医院门诊就诊者,经专业医师严格查体及筛选。
2、MR检查方法
2.1扫描参数
应用GE 3.0T MR扫描机,头部线圈,采用稳态采集的快速成像序列(Fast Image Employing Steady-state Acquisition;3D-FIESTA),扫描参数如下:重复时间(TR:ms):4.4,回波时间(TE:ms):Min,翻转角(FA,Flip Angle):55,扫描野(FOV):20带宽(Bandwidth):62.50,层厚1.6mm,矩阵:320×320,激励次数:2,每层位置数:30
2.2扫描方法
所有标本均先行MR常规轴位扫描,在轴位扫描图像中选取耳蜗、水平半规管显示较为清晰、完整的层面为轴位基础层面,在轴位基础层面上,以膝状神经节和水平半规管为标志,与正中矢状轴斜矢状成角确定斜矢状位扫描基线,再将已确定的斜矢状平面内倾适当角度进行MR扫描。比较不同扫描基线和内倾角度所获取的鼓乳段面神经影像,选取鼓乳段面神经全程显示最完整、连续的影像,记录该影像所对应的扫描基线和内倾角。
3、测量方法
采用3D-FIESTA序列采集图像数据,利用磁共振机上相应软件直接测量我们所确定的每侧鼓乳段面神经斜矢状位最佳扫描平面的扫描基线与正中矢状轴之间的“夹角”,斜矢状扫描平面的“内倾角”以及各段面神经的长度、直径及各种相关技术参数等指标的测量和统计,所有数据均连续测量三次,取平均值。
4、统计学处理
实验结果以均数±标准差表示。用SPSS 12.0统计软件包对所得数据进行统计学处理,得出各指标的均数及正常范围。利用单因素方差分析(One-way ANOVA)对颞骨标本组和正常人组测量结果进行统计学分析,以明确有无统计学显著性意义。
结果:
1、50例(100侧耳)正常人颞骨内鼓乳段面神经全程均得到良好显示。从MR斜矢状位扫描影像可以清楚地观察到颞骨内鼓乳段面神经的形态和走行,鼓室段、锥段、乳突段等各段面神经显示清晰,与颞骨标本的斜矢状位MR扫描成像结果及斜矢状位断层解剖观察结果一致。
2、我们分别测量颞骨内鼓乳段面神经全程显示最佳的MR斜矢状位扫描平面其扫描基线与正中矢状轴所成夹角角度,斜矢状平面内倾角角度,以确定每侧的最佳斜矢状位扫描平面。在该平面上进行鼓乳段面神经相关长度和径线的测量,将所获结果与颞骨标本组MR斜矢状位扫描成像测量结果进行统计学分析,均无统计学显著性意义。
结论:
1、MR斜矢状位扫描是观察颞骨内鼓乳段面神经的有效影像学检查方法,可以得到颞骨内鼓乳段面神经全程的完整影像。该结论与颞骨标本组及断层解剖研究结果一致。
2、本研究测得50例正常人(100侧耳)的MR斜矢状位最佳扫描平面的扫描基线与正中矢状轴所成夹角角度为23.67°±5.46°,斜矢状位扫描平面内倾角角度为6.15°±3.30°,该结果与颞骨标本组测量结果统计学无显著性意义,说明我们所选取的扫描基线和扫描平面准确、可靠。
3、在MR斜矢状位扫描图像上可以对颞骨内鼓乳段面神经全程进行细致形态学观察和解剖测量,测量结果和颞骨标本组无统计学显著性差异,可以为临床面神经影像学检查提供有力的解剖学参考。
PART ONE: Study of MR scanning of temporal bone about tympanic and mastoid segment of facial nerve
Background
As we all known,anatomy of the facial nerve is very complex.The tympanic and mastoid segment of facial nerve are the most complicated part because of it's tiny and the overlapping structures surrounding.At present,the overall level of the microsurgical of ear in our country is lower.Many basic and clinical researches can not carry through.There haven't been an identical standard of the diagnosis,treatment,prognosis of the facial nerve diseases. Though of the surgical indications,time of the operation and evaluation of the operations.How to make good images of the tympanic and mastoid sections of facial nerve is the goal of both scholars of Otolaryngology and Radiology.
Ordinary X-ray examination is very limited to facial nerve imaging. With the development of medical imaging technology,imaging and display technology of the tympanic and mastoid segment of facial nerve have been making considerable progresses.Especially in recent years,advanced technology of CT and MR make it sure to get more clear images of the tympanic and mastoid segment of facial nerve.To study the imaging anatomy of the tympanic and mastoid segment of facial nerve can provide valuable references to observations and diagnosis of ear diseases.More and more people are concerned about this.There are both advantages and disadvantages of CT and MRI to the diagnosis of facial nerve lesions.CT imaging is good for osseous structures,especially high-resolution CT scan can make clearly thin layer image of facial nerve intra-temporal bone.With the using of spiral CT and the three-dimensional reconstruction technique,it is possible to show the tiny structures of ear.Especially the using of curved-planar reconstruction (CPR)technique with a multi-slice spiral CT takes good advantage of this. CPR can image along the curve of our interested structures.Multi-dimensional CT and post-processing technology provide a good method to obtain a particularly observation of the facial nerve canal.The facial nerve canal within the structures of bilateral temporal bone showed at the same time.It allows us to make detailed morphological observations and measurements of it through the images.It is proved to be the best imaging method of the facial nerve canal up to the present.However,CPR technology is not ideal.The principle of CPR is the rearrange of original data on an axial plane at different levels to recompose a new dimension image with computer.It is to say,CPR is a method to make the tortuous course of the facial nerve canal straightened and displayed in a planar images.So the quality of CPR images is not as good as that of direct scanning images.It is a virtual structure of the facial nerve canal.Morphology of CPR image of the tympanic and mastoid segment of facial nerve is different from the true state of it.Besides,CPR techniques described are highly dependent on the skill level and the accuracy of the curve. Inaccurate position criterion of the aim structure may lead to offset curves. MRI takes advantages of non-invasive,direct multi-planar imaging,excellent soft-tissue resolution and no-hardening artifact which compared to CT.It is increasingly becoming an important facial nerve disease screening method. However,fewer reports of the MR imaging of tympanic and mastoid segment of facial nerve are found.
We haven't found any detailed and complete documentations of MR imaging of the tympanic and mastoid segment of facial nerve by far.In this study,we use an advanced 3.0 T MR scanning equipment and hope to make investigations of the tympanic and mastoid segment of facial nerve.We hope to get a good MR scanning criterion so that we can get clear images of the tympanic and mastoid segment of facial nerve.It allows us to perform all-around observations of the tympanic and mastoid segment of facial nerve. So we can get the results of MR imaging methods,imaging features of its anatomy and some measurement results in order to provide clinical references of facial nerve disease.
Objective:
1、To study the best position and method of MR scanning of the tympanic and mastoid segment of facial nerve.
2、To study the features of MR images of the tympanic and mastoid segment of facial nerve.
3、Make measurements and observations of the MR images of the tympanic and mastoid segment of facial nerve.
Materials and methods
1、Tissues sample
We choose 20(40 sides)temporal bones of adults without any significant diseases of skull.Before our experiment,all the temporal bones are formalin-fixed.There are 11 male and 9 female cases.All specimens come from the Department of Anatomy of Qingdao Medical College.
2、MR Scanning
2.1 scanning parameter
We use a GE 3.0T MR scanning equipment,head coil and 3D-Fast Image Employing Steady-state Acquisition(3D-FIESTA)to finish our imaging.Scanning parameters are as follows:repetition time(TR):4.4ms, echo time(TE):Min,Flip angle(FA):55,Scanning field(FOV):20, Bandwidth:62.50,Thickness 1.6 mm,Matrix:320×320,Stimulate number:2, Position number of each layer:30
2.2 scanning method
First,all specimens are given a general MR axial scanning.After the scanning finished,we select the plane which the tympanic segment of facial nerve showed well and then conduct an oblique sagittal scanning.Write down the data we got of the best scanning plane.
3、Measurement method
We get the MR images through using 3D-Fast Image Employing Steady-state Acquisition.Then we choose the right layer which the whole tympanic and mastoid segment of facial nerve showed well and allowed to make measurements.All data are measured three times for the average.
4、Statistically
We choose a SPSS 12.0 statistical package on the data for statistical analysis to get the normal range and noted the experimental results to mean±standard deviation.One-way ANOVA is used to compare the data of two sides.
Results:
1.All the tympanic and mastoid segment of facial nerve of 20 temporal bone specimens(40sides)displayed well.Oblique sagittal MR scanning makes it sure to observe the complete image of the tympanic and mastoid segment of facial nerve.We can observe the image of the tympanic and mastoid segment of facial nerve clearly and get more details about it through this position.
2、In our study,20 patients(40 sides)had an oblique sagittal scanning,then we measured the angle between the oblique sagittal scanning line with the median sagittal line and the angle intilted from the oblique sagittal scanning plane.We choose the best plane of the tympanic and mastoid segment of facial nerve to make our measurements of length and diameters.
Conclusion:
1、Oblique sagittal scanning of MR is the best method to show the tympanic and mastoid segment of facial nerve.
2、The angle between the oblique sagittal scanning line and the median sagittal line is 24.54°±4.59°,the angle intilted from the oblique sagittall scan plane is 5.97°±2.32°.
