研究背景：颈内动脉走行弯曲、周围解剖结构复杂，周围伴有众多的血管神经及复杂的颅底骨结构。更为精确的局部解剖学与影像解剖学的发展，为其相关学科的发展提供了基础，但目前颅底或头颈外科学等进展相对缓慢。深入开展颈内动脉的相关形态及功能解剖学研究，对于提高颅底、头颈微创外科手术的技术水平具有重要的临床意义。大多数急性心脑血管事件是由斑块破裂引起，富含脂质的斑块和血管正性重构区段的斑块更易破裂，关于冠状动脉的脂质斑块和血管重构相关研究较多，颈内动脉的脂质斑块和血管重构的研究相对较少，未见斑块稳定性与血管重构相关性的研究。深入开展颈内动脉斑块稳定性与血管重构相关性的研究对于预测急性脑血管事件的发生具有重要...Background: Internal carotid artery (ICA) walks crooked and has complex surrounding anatomical structures, with numerous nerves, blood vessels and the bones of the skull base around it. More precise regional anatomy and imaging anatomy provide the basis for the development of its related disciplines, but the progress of the skull base or head-neck surgery is relatively slow. It has important clini...学位：医学硕士院系专业：医学院_肿瘤学学号：2452010115338

殷咏梅

Xiamen University Institutional Repository

厦 门 大 学 博 硕 士 论 文 摘 要 库  学校编码：10384                                            密级       学号：24520101153383      硕  士  学  位  论  文  颈内动脉C1-2段影像解剖测量及其斑块特性与血管重构研究 Imaging anatomical measurements of the internal carotid artery C1-2 segment and its plaque characteristics related to vascular remodeling 殷咏梅  指导教师姓名： 段少银 教授授  专 业 名 称： 肿 瘤 学 论文提交日期： 2013年 5月 论文答辩日期： 2013年 5月 学位授予日期：  2013年  月 2013年  月                  答辩委员会主席：   评阅人：   2013年 5月  厦 门 大 学 博 硕 士 论 文 摘 要 库 厦 门 大 学 博 硕 士 论 文 摘 要 库  厦门大学学位论文原创性声明  本人呈交的学位论文是本人在导师指导下,独立完成的研究成果。本人在论文写作中参考其他个人或集体已经发表的研究成果，均在文中以适当方式明确标明，并符合法律规范和《厦门大学研究生学术活动规范（试行）》。 另外，该学位论文为（                            ）课题（组）的研究成果，获得（               ）课题（组）经费或实验室的资助，在（               ）实验室完成。（请在以上括号内填写课题或课题组负责人或实验室名称，未有此项声明内容的，可以不作特别声明。）  声明人（签名）：           年   月   日     厦 门 大 学 博 硕 士 论 文 摘 要 库 厦 门 大 学 博 硕 士 论 文 摘 要 库    厦门大学学位论文著作权使用声明  本人同意厦门大学根据《中华人民共和国学位条例暂行实施办法》等规定保留和使用此学位论文，并向主管部门或其指定机构送交学位论文（包括纸质版和电子版），允许学位论文进入厦门大学图书馆及其数据库被查阅、借阅。本人同意厦门大学将学位论文加入全国博士、硕士学位论文共建单位数据库进行检索，将学位论文的标题和摘要汇编出版，采用影印、缩印或者其它方式合理复制学位论文。 本学位论文属于： （     ）1.经厦门大学保密委员会审查核定的保密学位论文，于   年  月  日解密，解密后适用上述授权。 （     ）2.不保密，适用上述授权。 （请在以上相应括号内打“√”或填上相应内容。保密学位论文应是已经厦门大学保密委员会审定过的学位论文，未经厦门大学保密委员会审定的学位论文均为公开学位论文。此声明栏不填写的，默认为公开学位论文，均适用上述授权。）                                声明人（签名）： 年   月   日 厦 门 大 学 博 硕 士 论 文 摘 要 库 厦 门 大 学 博 硕 士 论 文 摘 要 库   I 摘 要 研究背景：颈内动脉走行弯曲、周围解剖结构复杂，周围伴有众多的血管神经及复杂的颅底骨结构。更为精确的局部解剖学与影像解剖学的发展，为其相关学科的发展提供了基础，但目前颅底或头颈外科学等进展相对缓慢。深入开展颈内动脉的相关形态及功能解剖学研究，对于提高颅底、头颈微创外科手术的技术水平具有重要的临床意义。大多数急性心脑血管事件是由斑块破裂引起，富含脂质的斑块和血管正性重构区段的斑块更易破裂，关于冠状动脉的脂质斑块和血管重构相关研究较多，颈内动脉的脂质斑块和血管重构的研究相对较少，未见斑块稳定性与血管重构相关性的研究。深入开展颈内动脉斑块稳定性与血管重构相关性的研究对于预测急性脑血管事件的发生具有重要的意义。 目的:(1) 探讨颈内动脉三维成像及获取 C1-2 段相关结构解剖测量参数。（2）分析颈内动脉斑块性质与血管重构的关系。 方法：(1) 从本院 PACS 中选择 101 例行头颈 CTA检查且头颈部血管无明显病变患者作为研究对象，研究对象年龄 30-60 岁（＜40 岁 34 例，41-50 岁 34 例， ＞50 岁 33 例）。采用 GE AW 4.2 工作站进行三维成像，成像方法主要包括分解、融合、透明、伪彩容积重建技术（SFOF-VR）、容积重建法（volume rendering，VR）、多平面重建（multiple planar reconstruction MPR），并进行相关数据测量，测量参数包括：颈动脉壁厚度（CAWT）；颈内动脉颈段与颈内静脉最远、近距离；颈内动脉颈段与枕骨、C1、C2、正中线最近距离；颈内动脉岩段与颞下窝间骨板厚度；颈内动静脉间骨板厚度；颈内动脉岩段与耳蜗间骨板厚度。（2）从本院 PACS 中选择 65 例 2012 年 1 月-2012 年 12 月行头颈 CTA 检查患者作为研究资料，其中 103 处颈内动脉 C1、C2 段明显非钙化斑块资料作为最终研究对象，研究对象年龄为 40-80 岁。主要采用 VR、MPR 三维成像方法，测量参数包括：斑块 CT 值；斑块处血管面积；邻近无斑块处血管面积；计算血管重构指数（RI：斑块处血管面积/邻近无斑块处血管面积），分析斑块稳定性与血管重构性质的关系。 结果：（1） SFOF-VR 三维成像能较好显示颈内动脉及周围解剖结构。（2）正常人群组双侧颈动脉管壁厚度（CAWT）平均值：＜40 岁组：左侧及右侧分厦 门 大 学 博 硕 士 论 文 摘 要 库   II 别为 0.675±0.261mm、 0.666±0.271mm； 41-50 岁组：左侧及右侧分别为0.872±0.202mm、0.844±0.172mm；＞50 岁组：左侧及右侧分别为 0.978±0.283mm、0.950±0.281mm；左侧及右侧各年龄组间 CAWT 分别进行两两比较，＜40 岁组与 41-50 岁组，＜40 岁组与＞50 岁组之间比较有统计学差异（P<0.05），41-50岁组与＞50 岁组之间比较无统计学差异（P>0.05），各年龄段左、右两侧 CAWT比较无统计学差异（P>0.05）。（3） 左侧颈动脉壁厚度（CAWT）与年龄的相关系数 r=0.696（P<0.01），右侧颈动脉壁厚度（CAWT）与年龄的相关系数 r=0.616（P<0.01），说明颈总动脉 CAWT 与年龄呈线性正相关。（4） 颈内动脉颈段与颈内静脉最远、近距离左侧及右侧分别为左远 5.64±1.25mm 、左近0.75±0.25mm、右远 5.98±1.05mm、右近 0.86±0.32mm；颈内动脉颈段与枕骨最近距离：左侧及右侧分别为 7.20±1.73mm、6.88±1.45mm；颈内动脉颈段与 C1最近距离左侧及右侧分别为 3.72±1.01mm、3.74±1.22mm；颈内动脉颈段与 C2最近距离左侧及右侧分别为 5.18±1.53mm、4.68±1.27mm ；颈内动脉颈段与正中线最近距离左侧及右侧分别为 21.68±1.81mm、21.52±1.87mm；颈内动脉岩段与颞下窝间骨板厚度左侧及右侧分别为 4.38±1.32mm、4.04±1.04mm；颈内动静脉间骨板厚度左侧及右侧分别为 2.67±1.39mm、2.59±1.09mm；颈内动脉岩段与耳蜗间骨板厚度左侧及右侧分别为 3.17±0.97mm、3.11±1.14mm。以上测量指标左、右两侧比较均无统计学差异（P>0.05），各年龄组间左、右两侧分别进行两两比较均无统计学差异（P>0.05）。（5） 103 处斑块 CT 值为 72±20HU；斑块处血管面积为 0.58±0.08cm2；邻近无斑块处血管面积 0.53±0.04cm2；血管重构指数（RI）为 1.10±0.14；60 处血管正性重构（RI>1.05）区段斑块 CT 值（61±15HU）明显低于 43 处非正性重构区段斑块 CT 值（89±14HU，P <0.001）。 结论：（1） SFOF-VR 三维成像技术能良好显示颈内动脉及周围解剖结构。（2）颈动脉管壁厚度（CAWT）与年龄呈线性正相关趋势，随着年龄的增长，颈动脉壁厚度有增厚的趋势。（3）颈内动脉 C1、C2 段解剖测量参数左右侧、年龄组间不存在显著性差异，影像解剖测量数据为相关临床与研究提供客观基础。（4）非钙化斑块 CT 值与血管重构性质间存在相关性，血管正性重构区段斑块 CT 值较非正重构者低，即血管正性重构区段的斑块含脂质成分更多。   厦 门 大 学 博 硕 士 论 文 摘 要 库   III 关键词：颈内动脉 ；影像解剖；斑块；血管重构 厦 门 大 学 博 硕 士 论 文 摘 要 库 厦 门 大 学 博 硕 士 论 文 摘 要 库   IV Abstract Background: Internal carotid artery (ICA) walks crooked and has complex surrounding anatomical structures, with numerous nerves, blood vessels and the bones of the skull base around it. More precise regional anatomy and imaging anatomy provide the basis for the development of its related disciplines, but the progress of the skull base or head-neck surgery is relatively slow. It has important clinical significance to further study on the function of internal carotid artery anatomy in improving technical level of minimally invasive surgery of the skull base, head-neck. Most of acute cardiocerebrovascular events are caused by plaque rupture. The plaques which are rich in lipid and locate in positive remodeling region are more likely to break. In the former study, most researchers had studied on lipid plaques and vascular remodeling of coronary artery, few on internal carotid artery. The correlation between plaque stability and vascular remodeling has never been researched. Therefore, depth study on the correlation of internal carotid artery plaque stability and vascular remodeling has the vital significance in predicting acute cerebrovascular event occurrence. Objective: (1) To discuss the three-dimensional imaging technique of ICA and have the measurements of C1-2 segment of ICA related to the surrounding structure. (2) To analyse the relation between plaque characteristics and vascular remodeling of ICA. Methods: (1) The scanning data of 101 patients without significant lesions on the head and neck vascular disease were selected from the PACS in our hospital, aged between30 and 60years,were divided into three groups according to age(<40 were 34 cases, 41-50 were 34 cases, >50 were 33 cases) 3D images were performed by GE AW 4.2 workstation. The imaging method include