颈部影像解剖

颈部影像解剖第1页/共25页颈部淋巴结的CT分区诊断二病房第2页/共25页Ⅰ区:为颌下及颏下淋巴结。Ⅰa颏下淋巴结。Ⅰb颌下淋巴结。Ⅱ区:位于颈内静脉周围，由二腹肌后腹－舌骨水平。Ⅱa副神经之前的淋巴结。Ⅱb副神经之后的淋巴结第3页/共25页Ⅲ区：位于舌骨下缘－环状软骨下缘之间的颈内静脉周围；Ⅳ区：颈内静脉链下组，位于环状软骨下缘－至锁骨水平的颈内静脉周围；第4页/共25页Ⅴ区：颈后三角区，胸锁乳头肌后缘、斜方肌前缘的三角区;Ⅵ区：中央区淋巴结。包括喉前、气管前和气管旁及气管食管沟淋巴结。Ⅶ区：上纵隔淋巴结；第5页/共25页淋巴结病变的CT诊断标准：在CT扫描一旦发现气管食管沟内淋巴结即可确定为病变性淋巴结，诊断标准：颈部Ⅰ-Ⅵ区以淋巴结最大横径≥１５ｍｍ，纵隔（Ⅶ区）以淋巴结最大横径≥10mm第6页/共25页有经验的外科医师仅可以触及表浅的0.5cm大小或深部1.0cm大小的淋巴结，但对位于胸锁乳路突肌深面、气管食管沟及咽后组等深部的淋巴结却难以触及。第7页/共25页pterygoidsstylopharyngeusstyloidprocesssuperiorpharconstrbuccinatorcarotidinternaljugularmasseterparotidretromandibvtonsillarpillarsparapharyngealspace定位标志1下颌骨下缘2茎突3腮腺第一层次第8页/共25页nodalstations:1a1b2a2b3456RPbetweenpharyngealmusclesandlonguscolli定位标志1下颌骨下缘2茎突3腮腺第9页/共25页platysmasubmandibularglandsoropharynxepiglottissuppharconstrictorcarotidsIJsSCMretromandibularv定位标志1颌下腺2下颌骨下缘第二层次第10页/共25页nodalstations:1a1b2a2b3456RPmedialtoanteriorbelliesofdigastricmuscleslateraltoanteriorbelliesofdigastricmusclesbacktoposterioredgeofsubmandibularglandfrombackofSMglandtobackofIJdeeptoSCMfrombackofIJtobackofSCM第11页/共25页platysmasubmandibularglandshyoidbonevalleculaepyriformsinusesoropharynxintervallecularseptumSCMcarotidsIJssupcornuthyroidcartepiglottisspharconstrtrapezius第三层次定位标志1舌骨第12页/共25页nodalstations:1a1b2a2b3456RPfrombackofSCMtofrontoftrapezius,belowtopofhyoidendsatTOPofhyoidallENDatbottomofhyoid第13页/共25页platysmaSCMstrapmmthyroidcartintjugularscarotidsvertebralspharyngealconstrictorpyriformsinuseslaryngopharynxperiglotticfatpre-epiglotticfataryepiglotticfoldsextjugulars第四层次定位标志1甲状软骨2会厌前间隙第14页/共25页nodalstations:1a1b2a2b3456RP(endbelowhyoid)deeptoSCM,belowhyoid(endsattopofhyoid)第15页/共25页thyroidcartlaryngealvestibulepyriformsinusesfalsecordsarytenoidspharyngealconstrictorstrapsSCMsIJscarotids第五层次定位标志1甲状软骨2室带第16页/共25页nodalstations:1a1b2a2b3456RP第17页/共25页arytenoidstranvs/obliqarytenoidmlaryngealaditusvocalligament(cord)vocalismthyroidcartilagestrapmpharyngealconstrictorSCMcarotidIJEJtributariesvertebrals第六层次定位标志1甲状软骨2声带第18页/共25页nodalstations:1a1b2a2b3456RPmanubriumtobottomofthyroidcart.,medialtoSCM,thyroidgland第19页/共25页cricoidthyroidglandstrapsSCMcarotidsIJslonguscolliscalenestracheaesophagus第七层次定位标志1环状软骨第20页/共25页nodalstations:1a1b2a2b3456RPbelowcricoid,deeptoSCMendsatbottomcricoidendsattransvcervicalvv第21页/共25页SCMsstrapscarotidsinternaljugularsesophagusthyroidantscalenesmiddle/postscalenesbrachialplexus第八层次定位标志1甲状腺2气管第22页/共25页nodalstations:1a1b2a2b3456RPends2cmabovesternoclavjointendsatmanubrium