3、Measurement results of length and diameters and general anatomy observations are accord to that reported in the literature.
PART TWO: Oblique sagittal sectional anatomy of the tympanic and mastoid segment of facial nerve
Background
As we all known,anatomy of the facial nerve is very complex.The tympanic and mastoid facial nerve is the most complicated part because of it's tiny and the overlapping structures.MRI takes good advantage of non-invasive,direct multi-planar imaging,excellent soft-tissue resolution and no-hardening artifact which compared to CT.It is increasingly becoming an important facial nerve disease screening method.However,better identification and analysis of the MR image of the tympanic and mastoid segment of facial nerve need the help of the thin specimens sectional anatomy study.
In resent years,some scholar mentioned about the oblique sagittal plan except the axial plan、coronal plan and the sagittal plan.But no one make any study about it.We found only one report written by Duan Ju-ru and Wang Shao-yu to study the sectional anatomy on transversal plane of tympanic and mastoid segment of facial nerve and compared it with the same CT images. They found the thin sections of the temporal bone can clearly delineate the anatomical details of the temporal bone and their relationships.The same specimen images post-processed by multi-planar reformation(MPR)came to coincidence completely with these sections.The thin sectional images of the temporal bone obtained by using computerized cryo-milling technique matched well with the CT images.It will be the base of study of the temporal bone and the facial nerve.We haven't searched any detailed documents of oblique sagittal sectional anatomy of the tympanic and mastoid segment of facial nerve so as those compared with the same MR images.
In our research,we use an advanced 3.0 T MR scanning equipment and hoped to get clear images of the tympanic and mastoid segment of facial nerve. Then we obtain the sectional data of the tympanic and mastoid segment of facial nerve using computerized cryo-milling technique.All the specimens were sliced into 0.4mm continuous sections with the computerized miller at the same condition as oblique sagittal MR scanning.Take photographs with digital camera,save the data into computer,then compare them with the same specimen's MR images so that to provide references to clinical.We hoped to improve the whole level of diagnosis、operation and treatment of facial nerve diseases.
Objective:
1、To obtain the oblique sagittal MR images of the tympanic and mastoid segment of facial nerve by using a 3.0 T MR scanning equipment.
2、To obtain the oblique sagittal sectional data of the tympanic and mastoid segment of facial nerve by using computerized cryo-milling technique at the same condition as oblique sagittal MR scanning.
3、To compare the thin oblique sagittal sectional images of the temporal bone obtained by computerized cryo-milling technique with the same MR images, so that to confirm the results we got from MR scanning of temporal bones and hope it may be the anatomy bases of studies of the temporal bone and the facial nerve.
Materials and methods
1、Tissues sample
We choose 20(40 sides)temporal bones of adults without any significant diseases of skull.Before our experiment,all the temporal bones are formalin-fixed.There are 11 male and 9 female cases.All specimens come from the Department of Anatomy of Qingdao Medical College.
2、MR Scanning
2.1 scanning parameter
We use GE 3.0T MR scanner,head coil and 3D-Fast Image Employing Steady-state Acquisition(3D-FIESTA)to finish our imaging. Scanning parameters are as follows:repetition time(TR):4.4ms,echo time (TE):Min,Flip angle(FA):55,Scanning field(FOV):20,Bandwidth:62.50, Thickness 1.6 mm,Matrix:320×320,Stimulate number:2,Position number of each layer:30
2.2 scanning method
First,all specimens are given a general axial scanning.After the scanning finished,we select the plane which the tympanic segment of facial nerve showed well and conduct an oblique sagittal scanning.Write down the number of the angle and the scanning plan of each specimen to prepare for sectional anatomy.
3、Computerized Cryo-milling Technique
3.1 Freezing,Embedding and Immovably
We collect 20 temporal bone specimens of Chinese adults.All specimens are freezing under profound hypothermia after an examination with 3.0T MR scanning.The temperature is-20℃,-30℃,-40℃in turn and each for two days.Then buried with an embedded bag of stainless steel,fixed-position, filling the embedded bag with three percent of the blue gelatin solution to be 7cm apart from the bottom of the embedded bag,then freeze it and make it solidify and stiffen for 24h.All specimens are fixed at the same position with which measured from MR scanning.Specimens were fixed with self-holder positioning and put in the embedded containers after which adding blue gelatin solution to the embedded box in turn for the second,third,fourth times. 24 hours time interval each time.
3.2 Computerized Milling
Computerized milling carried through in the milling room which keeping the temperature on-15℃.Put the specimens on the block of SKC500 with which milling accuracy is 0.001 mm.Fixed the specimen block and adjusted the distance of Z-axis of each milling time,and spindle speed 900 times/min,every rotation on X-axis direction to a distance of 0.4mm/time. When each layer finished,it stopped at end of the largest negative side of X-axis milling.At the same time,a collection box with counter、scale and color card come into the right position where the specimens will receive some treatment and prepare for photography.
3.3 Preservation and Photograph
Canon EOS 200D camera installed hood was used to take photographs of the sectional images.Adjust the vertical distance from the camera to the specimen section is 95 cm.When a whole milling procedures completed,tip of the milling machine stopped at the end of largest negative side of X-axis.We use Canon Utilities EOS Capture software control the camera,then take photos and save it into the computer.
4、Compare the Sectional images with MR images
All the specimens were sliced into 0.4mm continuous sections on an oblique sagittal plane with the computerized miller,take photographs with digital camera and save the data in computer.Photoshop software are used to make the sectional images look to be the best,then compare them with the same specimens MR images so that to provide reference to clinical.
Results:
1、All the tympanic and mastoid segment of facial nerve of 20 temporal bone specimens(40sides)are well displayed through oblique sagittal sectional anatomy study by using computerized cryomilling technique.We can observe the complete image of the tympanic and mastoid segment of facial nerve clearly.
2、Images come from computerized milling are so clear that allow good observations of the tympanic and mastoid segment of facial nerve.All images matched well with the images of MR scanning.
Conclusion:
1、The results of oblique sagittal sectional anatomy study by using computerized cryomilling technique indicate that the positions and data we got from oblique sagittal MR scanning are believable.
2、All results we got can provide important references to clinical application of facial nerve researches.
PART THREE: Anatomy and measurements of normal tympanic and mastoid segment of facial nerve by using an oblique sagittal MR scanning technique
Background
Facial nerve is the longest nerve that existed in the canal.It is also the most complicated part of our body.How to make good images of the tympanic and mastoid sections of facial nerve is the goal of both scholars of Otolaryngology and Radiology.Most facial paralyzes are caused by lesions in the temporal bone.Research of the facial nerve intra-temporal bone and the relationship with the surrounding structures is important to diagnosis and treatment of facial nerve diseases.Selection of operation mode of facial nerve decompression,some operations of the ear requires good control of the anatomy of facial nerve and it's surroundings.A successful conduct of the facial nerve and ear operations depend highly on anatomy.So familiar with the facial nerve and the normal variation of the surgery to avoid ear damage accidents is extremely important to clinical value.
We can not observe the tympanic and mastoid facial nerve clearly by using traditional image technique for a long time.Ordinary X-ray examination is very limited to facial nerve imaging.CT imaging is good for osseous structures.MRI takes advantages of non-invasive,direct multi-planar imaging, excellent soft-tissue resolution and no-hardening artifact which compared to CT.It is increasingly becoming an important facial nerve disease screening method.General MR scanning plane of facial nerve are axial scanning and coronal scanning.Axial MR scanning may show the geniculation ganglion and the tympanic segment of facial nerve on one same layer.The tympanic segment of the facial nerve is not in one plane,so we can see it in several planes.The mastoid segment of the facial nerve was only a point in the axial plane.Therefore general axial scanning revealed that it is not the best scanning plane of the facial nerve.Coronal scanning can only show the whole mastoid segment of the facial nerve.Therefore the conventional axial and coronal scanning are both not imaging the facial nerve well.It is difficult to find some small focus under this condition.
Multi-dimensional CT and post-processing technology provide a good method to obtain a particularly observation of the facial nerve canal.But it can not give us the true state of facial nerve.Oblique sagittal scanning reported in the literature said that we can see the geniculation ganglion,the tympanic segment and the mastoid segment of the facial nerve in one plane which can also show the relationships with vestibular,cochlea and the semicircular canal clearly.Theodora Dailiana et al.had given us an idea of oblique sagittal MR scanning but did not give a detailed description.Zhang Xiao-Hong reported a research about MR scanning with 1.5 T MR of 15sides healthy people and 3 sides of temporal bone to study the MR images of the facial nerve.In the report,they use a small number of cases and a scanning thickness of 3.0 mm and received poor image quality.We haven't searched any detailed and complete documentation of MR imaging of the tympanic and mastoid facial nerve.From researches of ourselves of MR scanning of temporal bones,we considered the oblique sagittal scanning is the best way to show the tympanic and mastoid segment of facial nerve.
We choose 50(100sides)healthy people to conduct the research.In this study,we use an advanced 3.0 T MR scanning equipment and hope to make investigations of MR images of the tympanic and mastoid segment of facial nerve.We hope to get a good MR scanning method so that we can get clear images of the tympanic and mastoid segment of facial nerve.It allows us to perform all-around observations of the tympanic and mastoid segment of facial nerve.So we can get the results of MR imaging methods,imaging features of its anatomy.The results we get from the study can provide references to clinical diagnosis treatment and surgery of facial nerve disease.
