多层螺旋CT舌动脉血管成像在OSAHS术前评估中的初步应用
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摘要
1、研究目的:获得优质的舌动脉CTA图像,对生理状态下舌动脉形态展开初步研究,并为OSAHS患者提供个体化的术前评估。
2、材料与方法:2007年12月至2008年10月在我院经多导睡眠监测(PSG)检查符合OSAHS杭州会议诊断标准的OSAHS患者共80例,男72例,女8例;采用德国西门子公司16层螺旋CT进行两阶段(闭口静息位及张口伸舌位)连续扫描,对舌动脉CTA图像质量做出分级(优、良、中、差),分为两组:可用组(优和良)和不可用组(中和差);对两个位置均进入可用组患者的CTA图像分别测量两侧舌动脉深度及两侧舌动脉距离并做统计学分析。
3、结果:静息位图像可用率96.25%,伸舌位图像可用率68.75%;舌动脉CTA闭口静息位图像质量明显高于张口伸舌位。闭口静息位与张口伸舌位两侧舌动脉深度及两侧舌动脉距离变化有统计学差异(P＜0.05)。
4、结论:多层螺旋CT可以获得优质的舌动脉三维图像,进行两个位置(闭口静息位及张口伸舌位)舌动脉相关数据的测量,为OSAHS术前评估中提供客观、准确及个体化的形态学资料,有较大的实用及指导意义。
OBJECTIVE To visualize the lingual artery in the rest position and the stretch position by using 16-slice spiral computed tomography angiography(CTA)for pre-operation obstructive sleep apnea-hypopnea syndrome(OSAHS)patients.
METHODS CTA examination of the carotid arteries were performed on 80 consecutive OSAHS patients from December 2007 to October 2008.MIP and volume rendering of the images were performed by using 16-slice spiral CT((SOMATOM Sensation 16,SIEMENS,GERMANY)and image postprocessing workstation (SIEMENS 16 SYNGO VB 3.0).The quality of CTA images with lingual arteries origins,pathways were evaluated according to visual scores(Excellent,Good,Moderate, Poor)by two senior radiologists.Paired t test was used to evaluated spatial changes of lingual artery at two different physiological positions.Chi square test was used to test the applicability ratio of the CTA images at the two different physiological states.
RESULTS According to visual scores,77 CTA images of the 80 cases(96.25%) were proved applicable in rest position.55 CTA images of the 80 cases(68.75%)were proved applicable in stretch position.Significant difference of applicability ratio(P＜0.05)exists between the rest and the stretch position.Significant difference(P＜0.05) exists in the bilateral lingual artery heights and width(left to right)at the two positions.
CONCLUSIONS CT angiography could show clearly the origin,the pathways of the lingual artery,as well as providing personal and fresh data about the lingual artery in physiological condition for the pre-operation patients,especially radiofrequency volumetric tissue reduction(RFVTR)operation,concerning the lingual artery.
2、材料与方法:2007年12月至2008年10月在我院经多导睡眠监测(PSG)检查符合OSAHS杭州会议诊断标准的OSAHS患者共80例,男72例,女8例;采用德国西门子公司16层螺旋CT进行两阶段(闭口静息位及张口伸舌位)连续扫描,对舌动脉CTA图像质量做出分级(优、良、中、差),分为两组:可用组(优和良)和不可用组(中和差);对两个位置均进入可用组患者的CTA图像分别测量两侧舌动脉深度及两侧舌动脉距离并做统计学分析。
3、结果:静息位图像可用率96.25%,伸舌位图像可用率68.75%;舌动脉CTA闭口静息位图像质量明显高于张口伸舌位。闭口静息位与张口伸舌位两侧舌动脉深度及两侧舌动脉距离变化有统计学差异(P＜0.05)。
4、结论:多层螺旋CT可以获得优质的舌动脉三维图像,进行两个位置(闭口静息位及张口伸舌位)舌动脉相关数据的测量,为OSAHS术前评估中提供客观、准确及个体化的形态学资料,有较大的实用及指导意义。
OBJECTIVE To visualize the lingual artery in the rest position and the stretch position by using 16-slice spiral computed tomography angiography(CTA)for pre-operation obstructive sleep apnea-hypopnea syndrome(OSAHS)patients.
