頸部影像解剖

1、頸部淋巴結(jié)的CT分區(qū)診斷,二病房,,Ⅰ區(qū): 為頜下及頦下淋巴結(jié)。 Ⅰ a 頦下淋巴結(jié)。 Ⅰ b 頜下淋巴結(jié)。Ⅱ區(qū): 位于頸內(nèi)靜脈周圍，由二腹肌后腹－舌骨水平。Ⅱ a 副神經(jīng)之前的淋巴結(jié)。Ⅱ b 副神經(jīng)之后的淋巴結(jié),,Ⅲ區(qū)：位于舌骨下緣－環(huán)狀軟骨下緣之間的頸內(nèi)靜脈周圍；Ⅳ區(qū)：頸內(nèi)靜脈鏈下組，位于環(huán)狀軟骨下緣－至鎖骨水平的頸內(nèi)靜脈周圍；,,Ⅴ區(qū)：頸后三角區(qū)，胸鎖乳頭肌后緣、斜方肌前緣的三角區(qū);Ⅵ區(qū)：中央?yún)^(qū)淋巴結(jié)。包括喉前、氣

2、管前和氣管旁及氣管食管溝淋巴結(jié)。Ⅶ區(qū)：上縱隔淋巴結(jié)；,,淋巴結(jié)病變的 CT 診斷標準：在 CT 掃描一旦發(fā)現(xiàn)氣管食管溝內(nèi)淋巴結(jié)即可確定為病變性淋巴結(jié)，診斷標準：頸部Ⅰ-Ⅵ區(qū)以淋巴結(jié)最大橫徑≥１５ｍｍ，縱隔（Ⅶ區(qū)）以淋巴結(jié)最大橫徑≥10mm,,有經(jīng)驗的外科醫(yī)師僅可以觸及表淺的0.5cm大小或深部1.0cm大小的淋巴結(jié)，但對位于胸鎖乳路突肌深面、氣管食管溝及咽后組等深部的淋巴結(jié)卻難以觸及 。,,pterygoids,stylophary

3、ngeus,styloid process,superior phar constr,buccinator,carotid,internal jugular,masseter,parotid,retromandib v,tonsillar pillars,parapharyngeal space,,定位標志1下頜骨下緣2莖突3腮腺,第一層次,,,nodal stations:1a1b2a2b3456RP,,bet

4、ween pharyngeal muscles and longus colli,定位標志1下頜骨下緣2莖突3 腮腺,,,,platysma,submandibular glands,oropharynx,epiglottis,sup phar constrictor,carotids,IJs,SCM,retromandibular v,定位標志1頜下腺2 下頜骨下緣,第二層次,nodal stations:1a1b2a

5、2b3456RP,,,,,,medial to anterior bellies of digastric muscles,lateral to anterior bellies of digastric musclesback to posterior edge of submandibular gland,from back of SM gland to back of IJdeep to SCM,from back

6、 of IJ to back of SCM,,,,,platysma,submandibular glands,hyoid bone,valleculae,pyriform sinuses,oropharynx,intervallecular septum,SCM,carotids,IJs,sup cornu thyroid cart,epiglottis,s phar constr,,trapezius,第三層次,定位標志1 舌骨,

7、nodal stations:1a1b2a2b3456RP,,from back of SCM to front of trapezius, below top of hyoid,,,,platysma,SCM,strap mm,thyroid cart,int jugulars,carotids,vertebrals,pharyngeal constrictor,pyriform sinuses,laryngopha

8、rynx,periglottic fat,pre-epiglottic fat,aryepiglottic folds,ext jugulars,第四層次,定位標志1甲狀軟骨2會厭前間隙,nodal stations:1a1b2a2b3456RP,,deep to SCM, below hyoid,,,,thyroid cart,laryngeal vestibule,pyriform sinuses,false

9、cords,arytenoids,pharyngeal constrictor,straps,SCMs,IJs,carotids,第五層次,定位標志1 甲狀軟骨2 室?guī)?nodal stations:1a1b2a2b3456RP,,,,,,arytenoids,tranvs/obliq arytenoid m,laryngeal aditus,vocal ligament (cord),vocalis m,thyr

10、oid cartilage,strap m,pharyngeal constrictor,SCM,carotid,IJ,EJ tributaries,vertebrals,第六層次,定位標志1 甲狀軟骨2 聲帶,nodal stations:1a1b2a2b3456RP,,manubrium to bottom of thyroid cart., medial to SCM, thyroid gland,,,,cr

11、icoid,thyroid gland,straps,SCM,carotids,IJs,longus colli,scalenes,trachea,esophagus,第七層次,定位標志1 環(huán)狀軟骨,nodal stations:1a1b2a2b3456RP,,below cricoid, deep to SCM,,SCMs,straps,carotids,internal jugulars,esophagus,th

12、yroid,ant scalenes,middle/post scalenes,brachial plexus,第八層次,定位標志1 甲狀腺2 氣管,nodal stations:1a1b2a2b3456RP,ends 2 cm above sternoclav joint,ends at manubrium,,1 U 形為舌骨2 V形為甲狀軟骨3 室?guī)в兄? 聲帶無脂肪5 胸鎖乳突肌為頸三角的定位標志