Objective:
1、To obtain the best MR scanning plane、scanning position and complete images of the tympanic and mastoid segment of facial nerve of healthy people.
2、Make detailed measurements and observations of the MR images of the tympanic and mastoid segment of facial nerve.
3、Make statistical analysis of measurement results and compare the results with those come from MR scanning of the temporal bone.We hope to confirm our technique results through this method.
Materials and methods
1、Tissues sample
We choose 50(100 sides)healthy adults without any significant diseases of ears.There are 26 male and 24 female cases.The average age is 45.3.All the people are choose by doctors of Otolaryngology.
2、MR Scanning
2.1 scanning parameter
We use GE 3.0T MR scanning equipment,head coil and 3D-Fast Image Employing Steady-state Acquisition(3D-FIESTA)to finish our imaging. Scanning parameters are as follows:repetition time(TR):4.4ms,echo time (TE):Min,Flip angle(FA):55,Scanning field(FOV):20,Bandwidth:62.50, Thickness 1.6 mm,Matrix:320×320,Stimulate number:2,Position number of each layer:30
2.2 scanning method
First,all people are given a general axial MR scanning.After the scanning finished,we select the plane which the tympanic segment of facial nerve showed well.The oblique sagittal plane we choose is the plane which paralleled with it.An oblique sagittal MR scanning of the facial nerve will going on the plane which we have selected.
3、Measurement method
We get the MR images through using 3D-Fast Image Employing Steady-state Acquisition.Then we choose the right layer which the whole tympanic and mastoid segment of facial nerve showed well and allowed to make measurements.All data are measured three times for the average.
4、Statistically
We choose a SPSS 12.0 statistical package on the data for statistical analysis to get the normal range and noted the experimental results to mean±standard deviation.One-way ANOVA is used to compare the data of normal people with that of the temporal bone.
Results:
1.All 50 people(100sides)of the tympanic and mastoid segment of facial nerve are well displayed.The tympanic and mastoid segment of facial nerve showed a clear and detailed anatomy image through oblique sagittal MR scanning.Oblique MR imaging scan make it sure to observe the complete image of the tympanic and mastoid segment of facial nerve.
2、In our study,50 normal people(100 sides)had an oblique sagittal scanning,then we measured the angle between oblique sagittal scanning line and the median sagittal line and the angle intilted from the oblique sagittal scanning plane.We choose the best plane to make our measurements of length and diameters.
Conclusion:
1、Oblique sagittal scanning of MR is the best method to show the tympanic and mastoid segment of facial nerve.The result is the same as that comes from MR scanning and sectional study of the temporal bone of tympanic and mastoid facial nerve.
2、The angle between the oblique sagittal scanning line and the median sagittal line is 23.67~0±5.46~0,the angle intilted from the oblique sagittal scanning plane is 6.15~0±3.30~0.One-way ANOVA is used to compare the data of normal people with that of the temporal bone.There have no evidently differences from statistic.
3、Measurement results and general anatomy observations are accord to that reported in the literature.
研究背景:
面神经的神经解剖和影像学表现较为复杂,而颞骨内鼓乳段面神经由于其位置重叠,结构细小,走行曲折,更是人体最复杂的解剖区域之一。目前我国耳显微外科的整体水平还不高,有关颞骨内鼓乳段面神经的基础和临床研究的深度和广度还不够,因此在鼓乳段面神经疾病的诊断、治疗、预后及手术适应症、手术时机选择、手术效果评价等方面的认识还未完全统一。如何通过有效的方法或手段良好地显示该段面神经的走行及形态,一直是国内外众多学者研究的目标。
普通X线对面神经检查十分有限,随着医学影像技术的发展,对颞骨内鼓乳段面神经的影像学检查及显示技术有了长足进展。尤其是近年来,采用先进的CT及MR技术进行颞骨内鼓乳段面神经的研究,为临床提供有参考价值的影像解剖学信息,受到越来越多的关注与重视。CT和MR对于面神经病变的诊断各有优势和不足。CT对骨质结构显示较好,薄层高分辨率颞骨CT扫描可以清晰地显示面神经管颞骨内段。随着螺旋CT的应用,其三维重建技术使良好显示耳部细微结构成为可能,特别是多层螺旋CT曲面重建技术(curved-planar reconstruction,CPR)在这方面显示出了明显的技术优势。CPR技术可以沿着“兴趣曲线”显示曲面结构,利用多层面CT扫描及其后处理技术,可以完整地显示双侧颞骨内面神经管的结构,为研究面神经管的影像解剖特征提供了一个良好的方法,所获影像可对面神经管进行详细的形态观察和解剖测量,是迄今为止研究面神经管影像解剖特征的最佳方法。但是CPR技术是利用计算机特殊软件将原始轴面数据在不同层面重新排列、组合为新的层面图像,亦即把走行曲折的面神经管拉直伸展开后,展示在一幅平面图像上,其图像质量不如直接扫描的图像真实,且与实际面神经管的解剖形态亦有差别,是“虚拟”面神经管解剖形态结构。不仅如此,CPR技术还高度依赖于描绘者的技术水平及其所绘曲线的准确性,不准确的定位线可以导致兴趣结构的曲线偏移,从而造成图像的偏差。由于CT具有对骨质结构显像好的特点,故其所获影像是面神经骨管的影像而并非面神经良好显示的影像,因而无法观察面神经的真实状况。由于MRI具有非侵袭性、多平面直接成像、高清的组织分辨率及无骨骼伪影等特点,可以直接观察面神经的影像,因而日益成为面神经疾病的重要影像学检查方法。
但是目前有关颞骨内鼓乳段面神经MR成像的文献报道较少,未见较为详尽、完整的有关颞骨内鼓乳段面神经MR成像研究的文献报道。本研究应用先进的3.0T MR设备,进行国人颞骨内鼓乳段面神经的斜矢状位MR扫描成像研究,以期获取能良好显示鼓乳段面神经全程的MR斜矢状位扫描基线,并观测所获面神经的MR斜矢状位影像学形态和相关技术参数,分析其影像解剖学表现特征,以探讨国人颞骨内鼓乳段面神经的最佳MR斜矢状位成像方法,从而为临床面神经疾病的影像学诊断、治疗、手术及预后等提供可靠参考。
目的:
1、探讨国人颞骨内鼓乳段面神经MR斜矢状位扫描的最佳扫描平面及扫描基线。
2、探讨国人颞骨内鼓乳段面神经的MR斜矢状位扫描影像的解剖学形态特征。
3、对国人颞骨内鼓乳段面神经MR斜矢状位扫描影像进行解剖观察和测量。
方法:
1、标本来源
选择经福尔马林固定的成人无明显颅底病变的颞骨标本20例(40侧),其中男11例,女9例。所有标本均来源于青岛大学医学院解剖学教研室。
2、扫描参数及方法
2.1扫描参数
应用GE 3.0T MR扫描机,头部线圈,采用稳态采集的快速成像序列(Fast Image Employing Steady-state Acquisition;3D-FIESTA),扫描参数如下:重复时间(TR:ms):4.4,回波时间(TE:ms):Min,翻转角(FA,Flip Angle):55,扫描野(FOV):20带宽(Bandwidth):62.50,层厚1.6mm,矩阵:320×320,激励次数:2,每层位置数:30。
2.2扫描方法
所有标本均先行MR常规轴位扫描,在轴位扫描图像中选取耳蜗、水平半规管显示较为清晰、完整的层面为轴位基础层面。在轴位基础层面上,以膝状神经节和水平半规管为标志,与正中矢状轴斜矢状成角确定斜矢状位扫描基线,再将已确定的斜矢状平面内倾适当角度进行MR扫描。比较不同扫描基线和内倾角度所获取的鼓乳段面神经影像,选取鼓乳段面神经全程显示最完整、连续的影像,记录该影像所对应的扫描基线和内倾角。