METHODS CTA examination of the carotid arteries were performed on 80 consecutive OSAHS patients from December 2007 to October 2008.MIP and volume rendering of the images were performed by using 16-slice spiral CT((SOMATOM Sensation 16,SIEMENS,GERMANY)and image postprocessing workstation (SIEMENS 16 SYNGO VB 3.0).The quality of CTA images with lingual arteries origins,pathways were evaluated according to visual scores(Excellent,Good,Moderate, Poor)by two senior radiologists.Paired t test was used to evaluated spatial changes of lingual artery at two different physiological positions.Chi square test was used to test the applicability ratio of the CTA images at the two different physiological states.
RESULTS According to visual scores,77 CTA images of the 80 cases(96.25%) were proved applicable in rest position.55 CTA images of the 80 cases(68.75%)were proved applicable in stretch position.Significant difference of applicability ratio(P＜0.05)exists between the rest and the stretch position.Significant difference(P＜0.05) exists in the bilateral lingual artery heights and width(left to right)at the two positions.
CONCLUSIONS CT angiography could show clearly the origin,the pathways of the lingual artery,as well as providing personal and fresh data about the lingual artery in physiological condition for the pre-operation patients,especially radiofrequency volumetric tissue reduction(RFVTR)operation,concerning the lingual artery.
引文
[1]阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准(杭州)。中华耳鼻咽喉科杂志,2003,37(6):403-404
[2]Kripke OF,Ancoli I,Klauber MR,et al.Prevalence sleep-disordered breathing in ages40-64years:a population-based survey.Sleep,1997,20:65.
[3]Bandla P,Brooks LJ,Trimarchi T,et al.Obstructive sleep apnea syndrome in children.Anesthesiol Clin North American,2005,23:535-49
[4]殷善开,易红良,曹振宇主编.阻塞性睡眠呼吸暂停低通气综合征(第一版)。北京:科学技术文献出版社,2006年,278.
[5]Moyer CA,Sonnad SS,Garetz SL,et al.Quality of life in obstructive sleep apnea:a systematic review of the literature.Sleep Med.2001 Nov;2(6):477-91.
[6]Hoffstein V.Is snoring dangerous to your health? Sleep,1996,19:506-16
[7]丁和远,任跃忠,沈华浩。睡眠呼吸暂停与代谢综合征。国外医学:呼吸系统分册,2005,25(8):577-579
[8]李莉。阻塞性睡眠呼吸暂停-心血管疾病的潜在危险。美国医学会杂志:中文版,2004,23(5):251-256
[9]徐雁,李舜伟等,阻塞性睡眠呼吸暂停综合征患者的认知功能改变与其睡眠结构紊乱间的关系。中国医学科学院学报,2002,24(6):632-634
[10]Decary A,Rouleau I,Montplaisir J.Cognitive deficits associated with sleep apean syndrome:a proposed neuropsychological test battery.Sleep,2000,23:369-81
[11]Baguet JP,Hammer L,L(?)vy P et al.Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients.J Hypertens.2005 Mar;23(3):521-7.