Separating, fusing, opacifying and false-coloring-volume rendering (SFOF-VR), volume rendering (VR), and multiple planar reconstruction (MPR), and related data were measured. Parameters measured 厦 门 大 学 博 硕 士 论 文 摘 要 库   V included: Carotid Artery Wall Thickness(CAWT); the maximum/minimum distance between the internal carotid artery (C1) and internal jugular vein; the minimum distance between the internal carotid artery (C1) and occipital bone, C1, C2, median line; the bone plate thickness between the internal carotid artery (C2) and infratemporal fossa; the bone plate thickness between the internal carotid artery and internal jugular vein; the bone plate thickness between the internal carotid artery (C2) and cochlea. (2) The scanning data of 65 patients without significant calcified plaque on the internal carotid artery (C1-2) were selected from the PACS in our hospital from January 2012 to December 2012, aged between 40 and 80 years. The imaging method include volume rendering (VR), and multiple planar reconstruction (MPR), and related data were measured. Parameters measured included: CT attenuation of plaque, cross-sectional vessel area, reference vessel area. Then, count the remodeling index (RI: lesion vessel area/reference vessel area), analyze the correlation between internal carotid artery plaque stability and vascular remodeling. Results: (1) SFOF-VR is a new 3D imaging technique which can clearly and directly show the internal carotid artery and its surrounding anatomical structures. (2) The left and right mean common carotid CAWT in experimental group are: the age <40 is 0.675±0.261mm,0.666±0.271mm; the age from 41 to 50 is 0.872±0.202mm, 0.844±0.172mm; the age >50 is 0.978±0.283mm, 0.950±0.281mm; There is no significantly differences between group(41-50years)and group(>50years)(P>0.05), There is no significantly differences between the left and right side(P>0.05). (3) The coefficient correlation r between left/right common carotid IMT and age is 0.696/0.616,both P<0.01, this account that there is a linear positive correlation between the common carotid CAWT and age. (4) The left and right maximum/minimum distance between the internal carotid artery (C1) and internal jugular vein are 5.64±1.25mm, 0.75±0.25mm, 5.98±1.05mm, 0.86±0.32mm; The left and right minimum distance between the internal carotid artery (C1) and occipital bone are 7.20±1.73mm, 6.88±1.45mm; the left and right minimum distance between the internal carotid artery (C1) and C1 are 3.72±1.01mm, 3.74±1.22mm; The left and right minimum distance between the internal carotid artery (C1) and C2 are 厦 门 大 学 博 硕 士 论 文 摘 要 库   VI 5.18±1.53mm, 4.68±1.27mm; The left and right minimum distance between the internal carotid artery (C1) and median line are 21.68±1.81mm, 21.52±1.87mm; The left and right bone plate thickness between the internal carotid artery (C2) and infratemporal fossa are 4.38±1.32mm,4.04±1.04mm; The left and right bone plate thickness between the internal carotid artery (C2) and internal jugular vein are 2.67±1.39mm, 2.59±1.09mm; The left and right bone plate thickness between the internal carotid artery (C2) and cochlea are 3.17±0.97mm, 