3、测量方法
采用3D-FIESTA序列采集图像数据,利用磁共振机上相应软件直接测量我们所确定的每侧鼓乳段面神经斜矢状最佳扫描平面的扫描基线与正中矢状轴之间的“夹角”,斜矢状扫描平面的“内倾角”以及各段面神经的长度、直径及各种相关技术参数等指标的测量,所有数据均连续测量三次,取平均值。
4、统计学处理
测量结果以均数±标准差表示。用SPSS 12.0统计软件包对所得数据进行统计学处理,获取各指标的均数及正常范围。对左、右两侧斜矢状位扫描相关角度的测量结果进行单因素方差分析(One-way ANOVA),以明确左、右两侧所获结果统计学有无显著性意义。
结果:
1、20例(40侧耳)颞骨标本鼓乳段面神经MR斜矢状位扫描均得到良好显示,可以清楚地观察到颞骨内鼓乳段面神经的全程完整影像,其形态及走行连续。鼓室段、锥段、乳突段等各段面神经显示清晰,可以进行细致解剖观测。
2、我们分别测量颞骨内鼓乳段面神经全程显示最佳的MR斜矢状位扫描平面其扫描基线与正中矢状轴所成夹角角度,斜矢状平面内倾角的角度,以确定每侧的最佳斜矢状位扫描平面,并在该平面上进行鼓乳段面神经相关长度和径线的测量,均得到满意结果。
结论:
1、MR斜矢状位扫描可良好显示颞骨内鼓乳段面神经的全程影像。
2、本研究测得20例(40侧)颞骨标本鼓乳段面神经的MR斜矢状位最佳扫描平面的扫描基线与正中矢状轴所成夹角角度为24.54°±4.59°,斜矢状位扫描平面内倾角角度为5.97°±2.32°,且左、右侧测量结果统计学无显著性意义。
3、本研究中颞骨内鼓乳段面神经的相关径线测量结果和大体解剖及文献报道结果基本符合,可以为临床面神经疾病的诊断、治疗、手术及预后等提供影像解剖学参考。
第二部分:国人颞骨内鼓乳段面神经的斜矢状位断层解剖学研究
研究背景:
颞骨结构体积微小、位置重叠,方向各异,是人体最复杂的解剖区域之一。长期以来,该区域一直是临床应用解剖学和医学影像学领域中的研究热点。近年来,先进的MR设备及图像后处理技术的迅速发展,能进行薄层扫描、多平面重建和三维成像,从而为展示颞骨内鼓乳段面神经的复杂结构提供了良好工具。但是要正确识别和分析颞骨内鼓乳段面神经的MR影像,尚需借助于相应的薄层断面标本进行详尽的相关解剖定位和对比、鉴别研究。
近年来,断层解剖学研究继常规轴位、冠状位、矢状位之外,又提出第“四维”的概念,即斜矢状位。但有关斜矢状位断层解剖研究的报道较少,未见国内外关于颞骨内鼓乳段面神经的斜矢状位薄层断面解剖研究,国内仅见段菊如,王韶玉等对成人颞骨标本面神经颞骨内段的横断面断层图像和CT图像进行对比,以探讨面神经及其周围结构在高分辨率CT上的定位,为面神经颞骨内段病变及耳科其他病变的影像诊断及手术治疗提供解剖学依据。未见有关颞骨内鼓乳段面神经的斜矢状位断层图像与斜矢状位MR扫描图像进行对比的研究。
本研究先应用先进的3.0T MR设备对所有颞骨标本先行斜矢状位扫描成像,获取颞骨内鼓乳段面神经全程显示良好的影像,记录每侧的扫描基线和内倾角度,然后应用先进的冷冻数控铣削技术,采用和MR斜矢状位扫描相同的基线和角度,对20例颞骨标本进行斜矢状位薄层连续切片,层厚0.4mm,数码相机摄影,计算机保存数据,最后将所获断层图像与同一标本相应层面的MR图像进行对比、观察,以获取颞骨内鼓乳段面神经的更为详尽的信息,进一步验证MR斜矢状位扫描成像的可行性及所获最佳扫描基线和角度的准确性,为颞骨内鼓乳段面神经的MR成像提供断层解剖学基础和依据,从而为临床面神经疾病的影像学诊断、治疗以及手术提供可靠参考。
目的:
1、将所有标本先经3.0T MR扫描机进行斜矢状位扫描,获取层厚为1.6mm的鼓乳段面神经全程显示良好的MR斜矢状位图像。
2、应用先进的冷冻铣削技术获取层厚为0.4mm的与MR斜矢状位扫描成像相同基线和内倾角度条件下的颞骨标本鼓乳段面神经的斜矢状位薄层断面解剖数据。
3、将斜矢状位断层图像和同一标本相对应的MR图像分别进行对照研究,以期获得颞骨内鼓乳段面神经准确、详尽的解剖信息,并进一步验证MR斜矢状位扫描成像的可行性和实用性,从而为鼓乳段面神经的MR影像学研究提供断层解剖学基础。
方法:
1、标本来源
选择经福尔马林固定的成人无明显颅底病变的颞骨标本20例(40侧),其中男11例,女9例。标本均来源于青岛大学医学院解剖学教研室。
2、MR扫描方法
2.1扫描参数
应用GE 3.0T MR扫描机,头部线圈,采用稳态采集的快速成像序列(Fast Image Employing Steady-state Acquisition;3D-FIESTA),扫描参数如下:重复时间(TR:ms):4.4,回波时间(TE:ms):Min,翻转角(FA,Flip Angle):55,扫描野(FOV):20带宽(Bandwidth):62.50,层厚1.6mm,矩阵:320×320,激励次数:2,每层位置数:30。
2.2扫描方法
所有标本均先行MR常规轴位扫描,在轴位扫描图像中选取耳蜗、水平半规管显示较为清晰、完整的层面为轴位基础层面,在轴位基础层面上,以膝状神经节和水平半规管为标志,与正中矢状轴斜矢状成角确定斜矢状位扫描基线,再将已确定的斜矢状平面内倾适当角度进行MR扫描。比较不同扫描基线和内倾角度所获取的鼓乳段面神经影像,选取鼓乳段面神经全程显示最完整、连续的影像,记录该影像所对应的扫描基线和内倾角,以备断层解剖之用。
3、冷冻数控铣削
3.1冷冻、包埋和固定
将经MR扫描后的标本放入低温冷冻室内,经过-20℃,-30℃,-40℃依次冷冻两天,然后采用不锈钢包埋箱包埋,标本固定角度及位置与该标本MR斜矢状位扫描基线位置及角度均相同。固定定位杆,填充3%蓝色明胶溶液至距离包埋箱底7cm处,并冷冻至使其凝固变硬。24h后,将标本用自制固定架固定定位,放入包埋容器中,依次向包埋箱内加入第二、三、四层明胶,其间隔时间为24h。
3.2数控铣削
在恒温-15℃铣削室内,把标本块放在铣削精度为0.001mm SKC500型数控机床的工作台上,固定标本块后,调整铣床Z轴每次进给距离为0.4mm,主轴转速900次/分,X轴方向上每转进给距离为0.4mm。每执行完一层,铣头停在X轴的最大负端,此时带有计数器、比例尺和比色卡的采集框走到合适的位置,此时根据情况对标本面进行适当的技术处理准备照相。
3.3断面图像的采集与保存
使用Canon EOS 20D相机,820万像素,加装遮光罩,调整镜头前缘距离标本断面垂直距离95cm。当铣床执行完一个完整程序后,铣头停留在X轴的最大负端,通过Canon Utilities EOS Capture软件控制相机,采集图像数据,图像采集结束后,备份原始数据。
4、解剖断层与MR图像的对照研究
将应用冷冻数控铣削技术获得的颞骨标本的0.4 mm薄层斜矢状位连续断层解剖图像在Photoshop上进行相应处理,使处理后图像的色彩、对比度、清晰度及背景都达到最佳水平,最后保存。观察鼓乳段面神经的断面解剖结构特征,并将其与相应的MR斜矢状位扫描图像层面进行对比研究,以观察其一致性。
结果:
1、应用先进的冷冻数控铣削技术,采用与MR斜矢状位扫描成像相同基线和内倾角度条件进行连续切片,所获颞骨内鼓乳段面神经斜矢状位连续薄层断面图像清晰,易于观察。颞骨内鼓乳段面神经的形态及走行得到良好显示。
2、将斜矢状位断层图像和同一标本相对应的MR图像分别进行对照研究,结果表明颞骨内鼓乳段面神经斜矢状位连续薄层断面图像和相应层面的MR图像结构对应良好。
结论:
1、应用冷冻数控铣削技术对颞骨内鼓乳段面神经进行斜矢状位连续薄层断面解剖研究结果表明MR斜矢状位扫描成像方法有效、可行,亦说明我们通过MR斜矢状位扫描获取的有关斜矢状位的扫描基线及角度准确、可靠。
2、通过断层图像与MR图像的对比研究可获取颞骨内鼓乳段面神经的详尽解剖信息,为颞骨内鼓乳段面神经的MR成像提供断层解剖学基础和依据,从而为临床颞骨内鼓乳段面神经的研究提供可靠参考。
第三部分:正常人颞骨内鼓乳段面神经的MR斜矢状位应用影像解剖学观测
研究背景:
面神经是人体内居于颅底骨管中最长的神经,且走行曲折,为了良好地显示其走行,多年来国内外众多学者对此进行了不懈的研究和探讨。研究颞骨内面神经行程及其与周围结构的毗邻关系对颞骨内病变所致的面神经损伤及相关面神经疾病的诊断和治疗具有重要意义。不仅如此,临床上面神经手术各种术式的选择以及耳科某些手术的成功进行都需要对面神经的行程及毗邻关系有清晰的了解和定位。因此熟悉面神经的正常与变异,对避免造成耳科及颅底等手术时的意外损害亦具有极其重要的临床价值。
长期以来,传统的影像学检查方法均不能充分显示颞骨内鼓乳段面神经的影像。因此,面神经曾一度是影像检查的盲区。随着医学影像技术的发展,颞骨内段面神经的影像学检查及显示技术有了长足进展。磁共振(MR)检查凭借其良好的软组织分辨力和任意方向扫描成像等优势,日益成为面神经的重要影像学检查方法。面神经MR的常规扫描层面有轴位、冠状位及矢状位。轴位MR扫描只能在同一扫描层面显示膝状神经节段及面神经鼓室段。冠状位MR扫描仅可显示面神经乳突段的全程。因而常规的MR轴位、冠状位及正中矢状位扫描均不能使面神经鼓室段和乳突段显示最佳,导致难以全面、直观地观察面神经的行程、毗邻及管径大小的改变等,不利于发现该段面神经早期及微小的病变。
近年来,应用CT及MPR技术可以观察到颞骨内鼓乳段面神经骨管的完整形态,但该方法无法反映面神经的真实状况。有文献报道斜矢状位扫描可同层显示膝状神经节段、鼓室段、乳突段并且可以充分显示面神经与前庭、耳蜗、半规管的关系。Theodora Dailiana等曾提出斜矢状位MR扫描的设想,但未详尽描述。张晓宏等报道应用1.5T MR技术得到3侧尸头标本和15侧健康人的颞骨内鼓乳段面神经的影像,但是例数较少且扫描层厚为3mm,所获图像质量欠佳而且未对扫描条件作详细描述。目前尚未见国内外关于颞骨内鼓乳段面神经MR成像的较为详尽、全面的报道。我们通过20例颞骨标本的MR斜矢状位扫描成像和斜矢状位断层解剖研究,亦认为斜矢状位更有利于观察颞骨内鼓乳段面神经的真实走行。
本研究中我们应用先进的3.0T MR扫描设备,探讨正常人颞骨内鼓乳段面神经的MR斜矢状位扫描的最佳扫描基线和角度,观察其斜矢状位影像形态学表现和解剖特征,并进行相关的解剖测量,从而为临床面神经疾病的影像学检查提供可靠参考,为临床面神经疾病的诊断、治疗及手术提供可靠的影像学依据。
目的:
1、对正常人颞骨内鼓乳段面神经进行MR斜矢状位扫描成像,获取正常人MR斜矢状位扫描的最佳扫描基线、角度和颞骨内鼓乳段面神经完整、连续的影像。
2、对所获颞骨内鼓乳段面神经的斜矢状位MR影像进行形态观察和解剖测量,获取颞骨内鼓乳段面神经斜矢状位MR详细的影像解剖学数据,以期为临床面神经的影像学研究提供参考,为面神经疾病的诊断、治疗及手术提供解剖学数据标准和参考。
3、将本组测量所得结果与颞骨标本MR斜矢状位扫描成像所获结果进行统计学分析,进一步验证颞骨内鼓乳段面神经MR斜矢状位成像的临床可行性和实用性。
方法:
1、实验对象
50例(100侧耳)无任何耳部疾患的成年志愿者,男26例,女24例,平均年龄45.3岁。所有志愿者均来源于青岛大学医学院附属医院门诊就诊者,经专业医师严格查体及筛选。
2、MR检查方法
2.1扫描参数
应用GE 3.0T MR扫描机,头部线圈,采用稳态采集的快速成像序列(Fast Image Employing Steady-state Acquisition;3D-FIESTA),扫描参数如下:重复时间(TR:ms):4.4,回波时间(TE:ms):Min,翻转角(FA,Flip Angle):55,扫描野(FOV):20带宽(Bandwidth):62.50,层厚1.6mm,矩阵:320×320,激励次数:2,每层位置数:30
2.2扫描方法
所有标本均先行MR常规轴位扫描,在轴位扫描图像中选取耳蜗、水平半规管显示较为清晰、完整的层面为轴位基础层面,在轴位基础层面上,以膝状神经节和水平半规管为标志,与正中矢状轴斜矢状成角确定斜矢状位扫描基线,再将已确定的斜矢状平面内倾适当角度进行MR扫描。比较不同扫描基线和内倾角度所获取的鼓乳段面神经影像,选取鼓乳段面神经全程显示最完整、连续的影像,记录该影像所对应的扫描基线和内倾角。
