颞骨CT解剖图解

颞骨轴位CT图解:

耳部及侧颅底疾病的诊断除了临床体格检查、听力检查、前庭功能检查外,影像学检查已成为临床常规检查项目。CT观察骨结构以骨算法扫描最为清晰,可以观察细小骨质改变。而MRI可避免骨质干扰,常用于软组织病变的检查。耳部CT轴位,取听-眦线,于外耳道孔上方10mm处往下连续扫描。

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图1.——图4 显示岩尖部和上半规管。

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图5.起出现内听道。

图6.出现耳蜗顶旋,同时在内听道外侧有一通向上鼓室的通道,是面神经迷路段。内听道的听神经到达耳蜗为止,前庭神经止于前庭和半规管。唯有面神经向鼓室方向延伸,形成面神经迷路段。

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图7的重要结构为面神经出迷路后有一膨大区,为膝状神经节,由此向前有一分支为岩前大神经,向后为面神经鼓室段,此结构呈“T”型,垂直于岩前大神经和面神经鼓室段的是面神经迷路段。前庭和后半规管在此层面出现,同时出现颈内动脉的升段。

图8.为典型的前庭层面。在上鼓室出现锤砧关节,呈冰淇淋样结构,前端为锤骨头,后方为砧骨体。耳蜗内侧可见面神经鼓室段。在后 半规管的内侧有一与之平行的裂隙,为前庭导水管,一般不超过1.5mm宽。在较大的前庭腔后外侧,有与之相通的半弧形的水平半规管腔。

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图9.耳蜗中旋出现。颈内动脉水平部初现,面神经鼓室段向后延伸至水平半规管。

图10.在面神经鼓室段的外侧可见有小的隆起为匙突。同一平面出现开放的面神经外膝部,又称锥曲部。后鼓室显示内侧的鼓室窦和外侧的面神经隐窝。鼓室内锤骨柄和砧骨长突可见。

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图11.为典型的耳蜗层面,耳蜗的上中下旋在一个层面共现,耳蜗底旋初现圆窗龛及其内侧的圆窗间隙清晰。砧镫关节在此层面出现,可见镫骨板上结构和部分底板。面神经锥曲段呈椭圆形。

图12.此层面出现外耳道,锥隆起显示明显。耳蜗导水管为一细缝隙,与外耳道方向平行,耳蜗仅见宽大的底旋。

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图13—图14.颈动脉管水平段全程出现。耳蜗中旋和底旋明显,耳蜗的后方有一个膨大的圆形前庭腔,在前庭腔的后方可见后半规管的膨大壶腹。耳蜗外上方有一细长的鼓膜张肌管腔,其后方的小突起为匙突。外膝部的面神经因为骨壁薄呈开放状。上鼓室外上方有一小骨嵴称齿突,其前方是前上鼓室,后方容纳锤骨头和砧骨长突,前上鼓室是胆脂瘤经常侵及的部位。

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图15.鼓膜张肌管明显。耳蜗仅见底旋,在耳蜗底旋后方可见圆窗和圆窗龛。面神经渐向乳突内移,其面向中耳腔的开放处是镫骨肌处,镫骨肌内外分别是鼓室窦和面隐窝。耳蜗内侧水平向内的一个细狭管腔是耳蜗导水管。

图16.耳蜗底旋内侧水平走向的耳蜗导水管清晰,面神经乳突段呈圆形管腔。颈动脉管外前方是咽鼓管,其形态与上一层面的鼓膜张肌管相似。锥隆起内外侧为鼓室窦和面隐窝。此层面外耳道开始宽大。

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图17.面神经乳突段呈圆形管腔,耳蜗仅见底部无管腔,耳蜗导水管开口宽大,其内侧为颈静脉孔。颈总动脉水平段消失,显示颈总动脉升段,呈圆形空腔,位于咽鼓管内侧。

图18.颈静脉孔明显,在其外后方出现颈静脉球。耳蜗消失。咽鼓管和劲动脉升段前内方含气房处是岩尖部。颈静脉孔外侧可见耳蜗导水管开口。

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图19。颈静脉孔区显示明显,内侧为神经部,外侧为血管区,与下鼓室邻近。

图20.鼓膜开始显现。

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图21.鼓膜完整显示。下鼓室清晰,与内侧颈静脉孔血管部相邻。

图22.外耳道底层面,渐离开颈静脉孔区,颈静脉与颈动脉二个半弧形相邻,部分相连。

 

