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汗欢褚
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1 f zu{ } 19 í } Çf Chinese Journal of Tissue Engineering Research April 9, 2015 Vol.19, No.15 È¼ÙŒ š µ Ñ ~ ¾äÉ j 1 Âhþ 2 2 ( 1 öž { œ È ) s 1 p CT Œ ƒ xèùœš µq gº Ñ q o q º Âv ùå}g 2 È¼ÙŒš µ C4 C5 }õ È¼ÙŒ¾äÉ Çjq i gu{è¼ùœv äqöm ö ö v o ² ž Ù qõ } Ñ ºÀ z ÈÙŒ CT Ñ ¾ä Ž y gè ÈÙŒ, Ñ «Ù Ž y Èr( ) È¼ÙŒš µ npè Î q³ p q Ä Ã ž~ ³ (DSA) Ìp xè¼ùœqÿz i Ñ CT Ìp xè¼ùœ~ ¼ grºu{ o q rq vè¼ùœš µrº ö¾äé g grºç g uu{ ² 50 x Ÿ È CT ž~³ o 206 gu{ Ég ¾ä 70 ¾ä 136 È¼ÙŒš µ ºÉ ( š µq Ñ Ég U V C S ) ¾äÉ C4 C5 q ö~ ¼ È¼ÙŒš µ ¾ä 70 Úg(59.17±10.27) š µ U ë 35.7% V 30.7% C ë 27.2% S ë 6.4% ºfeŒÉ rü ë 33.3%(25/70 ) ~ ¼ g(4.92±0.63) mm š µ C4 C5 ÉÌg(87.23±16.66) (49.21±16.01) ¾ä 136 Úg(67.39±9.32) š µ U ë 41.5% V 33.1% C ë 24.3% S ë 1.1% ºfeŒÉ rü ë 43.4%(59/136 ) ~ ¼ g(4.90±0.44) mm š µ C4 C5 ÉÌg(84.44±17.20) (52.57±14.16) É e Â Ú S É (P < 0.05) š µ~ ¼ C4 C5 (P > 0.05) ¾ä ö¾ä C4 ¼ ç¾äéìë 13.60% 19.01% C5 ë 27.34% 16.52% C6 ë 9.94% 13.60% Ÿ È¼š µ x U V C eœé ü ² 50% ~ ¾äx C5 ¼ ç C4 çº ¾äÃ Ú ömi ºf¾äš µ S ömi±ƒ ¾ä ~ º é 1963 µ É 2004 Î Ú Ú { š x CT MR Ôd Š Ì { œ È f É ú:r318 h u:b ú: (2015) ÈÍ j Âhþ. È¼ÙŒ š µ Ñ ~ ¾äÉ [J].f zu{ (15): doi: /j.issn Three-dimensional reconstruction of the carotid artery: anatomical measurement and calcification distribution of the carotid siphon Zhou Le-fu 1, Chen Li-jun 2, Duan Shao-yin 2 ( 1 Shenzhen Longgang Hospital of TCM, Shenzhen , Guangdong Province, China; 2 Zhongshan Hospital of Xiamen University, Xiamen , Fujian Province, China) Abstract BACKGROUND: The carotid siphon has a complex structure, which is difficult for two-dimensional imaging observation due to shelter from the basicranial bone. Digital subtraction angiography is conducive to display the course of carotid siphon, but there is a lack of anatomical landmarks. Three-dimensional CT imaging is beneficial to show the structure of carotid siphon and have its measurement, which provides a new and effective means in relevant studies. OBJECTIVE: To clarify the morphology and calcification distribution of the carotid siphon, thereby providing an objective basis for relevant clinical and basic research. METHODS: A total of 206 patients, over 50 years old, with no lesions or variation under head and neck CT angiography were selected and divided into non-calcification group (n=70) and calcification group (n=136). The Zhou Le-fu, Master, Associate chief physician, Shenzhen Longgang Hospital of TCM, Shenzhen , Guangdong Province, China Corresponding author: Duan Shao-yin, M.D., Professor, Chief physician, Zhongshan Hospital of Xiamen University, Xiamen , Fujian Province, China Accepted: ISSN CN /R CODEN: ZLKHAH 2371