3、测量方法
采用3D-FIESTA序列采集图像数据,利用磁共振机上相应软件直接测量我们所确定的每侧鼓乳段面神经斜矢状位最佳扫描平面的扫描基线与正中矢状轴之间的“夹角”,斜矢状扫描平面的“内倾角”以及各段面神经的长度、直径及各种相关技术参数等指标的测量和统计,所有数据均连续测量三次,取平均值。
4、统计学处理
实验结果以均数±标准差表示。用SPSS 12.0统计软件包对所得数据进行统计学处理,得出各指标的均数及正常范围。利用单因素方差分析(One-way ANOVA)对颞骨标本组和正常人组测量结果进行统计学分析,以明确有无统计学显著性意义。
结果:
1、50例(100侧耳)正常人颞骨内鼓乳段面神经全程均得到良好显示。从MR斜矢状位扫描影像可以清楚地观察到颞骨内鼓乳段面神经的形态和走行,鼓室段、锥段、乳突段等各段面神经显示清晰,与颞骨标本的斜矢状位MR扫描成像结果及斜矢状位断层解剖观察结果一致。
2、我们分别测量颞骨内鼓乳段面神经全程显示最佳的MR斜矢状位扫描平面其扫描基线与正中矢状轴所成夹角角度,斜矢状平面内倾角角度,以确定每侧的最佳斜矢状位扫描平面。在该平面上进行鼓乳段面神经相关长度和径线的测量,将所获结果与颞骨标本组MR斜矢状位扫描成像测量结果进行统计学分析,均无统计学显著性意义。
结论:
1、MR斜矢状位扫描是观察颞骨内鼓乳段面神经的有效影像学检查方法,可以得到颞骨内鼓乳段面神经全程的完整影像。该结论与颞骨标本组及断层解剖研究结果一致。
2、本研究测得50例正常人(100侧耳)的MR斜矢状位最佳扫描平面的扫描基线与正中矢状轴所成夹角角度为23.67°±5.46°,斜矢状位扫描平面内倾角角度为6.15°±3.30°,该结果与颞骨标本组测量结果统计学无显著性意义,说明我们所选取的扫描基线和扫描平面准确、可靠。
3、在MR斜矢状位扫描图像上可以对颞骨内鼓乳段面神经全程进行细致形态学观察和解剖测量,测量结果和颞骨标本组无统计学显著性差异,可以为临床面神经影像学检查提供有力的解剖学参考。
PART ONE: Study of MR scanning of temporal bone about tympanic and mastoid segment of facial nerve
Background
As we all known,anatomy of the facial nerve is very complex.The tympanic and mastoid segment of facial nerve are the most complicated part because of it's tiny and the overlapping structures surrounding.At present,the overall level of the microsurgical of ear in our country is lower.Many basic and clinical researches can not carry through.There haven't been an identical standard of the diagnosis,treatment,prognosis of the facial nerve diseases. Though of the surgical indications,time of the operation and evaluation of the operations.How to make good images of the tympanic and mastoid sections of facial nerve is the goal of both scholars of Otolaryngology and Radiology.
Ordinary X-ray examination is very limited to facial nerve imaging. With the development of medical imaging technology,imaging and display technology of the tympanic and mastoid segment of facial nerve have been making considerable progresses.Especially in recent years,advanced technology of CT and MR make it sure to get more clear images of the tympanic and mastoid segment of facial nerve.To study the imaging anatomy of the tympanic and mastoid segment of facial nerve can provide valuable references to observations and diagnosis of ear diseases.More and more people are concerned about this.There are both advantages and disadvantages of CT and MRI to the diagnosis of facial nerve lesions.CT imaging is good for osseous structures,especially high-resolution CT scan can make clearly thin layer image of facial nerve intra-temporal bone.With the using of spiral CT and the three-dimensional reconstruction technique,it is possible to show the tiny structures of ear.Especially the using of curved-planar reconstruction (CPR)technique with a multi-slice spiral CT takes good advantage of this. CPR can image along the curve of our interested structures.Multi-dimensional CT and post-processing technology provide a good method to obtain a particularly observation of the facial nerve canal.The facial nerve canal within the structures of bilateral temporal bone showed at the same time.It allows us to make detailed morphological observations and measurements of it through the images.It is proved to be the best imaging method of the facial nerve canal up to the present.However,CPR technology is not ideal.The principle of CPR is the rearrange of original data on an axial plane at different levels to recompose a new dimension image with computer.It is to say,CPR is a method to make the tortuous course of the facial nerve canal straightened and displayed in a planar images.So the quality of CPR images is not as good as that of direct scanning images.It is a virtual structure of the facial nerve canal.Morphology of CPR image of the tympanic and mastoid segment of facial nerve is different from the true state of it.Besides,CPR techniques described are highly dependent on the skill level and the accuracy of the curve. Inaccurate position criterion of the aim structure may lead to offset curves. MRI takes advantages of non-invasive,direct multi-planar imaging,excellent soft-tissue resolution and no-hardening artifact which compared to CT.It is increasingly becoming an important facial nerve disease screening method. However,fewer reports of the MR imaging of tympanic and mastoid segment of facial nerve are found.
We haven't found any detailed and complete documentations of MR imaging of the tympanic and mastoid segment of facial nerve by far.In this study,we use an advanced 3.0 T MR scanning equipment and hope to make investigations of the tympanic and mastoid segment of facial nerve.We hope to get a good MR scanning criterion so that we can get clear images of the tympanic and mastoid segment of facial nerve.It allows us to perform all-around observations of the tympanic and mastoid segment of facial nerve. So we can get the results of MR imaging methods,imaging features of its anatomy and some measurement results in order to provide clinical references of facial nerve disease.
Objective:
1、To study the best position and method of MR scanning of the tympanic and mastoid segment of facial nerve.
2、To study the features of MR images of the tympanic and mastoid segment of facial nerve.