3.11±1.14mm. There is no significantly differences between the left and right side in each group (P>0.05), There is no significantly differences between each group (P>0.05). (5) The mean CT attenuation of the atherosclerotic plaque in the 103 lesions is 72±20HU，the mean cross-sectional vessel area in the lesions is 0.58±0.08cm2, the mean reference vessel area is 0.53±0.04cm2, CT attenuation of plaque was significantly lower in 60 lesions that displayed positive remodeling (61±15HU) than in 43 lesions with no or with negative remodeling (89±14HU, p < 0.001).  Conclusions: (1) SFOF-VR is a good 3D imaging technique which can clearly and directly show the ICA and its surrounding structures. (2) There is a positive correlation with the age in the CAWT, which can be an important index of vascular age. (3) There is no significant difference in the measurements of ICA between the left and right side, and among three age groups. Imaging measurements can provide objective basis for the clinical and research. (4) There is a correlation between CT attenuation of non-calcified plaque and vascular remodeling. CT attenuation of plaque of positive remodeling is lower than that of non positive remodeling, and the plaque of positive remodeling is lipid-rich.  Key words：internal carotid artery ; imaging anatomy; plaque; vascular remodeling  厦 门 大 学 博 硕 士 论 文 摘 要 库 厦 门 大 学 博 硕 士 论 文 摘 要 库   VII 缩略词索引 英文缩写 英文全名      中文全名 MSCT         multi-detector-row spiral                   多排螺旋 CT computed tomography MSCTA    multi slice spiralcomputed tomography angiography                         多排螺旋 CT 血管造影                                            CTA        computed tomography angiography              CT 血管造影  IVUS        intravascular ultrasound                     血管内超声成像  CDFI     color Doppler flow imaging                      彩色多普勒血流显像 CEUS     contrast-enhanced ultrasound                          超声造影 SFOF-VR  separating, fusing, opacifying and      分解、融合、透明、伪彩容积 false-coloring-volume rendering,                 重建技术 MPR     multiple planar reconstruction                    多平面重建 CPR     curved planar reformation                     曲面重建 SSD      surface shadow display                         表面阴影显示 MIP      maximum intensity projection                   最大密度投影法 VR        volume rendering                            容积重建 CAWT   carotid artery wall thickness                         颈动脉壁厚度 IMT       intima-media thickness                   颈动脉内膜中层厚度 RI        remodeling index                            重构指数 AS        atherosclerosis                           动脉粥样硬化   厦 门 大 学 博 硕 士 论 文 摘 要 库 厦 门 大 学 博 硕 士 论 文 摘 要 库Degree papers are in the “Xiamen University Electronic Theses and Dissertations Database”. 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Imaging anatomical measurements of the internal carotid artery C1-2 segment and its plaque characteristics related to vascular remodeling

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Imaging anatomical measurements of the internal carotid artery C1-2 segment and its plaque characteristics related to vascular remodeling

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