中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2013年
8期
628-633
,共6页
张道宫%史宏璐%樊兆民%王光彬%韩月臣%李亚伟%王海波
張道宮%史宏璐%樊兆民%王光彬%韓月臣%李亞偉%王海波
장도궁%사굉로%번조민%왕광빈%한월신%리아위%왕해파
梅尼埃病%磁共振成像%钆DTPA%听力%前庭功能试验
梅尼埃病%磁共振成像%釓DTPA%聽力%前庭功能試驗
매니애병%자공진성상%구DTPA%은력%전정공능시험
Meniere disease%Magnetic resonance imaging%Gadolinium DTPA%Hearing%Vestibular function tests
目的 对梅尼埃病(Meniere's disease)患者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磁共振(three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging,3D-FLAIR MRI)扫描,将影像学显示的膜迷路积水情况与临床听力及前庭功能检查结果进行比较,探讨经鼓室钆注射内耳成像磁共振在梅尼埃病诊断中的应用价值.方法 32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对比剂钆喷酸葡胺稀释液,24 h后行3D-FLAIR MRI和三维平衡快速梯度回波磁共振扫描,观察双侧耳蜗、前庭和半规管外淋巴间隙的增强显影,对耳蜗底转鼓阶和前庭阶分别进行评分,并对前庭外淋巴间隙显影范围进行测量.患者常规行纯音测听、冷热试验、前庭诱发肌源性电位(vestibular evoked myogenic potential,VEMP)和耳蜗电图检查.将患侧耳蜗底转前庭阶评分及前庭外淋巴间隙显影范围分别按纯音测听、冷热试验、VEMP、耳蜗电图的检查结果分组进行比较,采用SPSS17.0统计软件进行数据分析.结果 全部患者内耳3D-FLAIR MRI均显示对比剂钆广泛分布于耳蜗、前庭和半规管的外淋巴间隙,可清晰对比显示内淋巴间隙.患侧耳蜗底转前庭阶评分值与健侧比较,差异具有统计学意义(Z=4.309,P＜0.05)；患侧与健侧前庭外淋巴间隙显影范围(-x±s)分别为(6.04±2.89)mm2和(8.28±3.04) mm2,二者比较差异具有统计学意义(t =3.322,P ＜0.05).VEMP异常组患者与VEMP正常组比较,患侧前庭显影范围明显缩小,差异具有统计学意义(F=11.96,P＜0.05).耳蜗电图异常组患者与正常组比较,耳蜗底转前庭阶评分明显偏低,差异具有统计学意义(Z=3.17,P＜0.05).患侧耳蜗前庭阶评分及前庭显影范围与患者听力水平及冷热试验结果无明显相关.结论 经鼓室钆注射内耳3 D-FLAIRMRI可以区分内、外淋巴间隙的边界,显示膜迷路积水情况,可为梅尼埃病的诊断提供影像学参考.VEMP和耳蜗电图检查结果可能与前庭和耳蜗积水程度有一定相关性.
目的 對梅尼埃病(Meniere's disease)患者採用經鼓膜穿刺鼓室內註入對比劑釓、內耳三維快速液體衰減反轉恢複磁共振(three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging,3D-FLAIR MRI)掃描,將影像學顯示的膜迷路積水情況與臨床聽力及前庭功能檢查結果進行比較,探討經鼓室釓註射內耳成像磁共振在梅尼埃病診斷中的應用價值.方法 32例經臨床確診的單側梅尼埃病患者,雙側耳均經鼓膜穿刺鼓室內註入對比劑釓噴痠葡胺稀釋液,24 h後行3D-FLAIR MRI和三維平衡快速梯度迴波磁共振掃描,觀察雙側耳蝸、前庭和半規管外淋巴間隙的增彊顯影,對耳蝸底轉鼓階和前庭階分彆進行評分,併對前庭外淋巴間隙顯影範圍進行測量.患者常規行純音測聽、冷熱試驗、前庭誘髮肌源性電位(vestibular evoked myogenic potential,VEMP)和耳蝸電圖檢查.將患側耳蝸底轉前庭階評分及前庭外淋巴間隙顯影範圍分彆按純音測聽、冷熱試驗、VEMP、耳蝸電圖的檢查結果分組進行比較,採用SPSS17.0統計軟件進行數據分析.結果 全部患者內耳3D-FLAIR MRI均顯示對比劑釓廣汎分佈于耳蝸、前庭和半規管的外淋巴間隙,可清晰對比顯示內淋巴間隙.患側耳蝸底轉前庭階評分值與健側比較,差異具有統計學意義(Z=4.309,P＜0.05)；患側與健側前庭外淋巴間隙顯影範圍(-x±s)分彆為(6.04±2.89)mm2和(8.28±3.04) mm2,二者比較差異具有統計學意義(t =3.322,P ＜0.05).VEMP異常組患者與VEMP正常組比較,患側前庭顯影範圍明顯縮小,差異具有統計學意義(F=11.96,P＜0.05).耳蝸電圖異常組患者與正常組比較,耳蝸底轉前庭階評分明顯偏低,差異具有統計學意義(Z=3.17,P＜0.05).患側耳蝸前庭階評分及前庭顯影範圍與患者聽力水平及冷熱試驗結果無明顯相關.結論 經鼓室釓註射內耳3 D-FLAIRMRI可以區分內、外淋巴間隙的邊界,顯示膜迷路積水情況,可為梅尼埃病的診斷提供影像學參攷.VEMP和耳蝸電圖檢查結果可能與前庭和耳蝸積水程度有一定相關性.