3、Make measurements and observations of the MR images of the tympanic and mastoid segment of facial nerve.
Materials and methods
1、Tissues sample
We choose 20(40 sides)temporal bones of adults without any significant diseases of skull.Before our experiment,all the temporal bones are formalin-fixed.There are 11 male and 9 female cases.All specimens come from the Department of Anatomy of Qingdao Medical College.
2、MR Scanning
2.1 scanning parameter
We use a GE 3.0T MR scanning equipment,head coil and 3D-Fast Image Employing Steady-state Acquisition(3D-FIESTA)to finish our imaging.Scanning parameters are as follows:repetition time(TR):4.4ms, echo time(TE):Min,Flip angle(FA):55,Scanning field(FOV):20, Bandwidth:62.50,Thickness 1.6 mm,Matrix:320×320,Stimulate number:2, Position number of each layer:30
2.2 scanning method
First,all specimens are given a general MR axial scanning.After the scanning finished,we select the plane which the tympanic segment of facial nerve showed well and then conduct an oblique sagittal scanning.Write down the data we got of the best scanning plane.
3、Measurement method
We get the MR images through using 3D-Fast Image Employing Steady-state Acquisition.Then we choose the right layer which the whole tympanic and mastoid segment of facial nerve showed well and allowed to make measurements.All data are measured three times for the average.
4、Statistically
We choose a SPSS 12.0 statistical package on the data for statistical analysis to get the normal range and noted the experimental results to mean±standard deviation.One-way ANOVA is used to compare the data of two sides.
Results:
1.All the tympanic and mastoid segment of facial nerve of 20 temporal bone specimens(40sides)displayed well.Oblique sagittal MR scanning makes it sure to observe the complete image of the tympanic and mastoid segment of facial nerve.We can observe the image of the tympanic and mastoid segment of facial nerve clearly and get more details about it through this position.
2、In our study,20 patients(40 sides)had an oblique sagittal scanning,then we measured the angle between the oblique sagittal scanning line with the median sagittal line and the angle intilted from the oblique sagittal scanning plane.We choose the best plane of the tympanic and mastoid segment of facial nerve to make our measurements of length and diameters.
Conclusion:
1、Oblique sagittal scanning of MR is the best method to show the tympanic and mastoid segment of facial nerve.
2、The angle between the oblique sagittal scanning line and the median sagittal line is 24.54°±4.59°,the angle intilted from the oblique sagittall scan plane is 5.97°±2.32°.
3、Measurement results of length and diameters and general anatomy observations are accord to that reported in the literature.
PART TWO: Oblique sagittal sectional anatomy of the tympanic and mastoid segment of facial nerve
Background
As we all known,anatomy of the facial nerve is very complex.The tympanic and mastoid facial nerve is the most complicated part because of it's tiny and the overlapping structures.MRI takes good advantage of non-invasive,direct multi-planar imaging,excellent soft-tissue resolution and no-hardening artifact which compared to CT.It is increasingly becoming an important facial nerve disease screening method.However,better identification and analysis of the MR image of the tympanic and mastoid segment of facial nerve need the help of the thin specimens sectional anatomy study.
In resent years,some scholar mentioned about the oblique sagittal plan except the axial plan、coronal plan and the sagittal plan.But no one make any study about it.We found only one report written by Duan Ju-ru and Wang Shao-yu to study the sectional anatomy on transversal plane of tympanic and mastoid segment of facial nerve and compared it with the same CT images. They found the thin sections of the temporal bone can clearly delineate the anatomical details of the temporal bone and their relationships.The same specimen images post-processed by multi-planar reformation(MPR)came to coincidence completely with these sections.The thin sectional images of the temporal bone obtained by using computerized cryo-milling technique matched well with the CT images.It will be the base of study of the temporal bone and the facial nerve.We haven't searched any detailed documents of oblique sagittal sectional anatomy of the tympanic and mastoid segment of facial nerve so as those compared with the same MR images.
In our research,we use an advanced 3.0 T MR scanning equipment and hoped to get clear images of the tympanic and mastoid segment of facial nerve. Then we obtain the sectional data of the tympanic and mastoid segment of facial nerve using computerized cryo-milling technique.All the specimens were sliced into 0.4mm continuous sections with the computerized miller at the same condition as oblique sagittal MR scanning.Take photographs with digital camera,save the data into computer,then compare them with the same specimen's MR images so that to provide references to clinical.We hoped to improve the whole level of diagnosis、operation and treatment of facial nerve diseases.
Objective:
1、To obtain the oblique sagittal MR images of the tympanic and mastoid segment of facial nerve by using a 3.0 T MR scanning equipment.
2、To obtain the oblique sagittal sectional data of the tympanic and mastoid segment of facial nerve by using computerized cryo-milling technique at the same condition as oblique sagittal MR scanning.
3、To compare the thin oblique sagittal sectional images of the temporal bone obtained by computerized cryo-milling technique with the same MR images, so that to confirm the results we got from MR scanning of temporal bones and hope it may be the anatomy bases of studies of the temporal bone and the facial nerve.
Materials and methods
1、Tissues sample
We choose 20(40 sides)temporal bones of adults without any significant diseases of skull.Before our experiment,all the temporal bones are formalin-fixed.There are 11 male and 9 female cases.All specimens come from the Department of Anatomy of Qingdao Medical College.
2、MR Scanning
2.1 scanning parameter
We use GE 3.0T MR scanner,head coil and 3D-Fast Image Employing Steady-state Acquisition(3D-FIESTA)to finish our imaging. Scanning parameters are as follows:repetition time(TR):4.4ms,echo time (TE):Min,Flip angle(FA):55,Scanning field(FOV):20,Bandwidth:62.50, Thickness 1.6 mm,Matrix:320×320,Stimulate number:2,Position number of each layer:30
2.2 scanning method
First,all specimens are given a general axial scanning.After the scanning finished,we select the plane which the tympanic segment of facial nerve showed well and conduct an oblique sagittal scanning.Write down the number of the angle and the scanning plan of each specimen to prepare for sectional anatomy.
3、Computerized Cryo-milling Technique
3.1 Freezing,Embedding and Immovably
We collect 20 temporal bone specimens of Chinese adults.All specimens are freezing under profound hypothermia after an examination with 3.0T MR scanning.The temperature is-20℃,-30℃,-40℃in turn and each for two days.Then buried with an embedded bag of stainless steel,fixed-position, filling the embedded bag with three percent of the blue gelatin solution to be 7cm apart from the bottom of the embedded bag,then freeze it and make it solidify and stiffen for 24h.All specimens are fixed at the same position with which measured from MR scanning.Specimens were fixed with self-holder positioning and put in the embedded containers after which adding blue gelatin solution to the embedded box in turn for the second,third,fourth times. 24 hours time interval each time.
3.2 Computerized Milling
Computerized milling carried through in the milling room which keeping the temperature on-15℃.Put the specimens on the block of SKC500 with which milling accuracy is 0.001 mm.Fixed the specimen block and adjusted the distance of Z-axis of each milling time,and spindle speed 900 times/min,every rotation on X-axis direction to a distance of 0.4mm/time. When each layer finished,it stopped at end of the largest negative side of X-axis milling.At the same time,a collection box with counter、scale and color card come into the right position where the specimens will receive some treatment and prepare for photography.
3.3 Preservation and Photograph
Canon EOS 200D camera installed hood was used to take photographs of the sectional images.Adjust the vertical distance from the camera to the specimen section is 95 cm.When a whole milling procedures completed,tip of the milling machine stopped at the end of largest negative side of X-axis.We use Canon Utilities EOS Capture software control the camera,then take photos and save it into the computer.
4、Compare the Sectional images with MR images
All the specimens were sliced into 0.4mm continuous sections on an oblique sagittal plane with the computerized miller,take photographs with digital camera and save the data in computer.Photoshop software are used to make the sectional images look to be the best,then compare them with the same specimens MR images so that to provide reference to clinical.
Results:
1、All the tympanic and mastoid segment of facial nerve of 20 temporal bone specimens(40sides)are well displayed through oblique sagittal sectional anatomy study by using computerized cryomilling technique.We can observe the complete image of the tympanic and mastoid segment of facial nerve clearly.
2、Images come from computerized milling are so clear that allow good observations of the tympanic and mastoid segment of facial nerve.All images matched well with the images of MR scanning.
Conclusion:
1、The results of oblique sagittal sectional anatomy study by using computerized cryomilling technique indicate that the positions and data we got from oblique sagittal MR scanning are believable.
2、All results we got can provide important references to clinical application of facial nerve researches.
PART THREE: Anatomy and measurements of normal tympanic and mastoid segment of facial nerve by using an oblique sagittal MR scanning technique
Background
Facial nerve is the longest nerve that existed in the canal.It is also the most complicated part of our body.How to make good images of the tympanic and mastoid sections of facial nerve is the goal of both scholars of Otolaryngology and Radiology.Most facial paralyzes are caused by lesions in the temporal bone.Research of the facial nerve intra-temporal bone and the relationship with the surrounding structures is important to diagnosis and treatment of facial nerve diseases.Selection of operation mode of facial nerve decompression,some operations of the ear requires good control of the anatomy of facial nerve and it's surroundings.A successful conduct of the facial nerve and ear operations depend highly on anatomy.So familiar with the facial nerve and the normal variation of the surgery to avoid ear damage accidents is extremely important to clinical value.