[12]关建,殷善开,易红良等舌动脉和舌下神经的解剖特点及与舌根的解剖关系,临床耳鼻咽喉科杂志,2005,(3):108-111
[13]Lauretano AM,Li KK,Caradonna DS,et al:Anatomic location of the tongue base neurovascular bundle.Laryngoscope 1997,107:1057-1059
[14]Robinson S,Lewis R,Norton A,et al:Ultrasound-guided radiofrequency submucosal tongue-base excision for sleep apnoea:a preliminary report.Clin otolaryngol.2003,28,341-345
[15]Cosentini T,Donne RL,Mancini D,et al:Magnetic resonance imaging of the upper airway in obstructive sleep apnea.Radiol Med.2004,108:404-416,
[16]Nour SG,Lewin JS,Gutman M,et al:Percutaneous MR imaging-guided radiofrequency interstitial thermal ablation of tongue base in porcine models:implications for obstructive sleep apnea syndrome.Radiol 2004;230:359-368
[17]Lell M,Tomandi.BF,Anders K,et al.Compured tomography angiography versus digital subtraction angiography in vascular mapping for planning of microsurgical reconstruction of the mandible(J),Eur Radiol.2005,15:1514-1520.
[18]Lell,MM.et al New Techniques in CT Angiography.RadioGraphics.2006,26:S45-S62.
[19]江桂华,颜剑豪,林楚岚等,多层螺旋 CT 血管成像对面动脉的解剖学研究。南方医科大学学报2008,28(3)457-459
[20]MEI Jinyu,LIU Yehai,ZHAO Hong,et al.The study of clinical anatomy of lingual artery in physiological condition.J Clin Otorhinolaryngo(China),2007,21:396-399.
[21]Bremert T,Hoppe F,et al.Pseudoaneurysm of the lingual artery after temperature-controlled radiofrequency tongue base reduction:a severe complication.Laryngoscope.2006,Apr,116(4):665-7.
[1]何权瀛。阻塞性睡眠呼吸暂停低通气综合征流行病学研究的现状。中华结核和呼吸杂志,2003,26:260-26l
[2]阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准(杭州)。中华耳鼻咽喉科杂志,2003,37(6):403-404
[3]殷善开,易红良,曹振宇主编.阻塞性睡眠呼吸暂停低通气综合征(第一版)。北京:科学技术文献出版社,2006年,278.
[4]Bandla P,Brooks LJ,Trimarchi T,et al.Obstructive sleep apnea syndrome in children.Anesthesiol Clin North American,2005,23:535-49
[5]Moyer CA,Sonnad SS,Garetz SL,et al.Quality of life in obstructive sleep apnea:a systematic review of the literature.Sleep Med.2001 Nov;2(6):477-91.
[6]Hoffstein V.Is snoring dangerous to your health? Sleep,1996,19:506-16
[7]丁和远,任跃忠,沈华浩。睡眠呼吸暂停与代谢综合征。国外医学:呼吸系统分册,2005,25(8):577-579
[8]李莉。阻塞性睡眠呼吸暂停-心血管疾病的潜在危险。美国医学会杂志:中文版,2004,23(5):251-256
[9]徐雁,李舜伟等,阻塞性睡眠呼吸暂停综合征患者的认知功能改变与其睡眠结构紊乱间的关系。中国医学科学院学报,2002,24(6):632-634
[10]Decary A,Rouleau I,Montplaisir J.Cognitive deficits associated with sleep apean syndrome:a proposed neuropsychological test battery.Sleep,2000,23:369-81
[11]Baguet JP,Hammer L,L(?)vy P et al.Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients.J Hypertens.2005 Mar;23(3):521-7.
[12]Won CH,Li KK,Guilleminault C.Surgical treatment of obstructive sleep apnea:upper airway and maxillomandibular surgery.Proc Am Thorac Soc.2008 Feb 15;5(2):193-9.Review.
[13]殷善开,关建,曹振宇。阻塞性睡眠呼吸暂停低通气综合征的序列治疗.临床耳鼻咽喉科杂志,2003,17(12):765-767
[14]Powell NB,Riley RW,Troell RJ,et al Guilleminault C.Radiofrequency volumetric reduction of the tongue.A porcine pilot study for the treatment of obstructive sleep apnea syndrome.Chest.1997 May;111(5):1348-55
[15]Stuck BA,K(o|¨)pke J,H(o|¨)rmann K,et al.Volumetric tissue reduction in radiofrequency surgery of the tongue base.Otolaryngol Head Neck Surg.2005Jan;132(1):132-5.
