The Initial Study Of The MSCT Venography Of Cervical Vertebral Venous Plexus

Abstract：Objective：To explore the detectability of cervical vertebral venousplexus(VVP) by multi-slice CT venography (MSCTV), to observe thedistribution and space relationship of VVP in and out of spinal canal, to surveythe diameter of the longitudinal vessel of internal vertebral anterior venousplexus(LVIVAVP),In order to provide accordance for the assessment of thecervical vertebral venous plexus before operation in the area of skull base andcervical vertebral, to reduce the bleeding and pressure of spinal canal during theoperation, and provide the early days research value for further study of clinicalsignificance of the cervical VVP. Material and methods: Collect50casespatients that perform cervical CTA without venous disease, the age from26Y to76Y, the average age is55.18Y, include28cases male,22cases female. The27cases were cerebral artery disease,23cases were cervical artery diseases. All thecases without the intervertebral disk degeneration diseases (hernia, bulge and soon), the mass of the spinal canal, the fracture and so on, that should affect thespinal canal venous pressure. The scan equipment is the light-speed64slicesVCT of America GE company, scan parameter: the slice thickness and slice gapis0.625mm, the pith ratio is0.984:1, the rotation time of the tube is0.6s/circle,the tube voltage is120KV, the tube electric current is350mA, standard functionreconstruction, SFOV：Head，DFOV：22cm，the matrix is512×512，and thehigh pressure injector is ulrich medical XD2051. The scan distance is from thetop of head to the cervical root. Scan the3phases (plain phase, artery phase, venous phase) primary data，choose the venous phase data to perform VVPreconstruction at GE-AW4.4，include ordinary CT venography（CTV）andsubtraction CT venography（SCTV）. Then evaluate the SCTV detectability ofthe LVIVAVP in accordance with artery method and by3doctors-in-charge.Use excel-2003and SPSS-13.0statistical packages for data entry and statisticalanalysis. At the same time, Observe the distribution and space relationship ofinternal vertebral venous plexus（IVVP） and external vertebral venous plexus(EVVP) in and out of spinal canal。Use the vessel analysis (VA) software tosurvey the LVIVAVP diameter (Dmax, Dmin, Dmean) from C2to C5, then useexcel-2003and SPSS-13.0statistical packages for data entry and statisticalanalysis. To compare the diameter between C2and C3,C3and C4, C4and C5,compare the diameter between male and female, compare the diameter betweenthe age above55Y (include55Y) and below55Y. Result: Both of MIP and VRcan observe the distribution and courser and nearby space relationship ofcervical LVIVAVP and EVVP clearly. There are show55branches LVIVAVPvessels above III degree of the50cases, which in the one side or both of thespinal canal, the left side show37cases (the ratio is74%), the right side8cases(16%), the both side5cases (10%).MIP can detect the I44branches（80%），II9branches（16.3%），III2branches（3.7%），VR can detect the I42branches（76.4%），II12branches（21.8%），III1branch（1.8%）. There is no differentdetectability of cervical vertebral venous plexus between MIP and VR（p﹥0.05）. The EVVP present at the posterior-lateral of the vertebral and around theattachment, like the fasciculate, especially at the junctional zone between head and cervical. It is asymmetrical between left and right. It can’t detect theinternal vertebral posterior venous plexus (IVPVP) and the vertebral basal vein.The IVVP mainly present the LVIVAVP and the communication branch betweenIVVP and EVVP, between VVP and cerebral venous sinus. The LVIVAVP isregular flat，locate at the Epidural space of the anterior-lateral in the spinal canal,nearby the pedicle of vertebral arch. There are communication branch betweenleft and right that show both of LVIVAVP. There are communication branchbetween the LVIVAVP and EVVP through the intervertebral foramina. Go down,the cervical LVIVAVP stretch to thoracic segments. Go up, it cross out of thespinal canal along the anterior of vertebral artery through the groove forvertebral artery to confluent with the EVVP, and then communicate with thecerebral venous sinus through the skull, the combine point include sigmoidsinus37branches（67.3%）,confluens sinuum16branches（30.0%）,cavernoussinus2branches（3.7%）. The LVIVAVP Dmax， Dmin， Dmean are below：The general team：C2,3.51±0.32、2.69±0.30、3.10±0.27；C3，3.30±0.30、2.51±0.28、2.87±0.27；C4，3.16±0.29、2.35±0.27、2.70±0.27；C5，2.96±0.29、2.10±0.26、2.52±0.27. To perform analysis of variance with Dmax，Dmin， Dmean，there is statistical significance of the LVIVAVP diameterdeference between different cases. To perform t test，and then compare withSNK between nearby cervical segment， There is statistical difference ofLVIVAVP diameter between nearby cervical segment, and the LVIVAVPdiameter become small from C2to C5（P＜0.05）。Male team：C2，3.51±0.34、2.71±0.34、3.11±0.30；C3，3.35±0.33、2.54±0.32、2.94±0.29； C4，3.23 ±0.31、2.39±0.31、2.79±0.30；C5，3.05±0.30、2.11±0.30、2.61±0.31。Female team：C2，3.50±0.29、2.66±0.24、3.09±0.23；C3，3.23±0.24、2.44±0.17、2.78±0.21；C4，3.07±0.23、2.29±0.20、2.59±0.18；C5，2.86±0.24、2.09±0.21、2.41±0.17。There is no statistical significance of the C2Dmax between male and female（P＞0.05），There is statistical significance ofthe C3to C5Dmax between male and female（P＜0.05），There is no statisticalsignificance of C2to C5Dmin between male and femal（eP＞0.05），There is nostatistical significance of the C2Dmean between male and female（P＞0.05），There is statistical significance of the C3to C5Dmean between male andfemale（P＜0.05）。The age above55Y (include55Y) team：C2，3.46±0.34、2.63±0.24、3.07±0.25；C3，3.28±0.29、2.49±0.23、2.85±0.25； C4，3.15±0.28、2.29±0.23、2.67±0.23；C5，2.95±0.26、2.06±0.23、2.46±0.21。The age below55Y are team：C2，3.56±0.28、2.75±0.34、3.17±0.29；C3，3.31±0.30、2.54±0.32、2.92±0.29； C4，3.19±0.31、2.41±0.30、2.73±0.30；C5，2.97±0.33、2.16±0.29、2.56±0.26。There is no statistical significance ofLVIVAVP diameter between the age team. Conclusion：MSCTV can detect thecervical vertebral venous plexus clearly，especially the LVIVAVP，it can observethe distribution and space relationship， whether enlarged， and thecommunication branches directly. It has important value in the assessment of thecervical vertebral venous plexus before operation as well as in the furtherstudying the clinic significance.