We can not observe the tympanic and mastoid facial nerve clearly by using traditional image technique for a long time.Ordinary X-ray examination is very limited to facial nerve imaging.CT imaging is good for osseous structures.MRI takes advantages of non-invasive,direct multi-planar imaging, excellent soft-tissue resolution and no-hardening artifact which compared to CT.It is increasingly becoming an important facial nerve disease screening method.General MR scanning plane of facial nerve are axial scanning and coronal scanning.Axial MR scanning may show the geniculation ganglion and the tympanic segment of facial nerve on one same layer.The tympanic segment of the facial nerve is not in one plane,so we can see it in several planes.The mastoid segment of the facial nerve was only a point in the axial plane.Therefore general axial scanning revealed that it is not the best scanning plane of the facial nerve.Coronal scanning can only show the whole mastoid segment of the facial nerve.Therefore the conventional axial and coronal scanning are both not imaging the facial nerve well.It is difficult to find some small focus under this condition.
Multi-dimensional CT and post-processing technology provide a good method to obtain a particularly observation of the facial nerve canal.But it can not give us the true state of facial nerve.Oblique sagittal scanning reported in the literature said that we can see the geniculation ganglion,the tympanic segment and the mastoid segment of the facial nerve in one plane which can also show the relationships with vestibular,cochlea and the semicircular canal clearly.Theodora Dailiana et al.had given us an idea of oblique sagittal MR scanning but did not give a detailed description.Zhang Xiao-Hong reported a research about MR scanning with 1.5 T MR of 15sides healthy people and 3 sides of temporal bone to study the MR images of the facial nerve.In the report,they use a small number of cases and a scanning thickness of 3.0 mm and received poor image quality.We haven't searched any detailed and complete documentation of MR imaging of the tympanic and mastoid facial nerve.From researches of ourselves of MR scanning of temporal bones,we considered the oblique sagittal scanning is the best way to show the tympanic and mastoid segment of facial nerve.
We choose 50(100sides)healthy people to conduct the research.In this study,we use an advanced 3.0 T MR scanning equipment and hope to make investigations of MR images of the tympanic and mastoid segment of facial nerve.We hope to get a good MR scanning method so that we can get clear images of the tympanic and mastoid segment of facial nerve.It allows us to perform all-around observations of the tympanic and mastoid segment of facial nerve.So we can get the results of MR imaging methods,imaging features of its anatomy.The results we get from the study can provide references to clinical diagnosis treatment and surgery of facial nerve disease.
Objective:
1、To obtain the best MR scanning plane、scanning position and complete images of the tympanic and mastoid segment of facial nerve of healthy people.
2、Make detailed measurements and observations of the MR images of the tympanic and mastoid segment of facial nerve.
3、Make statistical analysis of measurement results and compare the results with those come from MR scanning of the temporal bone.We hope to confirm our technique results through this method.
Materials and methods
1、Tissues sample
We choose 50(100 sides)healthy adults without any significant diseases of ears.There are 26 male and 24 female cases.The average age is 45.3.All the people are choose by doctors of Otolaryngology.
2、MR Scanning
2.1 scanning parameter
We use GE 3.0T MR scanning equipment,head coil and 3D-Fast Image Employing Steady-state Acquisition(3D-FIESTA)to finish our imaging. Scanning parameters are as follows:repetition time(TR):4.4ms,echo time (TE):Min,Flip angle(FA):55,Scanning field(FOV):20,Bandwidth:62.50, Thickness 1.6 mm,Matrix:320×320,Stimulate number:2,Position number of each layer:30
2.2 scanning method
First,all people are given a general axial MR scanning.After the scanning finished,we select the plane which the tympanic segment of facial nerve showed well.The oblique sagittal plane we choose is the plane which paralleled with it.An oblique sagittal MR scanning of the facial nerve will going on the plane which we have selected.
3、Measurement method
We get the MR images through using 3D-Fast Image Employing Steady-state Acquisition.Then we choose the right layer which the whole tympanic and mastoid segment of facial nerve showed well and allowed to make measurements.All data are measured three times for the average.
4、Statistically
We choose a SPSS 12.0 statistical package on the data for statistical analysis to get the normal range and noted the experimental results to mean±standard deviation.One-way ANOVA is used to compare the data of normal people with that of the temporal bone.
Results:
1.All 50 people(100sides)of the tympanic and mastoid segment of facial nerve are well displayed.The tympanic and mastoid segment of facial nerve showed a clear and detailed anatomy image through oblique sagittal MR scanning.Oblique MR imaging scan make it sure to observe the complete image of the tympanic and mastoid segment of facial nerve.
2、In our study,50 normal people(100 sides)had an oblique sagittal scanning,then we measured the angle between oblique sagittal scanning line and the median sagittal line and the angle intilted from the oblique sagittal scanning plane.We choose the best plane to make our measurements of length and diameters.
Conclusion:
1、Oblique sagittal scanning of MR is the best method to show the tympanic and mastoid segment of facial nerve.The result is the same as that comes from MR scanning and sectional study of the temporal bone of tympanic and mastoid facial nerve.
2、The angle between the oblique sagittal scanning line and the median sagittal line is 23.67~0±5.46~0,the angle intilted from the oblique sagittal scanning plane is 6.15~0±3.30~0.One-way ANOVA is used to compare the data of normal people with that of the temporal bone.There have no evidently differences from statistic.
3、Measurement results and general anatomy observations are accord to that reported in the literature.
引文
1.迟放鲁.面神经研究的现状与发展方向.中华耳鼻咽喉头颈外科杂志,2006,1,vol 41(1):3-4
2.石会兰,张云亭,苏大同等.多层螺旋CT多平面和曲面重建成像显示面神经管的应用价值.天津医科大学学报,2006,9,vol12(3):417-419
3.张晓宏,刘筠,巫北海等.面神经、前庭蜗神经的MRI:薄层断层影像解剖学研究.第三军医大学学报2002,4,vol24(4):485-487
4.Theodora D,Donald C,Petra S,et al.High resolution MR of the intra-parotid facial nerve and parotid duct.[J]AJNR,1997,18:165-172
5.Mark L P,Yetkin F Z,Hendrix L E,et al.Visualization of the distal intratemporal facial nerve with MR imaging:use of an oblique plane[J]Radiology,1992,182():891-893.
6.Teresi L,Lufkin R,Wortham D.et al.MR imaging of the intratemporal facial nerve by using a surface coil.AJR,1987,148(3):589-594
7.张晓宏,巫北海,刘筠等。颞骨内面神经的影像学研究:多层面CT和高场强MR中国医学计算机成像杂志2001,7(5):295-297
8.Fisch.Facial Nerve Surgery.Lned.Birmingham Alabama:Aesculapius Publishing Company,1977.13-9.
9.张淑香,何凡,王燕楠颞骨内面神经解剖及测量 Tianjin Med J,Nov 2002.Vol 30 No 11 698-699
10.汪建华,卢仁根,胡碧波等.多层螺旋CT面神经管曲面重建图像的解剖与临床应用。临床放射学杂志2003,22(11):919-923
11.陈青华,柳澄,刘凯等.多层CT面神经管MPR双斜位成像方法.医学影像学杂志,2006,16(6):541-544
12.Proctor B.The anatomy of the facial nerve.Otolaryngol Clin North Am,1991,24(3):479-504
13.梅桢峰,孙敬武,叶非常等,中耳手术相关面神经管的解剖观测。 J Clin Otorhinolaryngol(China),November 1999,Vol 13,No 11:488-489
14.朱俊德,黄筑新 颞骨内面神经管的解剖测量及其临床意义四川解剖 学杂志2007,15(2):11-12
15.徐金操,郭梦和,张宏征等中耳手术避免面神经损伤的相关解剖学数据测量。中国临床康复2006,10(4):125-127
16.宋光义,刘俊华,赵光明等.多层螺旋CT面神经管曲面重建与解剖对照研究.头颈部放射学,2006,12,22(12):1441-1445
1.段菊如,林敏,熊俊平等.面神经颞骨内段在横断薄层和CT上的定位及临床意义.中国临床解剖学杂志,2004,22(3):257-260
2.王韶玉,刘树伟,柳澄等.颞骨的薄层断面数据获取研究.医学影像学杂志,2005,15(10):894-896
3.李忠华,王兴海.解剖学技术[M].第2版.北京:人民卫生出版社,1997,92-96.
4.邱明国,张绍祥,刘正津等.颞骨及其邻近区塑化薄层断面解剖学研究.[J].第三军医大学学报,2002,24(3):252-254.
5.靳颖,刘津平,田德润等.颞骨的断层解剖学研究及其临床意义.[J].中国临床解剖学杂志.2004,22(4):353-356.
6.Mark L P,Yetkin F Z,Hendrix L E,et al.Visualization of the distal intratemporal facial nerve with MR imaging:use of an oblique plane[J]Radiology,1992,182():891-893.
7.Teresi L,Lufkin R,Wortham D.et al.MR imaging of the intratemporal facial nerve by using a surface coil.AJR,1987,148(3):589-594
1.姜泗长.耳解剖学与颞骨组织病理学[M].北京:人民军医出版社,1999.
2.Kumar A,Mafee MF.MasonT Value of imaging in disorders of the facial nerve[J].Top Magn Reson Imaging,2000,11:38-51.