[16]Cavaliere M,Mottola G,Iemma M.Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical technique in treatment of inferior turbinate hypertrophy.Otolaryngol Head Neck Surg.2005 Dec;133(6):972-8.
[17]Birkent H,Soken H,Akcam T,Karahatay S,Gerek M.The effect of radiofrequency volumetric tissue reduction of soft palate on voice.Eur Arch Otorhinolaryngol.2008 Feb;265(2):195-8.Epub 2007 Sep 26.
[18]关建,殷善开,易红良等舌动脉和舌下神经的解剖特点及与舌根的解剖关系,临床耳鼻咽喉科杂志,2005,(3):108-111
[19]Lauretano AM,Li KK,Caradonna DS,et al:Anatomic location of the tongue base neurovascular bundle.Laryngoscope 1997,107:105 7-1059
[20]Bremert T,Hoppe F,et al.Pseudoaneurysm of the lingual artery after temperature-controlled radiofrequency tongue base reduction:a severe complication.Laryngoscope.2006,Apr,116(4):665-7.
[21]RobinsonS,Lewis R,Norton A,et al:Ultrasound-guided radiofrequency submucosal tongue-base excision for sleep apnoea:a preliminary report.Clin otolaryngol.2003,28,341-345
[22]Cosentini T,Donne RL,Mancini D,et al:Magnetic resonance imaging of the upper airway in obstructive sleep apnea.Radiol Med.2004,108:404-416,
[23]Nour SG,Lewin JS,Gutman M,et al:Percutaneous MR imaging-guided radiofrequency interstitial thermal ablation of tongue base in porcine models:implications for obstructive sleep apnea syndrome.Radiol 2004;230:359-368
[24]Lell M,Tomandi.BF,Anders K,et al.Compured tomography angiography versus digital subtraction angiography in vascular mapping for planning of microsurgical reconstruction of the mandible(J),Eur Radiol.2005,15:1514-1520.
[25]李树华,曲胜,等.正常成人上呼吸道 CT 测量及其意义。中国临床解剖学杂志,2002,20(6):447-450
[26]李树华,董莘,等.Ct 测量在阻塞性睡眠呼吸暂停综合征上呼吸道狭窄定位诊断中的意义。中华耳鼻咽喉科杂志,2002,37(2):133-136
[27]Lell,MM.et al New Techniques in CT Angiography.RadioGraphics.2006,26:S45-S62.
[28]MEI Jinyu,LIU Yehai,ZHAO Hong,et al.The study of clinical anatomy of lingual artery in physiological condition.J Clin Otorhinolaryngo(China),2007,21:396-399.
[2]Kripke OF,Ancoli I,Klauber MR,et al.Prevalence sleep-disordered breathing in ages40-64years:a population-based survey.Sleep,1997,20:65.
[3]Bandla P,Brooks LJ,Trimarchi T,et al.Obstructive sleep apnea syndrome in children.Anesthesiol Clin North American,2005,23:535-49
[4]殷善开,易红良,曹振宇主编.阻塞性睡眠呼吸暂停低通气综合征(第一版)。北京:科学技术文献出版社,2006年,278.
[5]Moyer CA,Sonnad SS,Garetz SL,et al.Quality of life in obstructive sleep apnea:a systematic review of the literature.Sleep Med.2001 Nov;2(6):477-91.
