CAJ | 학술논문

目的采用经鼓膜穿刺鼓室内注入对比剂钆、内耳三维快速液体衰减反转恢复(3D-FLAIR) MR扫描,探讨3D-FLAIR序列内耳内淋巴显像的可行性及对梅尼埃病的诊断价值.方法 19例经临床确诊的单侧梅尼埃病患者双侧耳均经鼓膜穿刺鼓室内注入Gd-DTPA稀释液,24 h后行3D-FLAIR和三维平衡快速梯度回波(3D-Balance-FFE) MR扫描,观察双侧耳蜗、前庭和(或)半规管外淋巴间隙的增强显影情况,对双侧耳蜗底转鼓阶和前庭阶分别进行评分,对双侧前庭显影范围和前庭及同层面脑干的信号强度比分别进行测量和计算,分别采用Wilcoxon符号秩检验和配对样本t检验进行统计学分析.结果所有患者内耳3D-FLAIR MRI均显示,对比剂广泛分布于耳蜗、前庭和(或)半规管的外淋巴间隙内,可以清晰对比显示内淋巴间隙.19例患者患侧耳蜗底转前庭阶评2分3例,1分9例,0分7例,健侧耳蜗底转前庭阶评2分15例,1分2例,0分2例,二者比较差异有统计学意义(U=3.090,P＜0.05)；患侧与健侧前庭显影范围分别为(5.77±2.33) mm2和(8.11±3.32) mm2,二者比较差异有统计学意义(t =2.638,P＜0.05).结论运用经鼓膜穿刺鼓室内注入对比剂钆、24 h后行内耳3D-FLAIR MR扫描的方法,基于3D-Balance-FFE MRI,根据外淋巴间隙增强显影情况,可以区分内、外淋巴间隙的边界,推断出膜迷路积水,为梅尼埃病的诊断提供影像依据.
목적 채용경고막천자고실내주입대비제구、내이삼유쾌속액체쇠감반전회복(3D-FLAIR) MR소묘,탐토3D-FLAIR서렬내이내림파현상적가행성급대매니애병적진단개치.방법 19례경림상학진적단측매니애병환자쌍측이균경고막천자고실내주입Gd-DTPA희석액,24 h후행3D-FLAIR화삼유평형쾌속제도회파(3D-Balance-FFE) MR소묘,관찰쌍측이와、전정화(혹)반규관외림파간극적증강현영정황,대쌍측이와저전고계화전정계분별진행평분,대쌍측전정현영범위화전정급동층면뇌간적신호강도비분별진행측량화계산,분별채용Wilcoxon부호질검험화배대양본t검험진행통계학분석.결과 소유환자내이3D-FLAIR MRI균현시,대비제엄범분포우이와、전정화(혹)반규관적외림파간극내,가이청석대비현시내림파간극.19례환자환측이와저전전정계평2분3례,1분9례,0분7례,건측이와저전전정계평2분15례,1분2례,0분2례,이자비교차이유통계학의의(U=3.090,P＜0.05)；환측여건측전정현영범위분별위(5.77±2.33) mm2화(8.11±3.32) mm2,이자비교차이유통계학의의(t =2.638,P＜0.05).결론 운용경고막천자고실내주입대비제구、24 h후행내이3D-FLAIR MR소묘적방법,기우3D-Balance-FFE MRI,근거외림파간극증강현영정황,가이구분내、외림파간극적변계,추단출막미로적수,위매니애병적진단제공영상의거.
Objective After intratympanic gadolinium administration through the tympanic membrane,three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) was performed to evaluate endolymphatic visualization and its diagnostic value in Meniere's disease.Methods Twenty-four hours after intratympanic gadolinium administration through the tympanic membrane,19 patients with unilateral Meniere's disease diagnosed clinically underwent 3D-FLAIR and 3D-Balance-FFE imaging at 3.0 T MR scanner.The enhanced imaging of perilymphatic space in bilateral cochlea,vestibular and (or) canal were observed.Scala tympani and scala vestibule of bilateral cochlear basal turn were scored respectively.The enhanced range of bilateral vestibule and the signal intensity ratio (SIR) between the vestibule and the brain stem were measured. Wilcoxon tests and paired t tests were used.Results The gadolinium appeared in almost all parts of the perilymph in cochlea,vestibular and (or) canal,so the endolymphatic space was clearly visualized on 3D-FLAIR imaging.The score of scala vestibuli between the affected side (3 cases scored 2,9 cases scored 1,7 cascs scored 0) and the healthy side ( 15 cases scored 2,2 cases scored 1,2 cases scored 0 ) were significantly different ( U =3.090,P ＜ 0.05 ).The area of enhanced vestibular were (5.77 ± 2.33) mm2 and (8.11 ± 3.32) mm2 for the affected side and the healthy side,which were significantly different ( U =3.090,P ＜ 0.05 and t =2.638,P ＜ 0.05 ).Conclusions According to 3D-Balance-FFE MRI and the enhancement of perilymphatic space,3D-FLAIR MRI with intratympanic gadolinium injection through the tympanic membrance can be used to show the border between the perilymph and the endolymph and confirm endolymphatic hydrops,thus providing radiographic evidence for the diagnosis of Meniere's disease.