3.TuccaR E,Tekdemir I,Asian A,et al.Radiological anatomy of the intratemporal course of facial nerve[J].Clin Anat,2000,13:83-87.
4.石会兰,张云亭,苏大同等.多层螺旋CT多平面和曲面重建成像显示面神经管的应用价值.天津医科大学学报,2006,9,vol12(3):417-419
5.Mark L P,Yetkin F Z,Hendrix L E,et al.Visualization of the distal intratemporal facial nerve with MR imaging:use of an oblique plane[J]Radiology,1992,182():891-893.
6.Theodora D,Donald C,Petra S,et al.High resolution MR of the intra-parotid facial nerve and parotid duct.[J]AJNR,1997,18:165-172
7.张晓宏,刘筠,巫北海等.面神经、前庭蜗的MRI:薄层断层影像解剖学研究.第三军医大学学报2002,4,vol24(4):485-487
8.迟放鲁.面神经研究的现状与发展方向.中华耳鼻咽喉头颈外科杂志,2006,1,vol 41(1):3-4
9.Teresi L,Lufkin R,Wortham D.et al.MR imaging of the intratemporal facial nerve by using surface of coil.AJR,1987,148(3):589-594
12.Fisch.Facial Nerve Surgery.Lned.Birmingham Alabama:Aesculapius Publishing Company,1977.13-9.
13.张淑香,何凡,王燕楠 颞骨内面神经解剖及测量 Tianjin Med J,Nov 2002.Vol 30 No 11 698-699
14.汪建华,卢仁根,胡碧波等.多层螺旋CT面神经管曲面重建图像的解剖与临床应用。临床放射学杂志2003,22(11):919-923
15..陈青华,柳澄,刘凯等.多层CT面神经管MPR双斜位成像方法.医学影像学杂志,2006,16(6):541-544
16.Watanabe N,Sugai Y,Hosoya T,et al.High resolution computed tomography using multiplannar reconstruction of the facial nerve canal[J]. ActA Otolaryngol,2000,542(Suppl):44-48.
17.宁文德,白少华,董季平.面神经管多层螺旋CT曲面重建的测量.实用放射学杂志.2004,10,20(10):877-880
18.Proctor B.The anatomy of the facial nerve.Otolaryngol Clin North Am,1991,24(3):479-504
19.梅桢峰,孙敬武,叶非常等,中耳手术相关面神经管的解剖观测。J Clin Otorhinolaryngol(China),November 1999,Vol 13,No 11:488-489
20.朱俊德,黄筑新 颞骨内面神经管的解剖测量及其临床意义 四川解剖学杂志 2007,15(2):11-12
21.宋光义,刘俊华,赵光明等.多层螺旋CT面神经管曲面重建与解剖对照研究.头颈部放射学,2006,12,22(12):1441-1445
2.石会兰,张云亭,苏大同等.多层螺旋CT多平面和曲面重建成像显示面神经管的应用价值.天津医科大学学报,2006,9,vol12(3):417-419
3.张晓宏,刘筠,巫北海等.面神经、前庭蜗神经的MRI:薄层断层影像解剖学研究.第三军医大学学报2002,4,vol24(4):485-487
4.Theodora D,Donald C,Petra S,et al.High resolution MR of the intra-parotid facial nerve and parotid duct.[J]AJNR,1997,18:165-172
5.Mark L P,Yetkin F Z,Hendrix L E,et al.Visualization of the distal intratemporal facial nerve with MR imaging:use of an oblique plane[J]Radiology,1992,182():891-893.
6.Teresi L,Lufkin R,Wortham D.et al.MR imaging of the intratemporal facial nerve by using a surface coil.AJR,1987,148(3):589-594
7.张晓宏,巫北海,刘筠等。颞骨内面神经的影像学研究:多层面CT和高场强MR中国医学计算机成像杂志2001,7(5):295-297
8.Fisch.Facial Nerve Surgery.Lned.Birmingham Alabama:Aesculapius Publishing Company,1977.13-9.
9.张淑香,何凡,王燕楠颞骨内面神经解剖及测量 Tianjin Med J,Nov 2002.Vol 30 No 11 698-699
10.汪建华,卢仁根,胡碧波等.多层螺旋CT面神经管曲面重建图像的解剖与临床应用。临床放射学杂志2003,22(11):919-923
11.陈青华,柳澄,刘凯等.多层CT面神经管MPR双斜位成像方法.医学影像学杂志,2006,16(6):541-544
12.Proctor B.The anatomy of the facial nerve.Otolaryngol Clin North Am,1991,24(3):479-504
13.梅桢峰,孙敬武,叶非常等,中耳手术相关面神经管的解剖观测。 J Clin Otorhinolaryngol(China),November 1999,Vol 13,No 11:488-489
14.朱俊德,黄筑新 颞骨内面神经管的解剖测量及其临床意义四川解剖 学杂志2007,15(2):11-12
15.徐金操,郭梦和,张宏征等中耳手术避免面神经损伤的相关解剖学数据测量。中国临床康复2006,10(4):125-127
16.宋光义,刘俊华,赵光明等.多层螺旋CT面神经管曲面重建与解剖对照研究.头颈部放射学,2006,12,22(12):1441-1445
1.段菊如,林敏,熊俊平等.面神经颞骨内段在横断薄层和CT上的定位及临床意义.中国临床解剖学杂志,2004,22(3):257-260
2.王韶玉,刘树伟,柳澄等.颞骨的薄层断面数据获取研究.医学影像学杂志,2005,15(10):894-896
3.李忠华,王兴海.解剖学技术[M].第2版.北京:人民卫生出版社,1997,92-96.
4.邱明国,张绍祥,刘正津等.颞骨及其邻近区塑化薄层断面解剖学研究.[J].第三军医大学学报,2002,24(3):252-254.
5.靳颖,刘津平,田德润等.颞骨的断层解剖学研究及其临床意义.[J].中国临床解剖学杂志.2004,22(4):353-356.
6.Mark L P,Yetkin F Z,Hendrix L E,et al.Visualization of the distal intratemporal facial nerve with MR imaging:use of an oblique plane[J]Radiology,1992,182():891-893.
7.Teresi L,Lufkin R,Wortham D.et al.MR imaging of the intratemporal facial nerve by using a surface coil.AJR,1987,148(3):589-594
1.姜泗长.耳解剖学与颞骨组织病理学[M].北京:人民军医出版社,1999.
2.Kumar A,Mafee MF.MasonT Value of imaging in disorders of the facial nerve[J].Top Magn Reson Imaging,2000,11:38-51.
3.TuccaR E,Tekdemir I,Asian A,et al.Radiological anatomy of the intratemporal course of facial nerve[J].Clin Anat,2000,13:83-87.
4.石会兰,张云亭,苏大同等.多层螺旋CT多平面和曲面重建成像显示面神经管的应用价值.天津医科大学学报,2006,9,vol12(3):417-419
5.Mark L P,Yetkin F Z,Hendrix L E,et al.Visualization of the distal intratemporal facial nerve with MR imaging:use of an oblique plane[J]Radiology,1992,182():891-893.
6.Theodora D,Donald C,Petra S,et al.High resolution MR of the intra-parotid facial nerve and parotid duct.[J]AJNR,1997,18:165-172
7.张晓宏,刘筠,巫北海等.面神经、前庭蜗的MRI:薄层断层影像解剖学研究.第三军医大学学报2002,4,vol24(4):485-487
8.迟放鲁.面神经研究的现状与发展方向.中华耳鼻咽喉头颈外科杂志,2006,1,vol 41(1):3-4
9.Teresi L,Lufkin R,Wortham D.et al.MR imaging of the intratemporal facial nerve by using surface of coil.AJR,1987,148(3):589-594
12.Fisch.Facial Nerve Surgery.Lned.Birmingham Alabama:Aesculapius Publishing Company,1977.13-9.
13.张淑香,何凡,王燕楠 颞骨内面神经解剖及测量 Tianjin Med J,Nov 2002.Vol 30 No 11 698-699
14.汪建华,卢仁根,胡碧波等.多层螺旋CT面神经管曲面重建图像的解剖与临床应用。临床放射学杂志2003,22(11):919-923
15..陈青华,柳澄,刘凯等.多层CT面神经管MPR双斜位成像方法.医学影像学杂志,2006,16(6):541-544
16.Watanabe N,Sugai Y,Hosoya T,et al.High resolution computed tomography using multiplannar reconstruction of the facial nerve canal[J]. ActA Otolaryngol,2000,542(Suppl):44-48.
17.宁文德,白少华,董季平.面神经管多层螺旋CT曲面重建的测量.实用放射学杂志.2004,10,20(10):877-880
18.Proctor B.The anatomy of the facial nerve.Otolaryngol Clin North Am,1991,24(3):479-504
19.梅桢峰,孙敬武,叶非常等,中耳手术相关面神经管的解剖观测。J Clin Otorhinolaryngol(China),November 1999,Vol 13,No 11:488-489
20.朱俊德,黄筑新 颞骨内面神经管的解剖测量及其临床意义 四川解剖学杂志 2007,15(2):11-12
21.宋光义,刘俊华,赵光明等.多层螺旋CT面神经管曲面重建与解剖对照研究.头颈部放射学,2006,12,22(12):1441-1445