[6]Hoffstein V.Is snoring dangerous to your health? Sleep,1996,19:506-16
[7]丁和远,任跃忠,沈华浩。睡眠呼吸暂停与代谢综合征。国外医学:呼吸系统分册,2005,25(8):577-579
[8]李莉。阻塞性睡眠呼吸暂停-心血管疾病的潜在危险。美国医学会杂志:中文版,2004,23(5):251-256
[9]徐雁,李舜伟等,阻塞性睡眠呼吸暂停综合征患者的认知功能改变与其睡眠结构紊乱间的关系。中国医学科学院学报,2002,24(6):632-634
[10]Decary A,Rouleau I,Montplaisir J.Cognitive deficits associated with sleep apean syndrome:a proposed neuropsychological test battery.Sleep,2000,23:369-81
[11]Baguet JP,Hammer L,L(?)vy P et al.Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients.J Hypertens.2005 Mar;23(3):521-7.
[12]关建,殷善开,易红良等舌动脉和舌下神经的解剖特点及与舌根的解剖关系,临床耳鼻咽喉科杂志,2005,(3):108-111
[13]Lauretano AM,Li KK,Caradonna DS,et al:Anatomic location of the tongue base neurovascular bundle.Laryngoscope 1997,107:1057-1059
[14]Robinson S,Lewis R,Norton A,et al:Ultrasound-guided radiofrequency submucosal tongue-base excision for sleep apnoea:a preliminary report.Clin otolaryngol.2003,28,341-345
[15]Cosentini T,Donne RL,Mancini D,et al:Magnetic resonance imaging of the upper airway in obstructive sleep apnea.Radiol Med.2004,108:404-416,
[16]Nour SG,Lewin JS,Gutman M,et al:Percutaneous MR imaging-guided radiofrequency interstitial thermal ablation of tongue base in porcine models:implications for obstructive sleep apnea syndrome.Radiol 2004;230:359-368
[17]Lell M,Tomandi.BF,Anders K,et al.Compured tomography angiography versus digital subtraction angiography in vascular mapping for planning of microsurgical reconstruction of the mandible(J),Eur Radiol.2005,15:1514-1520.
[18]Lell,MM.et al New Techniques in CT Angiography.RadioGraphics.2006,26:S45-S62.
[19]江桂华,颜剑豪,林楚岚等,多层螺旋 CT 血管成像对面动脉的解剖学研究。南方医科大学学报2008,28(3)457-459
[20]MEI Jinyu,LIU Yehai,ZHAO Hong,et al.The study of clinical anatomy of lingual artery in physiological condition.J Clin Otorhinolaryngo(China),2007,21:396-399.
[21]Bremert T,Hoppe F,et al.Pseudoaneurysm of the lingual artery after temperature-controlled radiofrequency tongue base reduction:a severe complication.Laryngoscope.2006,Apr,116(4):665-7.
[1]何权瀛。阻塞性睡眠呼吸暂停低通气综合征流行病学研究的现状。中华结核和呼吸杂志,2003,26:260-26l
[2]阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准(杭州)。中华耳鼻咽喉科杂志,2003,37(6):403-404
[3]殷善开,易红良,曹振宇主编.阻塞性睡眠呼吸暂停低通气综合征(第一版)。北京:科学技术文献出版社,2006年,278.
[4]Bandla P,Brooks LJ,Trimarchi T,et al.Obstructive sleep apnea syndrome in children.Anesthesiol Clin North American,2005,23:535-49
[5]Moyer CA,Sonnad SS,Garetz SL,et al.Quality of life in obstructive sleep apnea:a systematic review of the literature.Sleep Med.2001 Nov;2(6):477-91.
[6]Hoffstein V.Is snoring dangerous to your health? Sleep,1996,19:506-16
[7]丁和远,任跃忠,沈华浩。睡眠呼吸暂停与代谢综合征。国外医学:呼吸系统分册,2005,25(8):577-579
[8]李莉。阻塞性睡眠呼吸暂停-心血管疾病的潜在危险。美国医学会杂志:中文版,2004,23(5):251-256
[9]徐雁,李舜伟等,阻塞性睡眠呼吸暂停综合征患者的认知功能改变与其睡眠结构紊乱间的关系。中国医学科学院学报,2002,24(6):632-634
[10]Decary A,Rouleau I,Montplaisir J.Cognitive deficits associated with sleep apean syndrome:a proposed neuropsychological test battery.Sleep,2000,23:369-81
[11]Baguet JP,Hammer L,L(?)vy P et al.Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients.J Hypertens.2005 Mar;23(3):521-7.
