Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan.
Surg Radiol Anat. 2021 Aug;43(8):1319-1325. doi: 10.1007/s00276-021-02729-2. Epub 2021 Mar 7.
To date, very few studies have explored the three-dimensional architecture of calvarial diploic venous channels (CDVCs). This study aimed to characterize the three-dimensional architecture of CDVCs using maximum intensity projection (MIP) images based on contrast-enhanced magnetic resonance imaging (MRI).
A total of 77 patients with intact calvarial hemispheres and underlying dura mater and dural sinuses underwent contrast-enhanced MRI. Among them, we extracted the data of 49 with at least a part of the major CDVC pathways identified on the MIP images for analysis.
On serial contrast-enhanced MRI images, the CDVCs were commonly detected as curvilinear structures with inhomogeneous diameters and tributaries, while the MIP images delineated the three-dimensional architecture of the developed CDVC pathways. More than such CDVC pathway was entirely delineated on the right in 67.3% and on the left in 71.4%, most frequently in the frontal and temporal regions, with their connecting sites to the sphenoparietal and superior sagittal sinuses. The morphology, distribution, and course of the identified CDVCs were highly variable. In 55.1%, the CDVCs formed fenestrations that were variable in size, shape, and number.
The developed CDVC pathways may be characterized by morphological variability and fenestrations. Thin-sliced, contrast-enhanced MRI is useful to depict diploic veins, while MIP images allow for better appreciation of the entire course of the developed CDVC pathways. Traumatic and intraoperative disconnection between the dura mater overlying the dural sinuses and the adjacent inner table of the skull can cause epidural venous bleeding.
迄今为止，很少有研究探索颅骨板障静脉（CDVC）的三维结构。本研究旨在通过对比增强磁共振成像（MRI）的最大强度投影（MIP）图像来描述 CDVC 的三维结构。
共有 77 例完整的颅骨半球和硬脑膜下以及硬脑膜窦患者接受了对比增强 MRI 检查。其中，我们提取了 49 例患者的数据，这些患者的 MIP 图像上至少有一部分主要的 CDVC 通路可以识别。
在连续的对比增强 MRI 图像上，CDVC 通常被检测为具有不均匀直径和分支的曲线结构，而 MIP 图像则描绘了发育中的 CDVC 通路的三维结构。右侧完全描绘出超过这样的 CDVC 通路的占 67.3%，左侧占 71.4%，最常见于额区和颞区，与蝶顶窦和上矢状窦相连。识别出的 CDVC 的形态、分布和行程变化很大。在 55.1%的情况下，CDVC 形成大小、形状和数量可变的孔。
发育中的 CDVC 通路可能具有形态变异性和孔的特征。薄层、对比增强 MRI 有助于描绘板障静脉，而 MIP 图像可以更好地了解发育中的 CDVC 通路的整个行程。硬脑膜窦上方的硬脑膜和相邻颅骨内板之间的创伤性和术中分离可能导致硬膜外静脉出血。