목적 대매니애병(Meniere's disease)환자채용경고막천자고실내주입대비제구、내이삼유쾌속액체쇠감반전회복자공진(three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging,3D-FLAIR MRI)소묘,장영상학현시적막미로적수정황여림상은력급전정공능검사결과진행비교,탐토경고실구주사내이성상자공진재매니애병진단중적응용개치.방법 32례경림상학진적단측매니애병환자,쌍측이균경고막천자고실내주입대비제구분산포알희석액,24 h후행3D-FLAIR MRI화삼유평형쾌속제도회파자공진소묘,관찰쌍측이와、전정화반규관외림파간극적증강현영,대이와저전고계화전정계분별진행평분,병대전정외림파간극현영범위진행측량.환자상규행순음측은、랭열시험、전정유발기원성전위(vestibular evoked myogenic potential,VEMP)화이와전도검사.장환측이와저전전정계평분급전정외림파간극현영범위분별안순음측은、랭열시험、VEMP、이와전도적검사결과분조진행비교,채용SPSS17.0통계연건진행수거분석.결과 전부환자내이3D-FLAIR MRI균현시대비제구엄범분포우이와、전정화반규관적외림파간극,가청석대비현시내림파간극.환측이와저전전정계평분치여건측비교,차이구유통계학의의(Z=4.309,P＜0.05)；환측여건측전정외림파간극현영범위(-x±s)분별위(6.04±2.89)mm2화(8.28±3.04) mm2,이자비교차이구유통계학의의(t =3.322,P ＜0.05).VEMP이상조환자여VEMP정상조비교,환측전정현영범위명현축소,차이구유통계학의의(F=11.96,P＜0.05).이와전도이상조환자여정상조비교,이와저전전정계평분명현편저,차이구유통계학의의(Z=3.17,P＜0.05).환측이와전정계평분급전정현영범위여환자은력수평급랭열시험결과무명현상관.결론 경고실구주사내이3 D-FLAIRMRI가이구분내、외림파간극적변계,현시막미로적수정황,가위매니애병적진단제공영상학삼고.VEMP화이와전도검사결과가능여전정화이와적수정도유일정상관성.
Objective To study the feasibility of endolymphatic visualization and the diagnosis of Meniere's disease by applying intratympanic gadolinium adminstration through the tympanic membrance and three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI).To study the relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests,such as pure tone audiometry (PTA),electrocochleography (EcoG),caloric test and vestibular evoked myogenic potential (VEMP).Methods With a three Tesla magnetic resonance imaging (MRI) unit,3D-FLAIR imaging was performed 24 hours after intratympanic gadolinium through the tympanic membrance in 32 patients with clinically diagnosed unilateral Meniere's Disease.We visualized the enhanced imaging of perilymphatic space in bilateral cochlea,vestibular and (or) canal,scoring scala tympani and scala vestibule of bilateral cochlear basal turn respectively and measuring the developing area of bilateral vestibule and the signal intensity ratio (SIR) between the vestibule and the brain stem subjectively.PTA,EcoG,caloric test and VEMP were performed.The relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests were studied.Results The gadolinium appeared in almost all parts of the perilymph in cochlea,vestibular and (or) canals in all 32 patients' inner ears,so the endolymphatic space was clearly shown on 3D-FLAIR imaging.The scala vestibuli score value between the affected side and the healthy side were statistically significant (Z =4.309,P ＜ 0.05).The developing vestibular area between the affected side and the healthy side [(6.04 ± 2.89) mm2,(8.28 ± 3.04) mm2] were statistically significant (t =3.322,P ＜ 0.05).Abnormal vestibular evoked myogenic potentials were significantly correlated with the developing vestibular area of the affected side (F =11.96,P ＜ 0.05).Abnormal electrocochleography were significantly correlated with scala vestibuli score value of cochlear basal turn in the affected side (Z =3.17,P ＜ 0.05).No significant correlation was found between the scala vestibuli score value or the developing vestibular area and caloric test or PTA findings.Conclusions 3D-FLAIR MRI with intratympanic gadolinium injection through the tympanic membrance can discriminate the border between the perilymph and the endolymph and show endolymphatic hydrops.This method may provide radiographic reference for the diagnosis of Meniere's disease.The results of VEMP and electrocochleography might have appropriate correlation with degree of vestibular and cochlear hydrops.