[12]Won CH,Li KK,Guilleminault C.Surgical treatment of obstructive sleep apnea:upper airway and maxillomandibular surgery.Proc Am Thorac Soc.2008 Feb 15;5(2):193-9.Review.
[13]殷善开,关建,曹振宇。阻塞性睡眠呼吸暂停低通气综合征的序列治疗.临床耳鼻咽喉科杂志,2003,17(12):765-767
[14]Powell NB,Riley RW,Troell RJ,et al Guilleminault C.Radiofrequency volumetric reduction of the tongue.A porcine pilot study for the treatment of obstructive sleep apnea syndrome.Chest.1997 May;111(5):1348-55
[15]Stuck BA,K(o|¨)pke J,H(o|¨)rmann K,et al.Volumetric tissue reduction in radiofrequency surgery of the tongue base.Otolaryngol Head Neck Surg.2005Jan;132(1):132-5.
[16]Cavaliere M,Mottola G,Iemma M.Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical technique in treatment of inferior turbinate hypertrophy.Otolaryngol Head Neck Surg.2005 Dec;133(6):972-8.
[17]Birkent H,Soken H,Akcam T,Karahatay S,Gerek M.The effect of radiofrequency volumetric tissue reduction of soft palate on voice.Eur Arch Otorhinolaryngol.2008 Feb;265(2):195-8.Epub 2007 Sep 26.
[18]关建,殷善开,易红良等舌动脉和舌下神经的解剖特点及与舌根的解剖关系,临床耳鼻咽喉科杂志,2005,(3):108-111
[19]Lauretano AM,Li KK,Caradonna DS,et al:Anatomic location of the tongue base neurovascular bundle.Laryngoscope 1997,107:105 7-1059
[20]Bremert T,Hoppe F,et al.Pseudoaneurysm of the lingual artery after temperature-controlled radiofrequency tongue base reduction:a severe complication.Laryngoscope.2006,Apr,116(4):665-7.
[21]RobinsonS,Lewis R,Norton A,et al:Ultrasound-guided radiofrequency submucosal tongue-base excision for sleep apnoea:a preliminary report.Clin otolaryngol.2003,28,341-345
[22]Cosentini T,Donne RL,Mancini D,et al:Magnetic resonance imaging of the upper airway in obstructive sleep apnea.Radiol Med.2004,108:404-416,
[23]Nour SG,Lewin JS,Gutman M,et al:Percutaneous MR imaging-guided radiofrequency interstitial thermal ablation of tongue base in porcine models:implications for obstructive sleep apnea syndrome.Radiol 2004;230:359-368
[24]Lell M,Tomandi.BF,Anders K,et al.Compured tomography angiography versus digital subtraction angiography in vascular mapping for planning of microsurgical reconstruction of the mandible(J),Eur Radiol.2005,15:1514-1520.
[25]李树华,曲胜,等.正常成人上呼吸道 CT 测量及其意义。中国临床解剖学杂志,2002,20(6):447-450
[26]李树华,董莘,等.Ct 测量在阻塞性睡眠呼吸暂停综合征上呼吸道狭窄定位诊断中的意义。中华耳鼻咽喉科杂志,2002,37(2):133-136
[27]Lell,MM.et al New Techniques in CT Angiography.RadioGraphics.2006,26:S45-S62.
[28]MEI Jinyu,LIU Yehai,ZHAO Hong,et al.The study of clinical anatomy of lingual artery in physiological condition.J Clin Otorhinolaryngo(China),2007,21:396-399.