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图23.外耳道到达骨性底壁,颈静脉孔区前方颈动脉管附着开放的腔管变浅,舌下神经孔呈半开放管腔。面神经乳突段接近颈静脉管附着管壁。

图24.面神经乳突段向前下茎乳孔方向移行。舌下神经管呈前后开放状。骨性外耳道消失,软骨段外耳道仍可见。颈静脉孔与颈动脉管附着处仍接近。

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图25.软骨段外耳道仍宽阔,低于骨性耳道平面。颈静脉球外缘呈半弧形,其前内相连的浅半弧切迹为颈动脉相连处。颈静脉球内侧为舌下神经管,呈管状裂隙,由前外向后内方向。舌下神经管内侧为斜坡。乙状窦切迹渐变大,沿颞骨岩部内缘由外向内行走。面神经乳突段渐向颈静脉球方向移行。

图26.耳道软骨部变窄接近耳道底部。此平面已离开颈静脉球,更开放的半弧形为颈内静脉,在其前内的颈内动脉切迹变小,颈动脉渐离开颅底骨。斜坡外侧舌下神经管呈喇叭状裂隙。乙状窦呈开放的管状结构。面神经乳突段与图25相似。

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图27.外耳道软骨部仅有部分显示。颈动脉已离开颅骨。颞骨前内侧仅见颈内静脉的半弧形切迹。斜坡与枕骨髁融合,舌下神经管呈浅喇叭形。二腹肌沟为浅切迹,其内侧为二腹肌嵴。乙状窦为长椭圆形管状结构,后内方为开放状。

图28.低于外耳道软骨部,仅见耳道口二腹肌沟出现,二腹肌嵴明显。舌下神经管消失。枕骨髁与斜坡连成一片。乙状窦椭圆形结构的后内开放口变小,有闭合趋势。面神经已接近颈内静脉处。

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图29.耳甲腔切迹可见。颈内静脉离开颅底。面神经达向前内开放的茎乳孔。乙状窦变小,为完全闭合的长椭圆形。二腹肌口加深,二腹肌嵴仍清晰。

图30.茎乳孔开口变大。乙状窦仅见小切迹。二腹肌沟同图29,但二腹肌嵴变小。

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图31.面神经离开茎乳孔,在原茎乳孔的位置有一扩大的半弧形切迹,为面神经处茎乳孔后的颞骨外段在颅底的行走区。茎突根部出现。二腹肌沟加深,二腹肌嵴变宽。

图32.茎突离开颅底骨。面神经在茎突后外的半开放区内仍可以定位。二腹肌沟及二腹肌嵴同图31。

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图33.茎突尖部显现。乳突明显变小。面神经离开颅底,不再有定位标志。二腹肌沟更开放,二腹肌嵴基本消失。

图34.乳突进一步变小。二腹肌沟由后外向前内呈贯穿趋势。茎突变细,远离乳突。

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颞骨冠状位CT图解

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37从颞颌关节前缘开始,颧骨近颞颌关节处出现气房,在颞颌关节内侧出现少量岩尖部气房,在岩尖气房内上,有一椭圆形略呈内下外上开放的骨管,为颈内动脉管水平段,冠位CT呈二端开放状。在图的最内侧为斜坡的前部。该层面所显示的均为颅中窝。

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38在图37的基础上,主要变化为颈动脉管,由于颈动脉从前向后行走时逐渐进入斜形段,其冠位CT内下方由开放的开口成为封闭状,使颈动脉管成为向外上方开口的盲管状腔。

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图39~40下颌骨升支开始出现,岩尖部和颧骨的气房比较明显。

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图41颈动脉管的前上方原开口处开始呈封闭状。

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图42下颌骨升支明显,但尚未达到骨髓腔,颈动脉管进入斜形段,为一封闭的椭圆形呈外上内下的管腔,周围被岩尖部的气房包绕。在颈动脉管的后下方,颞颌关节的内侧,咽鼓管由外上向内下开放的的腔隙。

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43 由于颈动脉与冠位不在一个平面,其下降过程中管腔逐渐变小更扁。在含气的咽鼓管的内侧,可见与咽鼓管平行的条索状软组织影,是鼓膜张肌管的张肌。此平面在岩尖与斜坡之间的间隙为后颅窝。在岩尖以上平面仍为中颅窝。

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44 在咽鼓管和鼓膜张肌管的外上方、颧骨气房的内侧由一圆形的气房,是前上鼓室。前上鼓室位于上鼓室的前方,由Cog(齿突)分隔。在前上鼓室的前方有一较深的弧形切迹。