2 carotid siphon was reconstructed on the imaging workstation to observe the classification ( U, V, C and S types) and calcification distribution, the bending angles of C4 and C5 segments as well as lumen diameter were measured. RESULTS AND CONCLUSION: The 70 patients in the non-calcification group were at a mean age of (59.17±10.27) years, and the U type accounted for 35.7%, V type for 30.7%, C type for 27.2%, and S type for 6.4%; Among them, 33.3% patients (25/70) had the same type at both sides; the lumen diameter was (4.92±0.63) mm, and the blending angles of C4 and C5 were (87.23±16.66) and (49.21±16.01). In the calcification group, the mean age was (67.39±9.32) years, and there were 41.5% of U type, 33.1% of V type, 24.3% of C type, 1.1% of 24.3%, and among the 136 patients, 43.4% (59/136) showed the same type at both sides; the lumen diameter was (4.90±0.44) mm, and the blending angles of C4 and C5 segments were (84.44±17.20) and (52.57±14.16). There were significant differences in age and S type between the two groups (P < 0.05), but no statistical difference in the lumen diameter and blending angles of C4 and C5 (P > 0.05). In the calcification group, the calcification percentage of inwardly and outwardly curved regions was 13.60% and 19.01% for C4, 27.34% and 16.52% for C5, 9.94% and 13.60% for C6. The morphology of the carotid siphon is mostly seen as U, V, C types, and over 50% types are different at both sides. Calcification of the lumen wall is seen most in the inwardly curved region of C5 segment, followed by the outwardly curved region of C4 segment. The incidence of calcification is increased with age, which is lower in the S-type carotid siphon. The lumen diameter and blending angle of the carotid siphon show no correlation with calcifications. Subject headings: Carotid Arteries; Imaging, Three-Dimensional; Dissection Funding: the National Natural Science Foundation of China, No Zhou LF, Chen LJ, Duan SY. Three-dimensional reconstruction of the carotid artery: anatomical measurement and calcification distribution of the carotid siphon. Zhongguo Zuzhi Gongcheng Yanjiu. 