颌骨动静脉畸形和静脉畸形的临床及CT影像学特征比较

doi:10.12439/kqhm.1005-4979.2026.03.008

摘要/Abstract

摘要：

目的：

比较颌骨动静脉畸形（arteriovenous malformations，AVMs）和颌骨静脉畸形（venous malformations，VMs）的临床表现及CT影像学特征。

方法：

回顾性分析2015年5月至2023年11月于我院确诊的10例颌骨血管畸形患者的病历资料，其中颌骨AVMs 4例 [经数字减影血管造影（digital subtraction angiography，DSA）或增强CT确诊]，颌骨VMs 6例（经术后病理确诊）。收集患者年龄、性别、病变部位、出血史、疼痛史等临床资料；分析CT影像学特征，包括病变边缘情况、病变内部结构、骨皮质完整性、牙根吸收情况及下颌神经管异常表现。采用Fisher确切概率检验比较2组影像学特征差异，并评价不同影像学征象对颌骨AVMs的诊断效能。

结果：

4例颌骨AVMs均发生于下颌骨，其中2例有出血史；CT均表现为边缘不清晰、内部可见纤维样分隔的低密度病变，患侧下颌神经管均表现为管腔扩大。6例颌骨VMs中5例发生于下颌骨，均无出血史；CT主要表现为类圆形低密度病变，边缘可清晰或不清晰，其中2例出现下颌神经管受压移位。2组比较显示，下颌神经管异常及骨皮质完整性差异具有统计学意义（P<0.05），其中下颌神经管异常对颌骨AVMs诊断的灵敏度和特异度均较高。

结论：

AVMs和VMs的CT影像学特征具有一定差异，临床上应注意鉴别诊断。

关键词: 颌骨, 动静脉畸形, 静脉畸形, 影像学特征

Abstract:

Objective:

To compare the clinical manifestations and CT imaging features of intraosseous arteriovenous malformations (AVMs) and intraosseous venous malformations (VMs) in the jaws.

Methods:

A retrospective analysis was conducted on 10 patients with intraosseous VMs of the jaws diagnosed in our hospital from May 2015 to November 2023, including 4 cases of jaw AVMs confirmed by digital subtraction angiography (DSA) or contrast-enhanced CT and 6 cases of jaw VMs confirmed by postoperative histopathology. Clinical data, including age, sex, lesion location, history of bleeding, and pain, were collected. CT imaging features, including lesion margin, internal structure, cortical bone integrity, tooth root resorption, and abnormalities of the mandibular canal, were analyzed. Fisher's exact test was used to compare imaging features between the two groups, and the diagnostic performance of different imaging features for identifying jaw AVMs was evaluated.

Results:

All 4 cases of jaw AVMs occurred in the mandible, and 2 patients had a history of bleeding. CT images showed ill-defined hypodense lesions with internal fibrous septa, and all mandibular canals on the affected side were enlarged. Among the 6 cases of jaw VMs, 5 occurred in the mandible, and none had a history of bleeding. CT images mainly showed round or oval hypodense lesions with either well-defined or ill-defined margins, and displacement of the mandibular canal was observed in 2 cases. Significant differences were found between the two groups in abnormalities of the mandibular canal and cortical bone integrity (P<0.05). Abnormalities of the mandibular canal demonstrated relatively high sensitivity and specificity for the diagnosis of jaw AVMs.

Conclusion:

CT imaging features differ between jaw AVMs and VMs, warranting careful clinical differentiation.

Key words: jaw bone, arteriovenous malformations, venous malformations, imaging features

张文溪, 文珊辉, 林梓桐. 颌骨动静脉畸形和静脉畸形的临床及CT影像学特征比较[J]. 《口腔颌面外科杂志》, 2026, 36(3): 228-232.

ZHANG Wenxi, WEN Shanhui, LIN Zitong. Comparative analysis of clinical and CT imaging features of intraosseous arteriovenous malformations and venous malformations in the jaws[J]. Journal of Oral and Maxillofacial Surgery(CN), 2026, 36(3): 228-232.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2026/V36/I3/228

图/表 6

图1 头颈部DSA和增强CT影像 A. DSA图像，箭头示左侧下颌骨团状染色影，提示富血管病变；B. DSA三维重建图像，箭头示供血动脉为左侧上颌动脉的下牙槽动脉分支；C.增强CT三维重建图像，箭头示右侧下颌骨外侧强化的血管团块。

Figure 1 Head and neck DSA and contrast-enhanced CT images

表1 2组患者临床资料

Table 1 Clinical data of the two patient groups

临床特征	AVMs组（n=4）	VMs组（n=6）
年龄/岁	10~38	40~75
性别（男/女）	1/3	0/6
病变部位（上颌/下颌）	0/4	1/5
出血史	2	0
疼痛史	1	2

图2 颌骨AVMs的影像学表现 A. CBCT轴位图，箭头示左侧下颌神经管较对侧明显扩大；B. CBCT斜矢状位图，箭头示右侧病变区边缘毛糙不规则；C. CBCT轴位图，左下颌骨病变区边界不清晰，箭头示病变内高密度纤维分隔。

Figure 2 Imaging features of jaw AVMs

图3 颌骨VMs的影像学表现 A. CBCT轴位图，箭头示右侧下颌神经管推挤；B. CBCT轴位图，右侧下颌骨病变区呈不规则低密度影，其间存在纤维样高密度分隔，箭头示病变边缘毛糙；C. CBCT轴位图，右侧下颌骨病变，箭头示边界清晰，边缘光滑。

Figure 3 Imaging features of jaw VMs

表2 2组患者影像学特征比较[n(%)]

Table 2 Comparison of imaging features between the two patient groups [n(%)]

影像学特征	AVMs组（n=4）	VMs组（n=6）	P值	Kappa值
病变边缘是否清晰			0.467	0.737
是	0	2(33.3)
否	4(100.0)	4(66.7)
下颌神经管异常			0.010	1.000
扩大	4(100.0)	0
推挤	0	2(33.3)
无	0	4(66.7)
骨皮质完整			0.048	1.000
是	0	5(83.3)
否	4(100.0)	1(16.7)
有无牙根吸收			0.524	1.000
有	3(75.0)	2(33.3)
无	1(25.0)	4(66.7)
病变内有无分隔			1.000	0.615
有	4(100.0)	5(83.3)
无	0	1(16.7)

表3 不同影像学征象对颌骨AVMs诊断的效能分析

Table 3 Diagnostic performance of imaging features for jaw AVMs

评价指标	病变边缘	下颌神经管	骨皮质	牙根吸收	病变内分隔
灵敏度/%	100.0	100.0	100.0	75.0	100.0
特异度/%	33.3	100.0	83.3	66.7	16.7
阴性预测值/%	100.0	100.0	100.0	80.0	100.0
阳性预测值/%	50.0	100.0	80.0	60.0	44.4

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