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45  前上鼓室变大,其前方弧形切迹的底部向下凹入,是岩大浅神经区。咽鼓管及鼓膜张肌与前上鼓室相邻。

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46  在前上鼓室的前方,原岩大浅神经区的部位下方出现一小的圆形腔,为膝状神经节。在膝状神经节前方有一骨质致密区为耳蜗的前缘,颈动脉的斜形段行走在耳蜗骨的下方。咽鼓管的上端与前上鼓室接近,咽鼓管与前上鼓室交界处略宽大的气房是管上隐窝。鼓膜张肌为一软组织突起,位于耳蜗骨的外侧。

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47  乳突气房出现。耳蜗可见骨迷路,在骨迷路外侧前上鼓室与中鼓室的前部仅有一小的骨性分隔(齿突Cog)。在前上鼓室与前中鼓室分隔的内侧紧贴耳蜗鼓岬处的软组织为鼓膜张肌。鼓岬上方的向外开放的小孔为膝状神经节。颈动脉紧贴在耳蜗鼓岬下方,邻近前中鼓室。

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48  耳蜗螺旋结构清晰。在耳蜗外上开放膝状神经节小孔与齿突连线平面以上为前上鼓室,可见部分锤骨头。在此平面以下到耳蜗鼓岬下缘平面为前中鼓室。鼓岬下缘与颈动脉同一高度的是下鼓室。鼓岬内侧仍可见鼓膜张肌。

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49   耳蜗的前部结构显示清晰,可见底旋和中旋。在耳蜗的正下方为颈动脉,颈动脉外侧的间隙为下鼓室。耳蜗的外侧缘是鼓岬,紧贴鼓岬伸向中耳腔的软组织阴影是鼓膜张肌。在鼓膜张肌上方耳蜗的外侧有一缺口,其中软组织为面神经水平段(鼓室段),在面神经鼓室段内侧耳蜗上方有一圆孔结构内含面神经迷路段。在上鼓室内可见锤骨头、锤骨颈 。在锤骨颈下方鼓膜将外耳道和中耳腔分隔。在耳蜗内侧内听道出现,在颞骨内侧出现一骨性缺口。

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50  耳蜗底旋变小,中旋依然清晰。耳蜗外上方面神经水平段呈圆形管腔,由于外侧骨壁薄,似呈开放状。原圆形面神经迷路段向内延伸为一细缝隙,上界为内听道顶部,下界为内听道横膈。内听道形态出现,由于部分前壁的因素,内听道有模糊的骨质影。锤骨头和锤骨颈的外侧为上鼓室外侧壁呈盾板(scutum),影像学又称鼓膜嵴。在盾板与锤骨颈之间的间隙(prussak space)是后天原发性胆脂瘤的好发部位。外耳道由于弯曲的缘故,耳道口尚未出现。鼓岬外侧仍可见鼓膜张肌。乳突气房逐渐增多。

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51  内听道轮廓基本形成,在内听道的中央横膈将其分为上下二部分。上端为面神经下端是耳蜗神经。在面神经水平段缺口的内上方有向上的弧形裂隙,是上半规管腔。在上半规管顶端颞骨缘隆出,是弓状隆起。此层面盾板清晰呈尖骨嵴,盾板变钝或消失提示胆脂瘤中耳炎的可能性。耳蜗结构为内侧的顶旋风外侧的中旋。鼓膜张肌向上行走接近面神经水平段。

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52  耳蜗后部的底旋呈半弧状,在其上方上半规管管腔变大。在耳蜗和上半规管交界处有镫骨板上结构(前弓)的阴影。面神经水平段在上半规管外侧壁下方有一圆形管腔影。在面神经水平段外侧的听骨是砧骨体、外耳道口出现。盾板仍为一向内下的尖骨嵴,内下连接鼓膜。颈动脉显示的是向上的垂直部。

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53  上半规管管腔变细,下方是水平半规管,水平半规管下方的膨大腔隙是前庭腔,前庭腔的下方仍为耳蜗底旋。上半规管、水平半规管、前庭、耳蜗底旋腔隙相互连通。鼓窦出现,此层面为鼓窦入口,在鼓窦入口后缘有一钝性骨嵴呈corner隔,corner隔是鼓窦和鼓窦入口的一个由天盖向下伸出的鼓嵴,手术时开放鼓窦入口常常先暴露corner隔。在水平半规管外侧的听骨为砧骨短突、砧骨长突和砧骨豆状突。砧骨豆状突指向内侧,所指方向水平半规管与耳蜗底旋之间,交界处骨质变薄是卵圆窗的部位。在伸向中耳腔的水平半规管底壁有一小骨槽,软组织成管腔状为面神经水平段向垂直段过渡的锥曲端为外膝部。