2015;19(15): Introduction È¼ÙŒ väg Žž~h{ µ ž È¼ÙŒ väq º g q Ú Ì Îžï o Î Œžo} ²Åè rºu{öj ÙŒŸzq ü~³ ž q fž~qž Ù ùœø oùœ väqöm mg Ù Œ vä rðqu{ [1-5] È¼ÙŒÈ¼ h{±g º È¼ÙŒš µqh{ g [5-9] CTž~³ g ÙŒ ooq n ÂviÎ npè¼ ÙŒ Ñu{ gºrºooq uu{ o q x È¼ÙŒ Ÿz ùx vè¼ùœq qº xùœ ¾ä â xæ È È ÙŒ sùœ öùœ ¾äqÉ } â z (volume rendering VR) (maximum intensity projection MIP) Å (multiple planar reconstruction MPR) d ³² üq x jè¼ùœü q q x È¼ÙŒ gè¼ùœooö o q o ² Ñ u [10-15] u{ìn q~û ²ŸÈ¼ÙŒ {Â q v ¾äqÈ¼ÙŒš µ g ²Ÿ Ì Ú}rºu{ gè¼ù Œrºg uu{ 1 Subjects and methods É d Âö Íp Ž òá 2372 Â f çã y k vòá Â f çãpacsf Ž12 ÂÈ ²Ç50 x ÈµCTž~³ (CT angiography CTA) q ºfâ ¾ä (ÈÙ Œš v¾äö± )70 n36 34 Ú5085 Úg(59.17±10.27) ¾ä (â ÈÙŒš ¾ä )136 n78 58 Ú5086 Úg(67.39±9.32) Â ÈµCTž~³ v ÈÙŒš ¾ä ö± Â ²Ÿ ÈµCTž~³ v È ¼ÙŒš µž~ ¾äö± ¾ä È¼Ù Œš µž~ ¾ä ¾ä ü ÈµÎÎ ± öž~ o ÈÙŒž~ É ± Ã Â ÈµÎÎn q± ï ž~ Èµž~ ÙŒp ÈÙŒ± ~ ý h{ ~ Â 64 CT(Light Speed VCT GE Inc. USA) ö}îï (STELLANT MEDRAD Inc. USA) Åy Ï h (320 mgi/ml GE Inc. USA) CTA zìƒ µ ² Ç ŽgÙŒ ŽÈ Ž SureStart º ç q Å õ ~nï120 kv ~n ma Âr mm ± Â330 ms/rot fåœx3.5 ml/sq i A}60 ml Ï(v ˆŒ370 gi/l) iýb}²ø 20 mlmkr ² gùœ µgr Å²ŸÈ égùœqct ²Í Ð q150 HU P.O. Box 10002, Shenyang

3 Ÿ 1 È¼ÙŒš µé Å¾ä ¾ä ±( úœü n/%) Table 1 Classification of the carotid siphon in the calcification and non-calcification groups Ÿ 3 ¾ä È¼ÙŒš µ 684 Éç¾äÉ Table 3 Calcification distribution in the 684 regions of the carotid siphon in the calcification group É Å¾ä (n= Œ) ¾ä (n= Œ) 2 P ¾äÉ ç ç ë 684 çqé (%) U 50/ / V 43/ / C 38/ / S 9/ 6.4 3/ a Ÿ Å¾ä ¾ä úœü ± a P < 0.05 Ÿ 2 È¼ÙŒš µ C4 C5 ef q ö~ ¼ (x _ ±s) Table 2 Bending angles and lumen diameters of C4 and C5 segments of the carotid siphon Å¾ä (140 Œ) ¾ä (272 Œ) t P C4 ( ) 87.23± ± C5 ( ) 49.21± ± ¼ (cm) 4.92± ± Ÿ e š µ C4 C5 ö~ ¼ É i ý k Äq ÈCTA Å ~Ž advantage workstation 4.2 Ìnê MPR VR } xr q Ñ ²Ÿ É öõ È¼ÙŒš µé ö¾ä Éç C4 C5 C6 ç¾äé x g uég¼ ç É6fç ü ¾äÉ ( 1 2) C4 C5 ef q ö ~ ¼ n MPR ²ef ˆ ÅÉÌÉ² C4-C5-C6 C3-C4-C5f ƒˆ ý s²c4 C5 ef ~ qf Ž ø² ~ qf ² ~ ¼ š µ~ g Â( 3) g e Ú ± È¼ ÙŒš µ Ñ C4 C5 ö~ ¼ È¼ÙŒ¾äÉ É rºõ öé õ Ìn SPSS 16.0±z²Ÿ ±t 2 Í 2 Results 2.1 e ð 206 Ég2 ý ké ¹µ² É 2.2 ð ô Â Ì ¾ä (70 ) Úg (59.17±10.27) ¾ä (136 ) Ú(67.39±9.32) e Ú ± i(t=9.32 P < 0.05 ) 2.3 Ó ÿ³ Î š µé eœrü Å ¾ä 33.3%(25/70 ) ¾ä ë43.4%(59/136 ) e i( 2=0.092 P=0.762) e ºƒš µ C C4 ¼ C C5 ¼ C C6 ¼ Ÿ C5 ¼ ë 27.34% C % É ö ± Ÿ1 ºf S e i( 2=9.270 P < 0.05) 2.4 C4 C5 ÌÀ ÓgðÎ«Ÿ2 e š µc4 C5 ö~ ¼ É i(p > 0.05) 2.5 Ó ÿœ ¾ä 136 È¼ÙŒš µº É1 632ç( =1 632) ºföj684ç ¾ä ¾ äé ig41.91% üçqé ÀöqÉ Ÿ3 ºf C5 ¼ ë27.34% C % 3 Discussion 3.1 Ó ÿ³ Ó ÿ Š È¼ÙŒg q È¼ zgš nè¼ùœ~¼øž ŒÐÙŒ ŒfÙŒqÉö g [6-7] š Ÿz Fischer 1938 ÇqÈ¼ÙŒ5 É f Ð { ³ üz È¼ÙŒš µ [16] 1996 BouthiIIier } Ç q7é [6 17] š µ ² f k h ºzg œæ È¼ÙŒ (parasellar ICA P-ICA) [18] np É ü²qüz u{ v n š µ œæ q Ð { ²3fµÉ r p7é qc4 C5 C6 3.2 Ô È¼ÙŒš µ Ÿ² ØŒ Ñ zº ÑqÅ ž Ù q t ³² š µqð µ ý µ ²š µq [19-20] ² ²q pè¼ùœ³ qœå (2D ) š µ ƒq un2d iâv dnp ø ²y ²~rm Âvq Â È¼ÙŒš µ { Â ±q í Êq g Ì p CT ²ŸÈÙŒš µq ƒ rº Ñõ DSA}2Dq u{ ±º q~û rºqu{ gè¼ùœooqg o uu{ o gâv q Ñ Ñ q Ÿµ 3.3 Ó ÿ³ œ š µq Ñ É È¼ÙŒùÉg4y â U V ISSN CN /R CODEN: ZLKHAH 2373

4 A B C 3 È¼ÙŒš µ S (A) U (B C Figure 3 Measurement of the blending angles of the carotid siphon, S type (A) and U type (B and C) ÉÌ x C4 C5 e (A B) ü x š µ ~ q¼ e (C) A B C È¼ÙŒš µé Figure 1 Classification of the carotid siphon U A B 14 V C 58 C D 912 S E F 1315 C S [19-20] U qg š µc4 C5 ef q U V g C4 ± r C5 q V dc4 C5 Ž ü Å C g C5 ² ¾ C S g š µc4 C5 efs v u{e ± öjå¾ä ¾ä É È¼ÙŒš µ x U V ö C e S r pºw ± e ± ¾ä q ± Î ÿºömväqùœ ± p² ù u{öjš µé C ºw h ³± [7-8] ²zfƒ~ q X ³ q q g V ŒÅ C5 q ± ±Žºw ý C5 q C C4 C5 ùœ ü Å g V i 3.4 œ ô È¼ÙŒvä ¹ ÙŒ vä ÈÙŒqŸj ³ Å öm Ãs Ú À ² Ø rð g t ž Œêfqöm Érº ÈÙŒvä Ë Ÿjg¼ f ñ ý² vä u Çj ¼Çž 2374 D E F ¾ä š µüç¾äé Figure 2 Calcification distribution of the carotid siphon in the calcification group C4 C5 C6 ç¾äé x g uég¼ ç g¼ ç g ç u Œ Â ž ö öž~h{} r qž Ù Ž ž Œž~ozqöm u{öj¾ä Å¾ä Ú ± È¼ÙŒ¾äÃ Ú º¾äq i Ø «öj¾ä Ú p65 Å¾ä Ú p 60 ù «öjè¼ùœ¾äqöm ºÉ q qµƒ öm öjè¼ ÙŒš µ¾ä pc4 C5 ºf pc5 ¼ ç ë ç q27.34% º gc4 ç ë ç q19.01% ² ùœ o µ qž Ù g º g² qrºž Âµ u{ k [21] 3.5 œ Ìc { š µq xc4 g C5 r ± e Å¾ä ¾ä iâ öjc4 C5 ² j ÿ ž Ù º ² u{ ù u{öjc4 C5 q q ² q q ž Ù üq ž Ù q üùœ ž ~~ q¾ä q ük [22-23] s ö C4 C5 äõ iùœ gük š P.O. Box 10002, Shenyang

5 µc4 C5 ³ ü Å q ± ²y ~³ ž ~ ¼ ± ž v ž~~ q¾ä š µ~ u{öjå¾ä ¾äe Â Ã Ú È¼ÙŒš µ~ ä ùœñ ~ µéƒpî ¼ º «h Š Ð Â é cmìúc Š d Š ò À é cmìúcš é cš n Š d ÌrÀ{ À À í q d k Ô w ñ¾ ì íx d g «n d CT n (CTA) Óÿ ƒ Â ÒÂ ¾ Ð tì ß ø ß DSA ÆhdCTA ß s { ÿ (Willis ) À{ c c ÿà ß dß É 2 hd u k À í À d 4 õ h References [1],Ç,,}.È¼ÙŒš µž q ~ Í[J]. çnmg,2013,28(1): [2] Âhþ,, Àé,}. pct È¼ÙŒš µ Âµ [J]. g ç z,2012,19(1):1-2. [3] ý,¾é,âhþ,}. È¼ÙŒpöý Šü qž [J].f zu{,2014,18(2): [4] Valen-Sendstad K, Piccinelli M, Steinman DA.High-resolution computational fluid dynamics detects flow instabilities in the carotid siphon: implications for aneurysm initiation and rupture? J Biomech. 