颈部影像解剖课件

颈部淋巴结的CT分区诊断二病房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；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。pterygoidsstylopharyngeusstyloidprocesssuperiorpharconstrbuccinatorcarotidinternaljugularmasseterparotidretromandibvtonsillarpillarsparapharyngealspace定位标志1下颌骨下缘2茎突3腮腺第一层次platysmasubmandibularglandsoropharynxepiglottissuppharconstrictorcarotidsIJsSCMretromandibularv定位标志1颌下腺2下颌骨下缘第二层次nodalstations:1a1b2a2b3456RPmedialtoanteriorbelliesofdigastricmuscleslateraltoanteriorbelliesofdigastricmusclesbacktoposterioredgeofsubmandibularglandfrombackofSMglandtobackofIJdeeptoSCMfrombackofIJtobackofSCMplatysmasubmandibularglandshyoidbonevalleculaepyriformsinusesoropharynxintervallecularseptumSCMcarotidsIJssupcornuthyroidcartepiglottisspharconstrtrapezius第三层次定位标志1舌骨platysmaSCMstrapmmthyroidcartintjugularscarotidsvertebralspharyngealconstrictorpyriformsinuseslaryngopharynxperiglotticfatpre-epiglotticfataryepiglotticfoldsextjugulars第四层次定位标志1甲状软骨2会厌前间隙nodalstations:1a1b2a2b3456RP(endbelowhyoid)deeptoSCM,belowhyoid(endsattopofhyoid)thyroidcartlaryngealvestibulepyriformsinusesfalsecordsarytenoidspharyngealconstrictorstrapsSCMsIJscarotids第五层次定位标志1甲状软骨2室带arytenoidstranvs/obliqarytenoidmlaryngealaditusvocalligament(cord)vocalismthyroidcartilagestrapmpharyngealconstrictorSCMcarotidIJEJtributariesvertebrals第六层次定位标志1甲状软骨2声带nodalstations:1a1b2a2b3456RPmanubriumtobottomofthyroidcart.,medialtoSCM,thyroidglandcricoidthyroidglandstrapsSCMcarotidsIJslonguscolliscalenestracheaesophagus第七层次定位标志1环状软骨SCMsstrapscarotidsinternaljugularsesophagusthyroidantscalenesmiddle/postscalenesbrachialplexus第八层次定位标志1甲状腺2气管nodalstations:1a1b2a2b3456RPends2cmabovesternoclavjointendsa