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54  上半规管消失,水平半规管、前庭、耳蜗底旋连成一个“Z”型管腔。内听道横嵴消失,内听道显示的是上前庭神经和下前庭神经的部位。鼓窦入口可见砧骨短突的尖部,卵圆窗外侧有镫骨的板上结构(后弓),颈动脉接近垂直部后缘,伴管腔变浅。茎突出现。

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55  上半规管后部隐约可见,水平半规管后半部显示部分管腔,向后膨大的腔隙为前庭腔。连接前庭腔的下方为耳蜗底旋,耳蜗底旋的外侧壁是鼓岬。该平面仍可见corner’s隔,显示的鼓窦空间实际上是鼓窦入口。外耳道上壁的内侧骨唇为鼓膜嵴,又称鼓膜盾板,是鼓膜的附着处,在鼓膜嵴下方可见斜形的鼓膜。水平半规管的下缘中部有一半圆形的骨管,是面神经水平段向外膝部移行的骨管。内听道接近后壁,因此,只有部分显示。中耳腔比较宽大,该平面见不到听骨。在下鼓室的下方,半弧形骨壁下为颈动脉管升段的后缘。茎突显示比较明显。外耳道全程可见。

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56  上半规管的后半段仍有管腔切迹,水平半规管已达到后半段,仅有部分管腔出现。上半规管和水平半规管的交界处前庭腔明显膨大。水平半规管下缘中段,面神经骨管向外侧移位,面神经管的内侧缘骨壁较厚,前和下骨壁较薄因而显示不清,面神经逐渐于乳突腔气房相连。在前庭的下方有一向外下鼓室开放的龛状腔隙是圆窗,其外上方的骨嵴为圆窗龛。颈动脉管不再出现,颈静脉球尚未显示。鼓室腔的下缘为鼓骨。鼓膜嵴消失、茎突清晰、外耳道腔宽大。内听道大部分消失,在内听道内侧仅有较浅的切迹。Corner’s隔消失,次层面乳突气房围绕的空腔为鼓窦。

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57  内听道消失,前庭腔的上端垂直的管腔为上半规管和后半规管形成的总脚,其下方相连的圆形管腔为后半规管壶腹终端。圆窗龛仅有很小的切迹。前庭的前方水平半规管部分显示管腔,水平半规管下缘面神经外膝部向乳突段移行,周围有乳突气房,外耳道深部骨壁出现,此处的中耳腔为后鼓室。在鼓室下方的骨壁后下出现浅弧形切迹,为颈静脉球的起始部。岩尖部与斜坡之间的腔隙为破裂孔的神经部,面对对神经部的岩尖处有一三角形的裂隙为耳蜗导水管。茎突达到最粗的截面。

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58  鼓窦变大,前庭消失,水平半规管后半部全程显示,水平半规管的后上方圆形管腔为总脚,后下方圆形管腔为后半规管壶腹终端。水平半规管下缘的面神经管到达水平半规管的外膜端与乳突相连,此处已到达垂直段面神经的起始处。骨性外耳道消失,外耳道显示的是软骨部,中耳腔显示的仍为后鼓室。后鼓室的内下方颈静脉球呈弧形切迹。岩部耳蜗导水管显示清晰,为三角形向内下开放的裂隙,在斜坡的外下方有一三角形的裂隙出现,为舌下神经管。茎突后缘模糊显示。从图54~图58任何一个层面水平半规管外侧末端的骨壁如呈开放状,提示水平半规管瘘。

59

59  水平半规管管腔变小,其后上方为后半规管上端,后下方为后半规管壶腹终端。面神经仍呈圆形管腔提示尚未完全进入垂直段。其前后下均为气房包裹。耳蜗导水管变浅,颈静脉球窝宽大,茎突消失。鼓室腔消失,舌下神经管管径变大。外耳道软骨部逐渐变窄提示外耳道主轴是由前内向后外。

60

60 水平半规管管腔消失,后半规管呈上下两个类圆形管腔,在后半规管上管腔的内下方有一很小的类圆形管腔为前庭导水管,内含内淋巴管。面神经已进入到垂直段,位于内耳外侧缘的下方,呈外上内下方向的长圆形管腔。在大部分情况下只有在水平半规管消失仅存后半规管的层面上能够找到面神经垂直段管腔。耳蜗导水管仍有很小的切迹。破裂孔的颈静脉球和神经部都较前宽大。外耳道消失,显示耳甲腔。