2014, 22;47(12): [5] Lauric A, Hippelheuser J, Safain MG, et al. Curvature effect on hemodynamic conditions at the inner bend of the carotid siphon and its relation to aneurysm formation. J Biomech. 2014, 47(12): [6] Bouthillier A,van Loveren HR,Keller JT,et al. Segments of the internal carotid artery: a new classification. Neurosurgery. 1996;38(3):425-32; discussion [7] Ç. tœž~x Ñ u{i :È¼ÙŒ qx Ñ[J].Å ç Ã,1982,32(2): [8] i.œž~³ [M],äs,t ìmçfx,1965: [9], º, }.È¼ÙŒ-sÙŒç o qct MR Ÿj[J].fé Ñ g,2014,19(3): [10],Ã.È¼ÙŒ u Œ žö q u{² [J].féx ç,2013,12(5): [11] Griessenauer CJ, Yalcin B, Matusz P, et al. Analysis of the tortuosity of the internal carotid artery in the cavernous sinus. Childs Nerv Syst [Epub ahead of print] [12] Leisser C, Kaufmann TA, Feltgen N, et al. Distribution of internal carotid artery plaque locations among patients with central retinal artery occlusion in the Eagle study population. Graefes Arch Clin Exp Ophthalmol [Epub ahead of print] [13] z, y,,}.è¼ùœ { sùœº q CT [J].} ¾ç,2014,36(11): [14] Saba L, Raz E, Anzidei M,et al. Differences in plaque morphology and correlation of stenosis at the carotid artery bifurcation and the carotidsiphon. AJR Am J Roentgenol. 2013, 201(5): [15] Gotovac N, Isgum I, Viergever MA,et al. Calcium at the carotid siphon as an indicator of internal carotid artery stenosis. Eur Radiol. 2013,23(6): [16] Ä. Ñ [M].äs:t ìmçfx, [17] Seoane E, Rhoton AL Jr, de OIiveira E. Microsurgical anatomy of the duralcollar(carotid collar)and rings around the clinoid segment of the internal carotid artery.neurosurgery. 1998;42(4) [18] Meng S, Costa Lda F, Geyer SH, et al. Three-dimensional description and mathematical characterization of the parasellar internal carotid artery in human infants.j Anat.2008, 212(5): [19] zú,ˆ,w,}.è¼ùœ Ñ pg ou{[j]. féx yoou{,2013;12(6): [20] ², lø.è¼ùœš µ n Ñ Ã ž~³ du{ö n[j].v,2004,13(1): [21],Âhþ,¾é,}.È¼ÙŒ h{ž Ù u{[j].f g nç,2014,10: [22] Bogunović H, Pozo JM, Cárdenes R,et al. Automated landmarking and geometric characterization of the carotid siphon. Med Image Anal. 2012;16(4): [23] Hong NR,Seo HS,Lee YH,et al.the correlation between carotid siphon calcification and lacunar infarction. Neuroradiology. 2011;53(9): ISSN CN /R CODEN: ZLKHAH 2375

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