61

61  耳蜗导水管切迹消失,前庭导水管逐渐出现呈后上到内下的管腔,由于未达到管腔的中央,管腔内呈模糊阴影。后半规管从原来的两个点状阴影变成开口向前庭导水管的弧形阴影。由于管腔没有完全显示,上下两端仍然为点状阴影,而中间的弧形管腔欠清晰。在后半规管骨质外侧缘下方可见一上下纵行的管腔为面神经垂直段,又称为面神经乳突段。目前的层面仅出现了垂直段的上半部。如果投影的角度适当,可以观察到从后半规管下方到茎乳孔的面神经全长。

62

62  后半规管呈向外侧半弧形管腔,周围骨质致密,在后半规管前方,前庭导水管呈后上向内下方斜行管腔,其管腔的宽度与后半规管的宽度相似。在此层面上,通常能够清晰地显示面神经垂直段。面神经垂直段的前缘位于后半规管管腔的后缘垂直线,面神经垂直段的后缘不超过后半规管骨管的后缘。在后半规管骨管与面神经垂直段骨管的上缘之间,为致密的骨质。如果面神经垂直段的上缘向后方的鼓窦区域开放,是面神经锥曲段骨管破坏的表现。垂直段的面神经骨管周围有气房包裹。在慢性炎症的情况下,面神经垂直段骨管周围通常是致密的骨质。在面神经瘤的病例,面神经管扩大或破坏。慢性炎症也可引起面神经骨管的破坏。医源性面瘫经常表现为面神经垂直段上缘骨质破坏呈开放状,同时伴有软组织增生。前庭导水管纵向的内下方的骨嵴称为颈静脉嵴。在后半规管和前庭导水管的下方,乳突边缘和颈静脉嵴包围成一个喇叭状的区域,为颈静脉球所在处。颈静脉嵴和乳突边缘的切线以下,为颈静脉孔的静脉区。枕骨的外侧,面向颈静脉孔处有一小的弧形切迹是颈静脉孔的神经部。枕骨髁内的舌下神经管的开放处逐渐向后上方移行。乳突内气房中央围绕着一个较大的空腔为鼓窦。

63

63  前庭导水管向内下方开放,开口位于颈静脉嵴的上方,后半规管弧形管腔变小,在后半规管的上方,前庭导水管上缘骨壁的后方,有一小的台阶状切迹,在此台阶的前内方是后颅窝,其后外上方是中颅窝。中颅窝的底部是乳突天盖,在正常情况下,乳突天盖为一致密的骨板。胆脂瘤型中耳炎经常破坏乳突天盖,造成骨板的缺失或部分缺失。面神经垂直段的下半部显示为一垂直的骨腔,并通过茎乳孔向下开放。舌下神经管外口逐渐呈闭合状,形成一个类圆形的管腔。

64

64  前庭导水管消失,其内侧的开口处仍可见切迹,后半规管消失,面神经垂直段基本消失,面神经的茎乳孔区呈喇叭状向下开放,其宽度为面神经垂直段的1.5倍。在实际情况下,面神经本身的直径并没有增加,而是由于在茎乳孔区有一圈环韧带包裹在面神经周围,使得面神经茎乳孔区的骨管增宽。舌下神经管变小,向外下的开口封闭,向内侧出现一个小的开口状切迹。颈静脉孔区为颈静脉和乙状窦的交界区。鼓窦消失,乳突内充满气房。在原面神经垂直段的前方,有一较大的气房,此气房接近岩尖部。

65

65  茎乳孔为一小的切迹,乳突内充满气房,气房的大小不一但气房间隙的骨质清晰。颈静脉孔区消失,枕骨髁与乳突连成一片。在枕骨髁与乳突相连的骨质上方,有一开口向上的横向椭圆形切迹,内纳乙状窦。舌下神经管消失,仅留下一个向内上方的切迹。乳突天盖变小,天盖的上方为中颅窝,天盖的前下方为后颅窝。从图61到图65乳突面积逐渐增大,除了乳突气房外无其他功能性结构。

66

66  茎乳孔消失,留下一个很浅的切迹,在此切迹的上方形成一个三角形的骨嵴为二腹肌嵴。此层面乙状窦的形态与图65相似,乳突内内耳和面神经的结构全部消失。

6768697071

图68-71显示天盖、乳突气房、二腹肌嵴及乙状窦形态,内耳和面神经的结构全部消失。

以上内容来自网络:影像园。

 

 

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