CAJ | 학술논문

目的：明确鼓室内钆造影剂注射后内耳显影对迟发性膜迷路积水（delayed endolymphatic hydrops ， DEH）诊断的临床价值，探讨迟发性膜迷路积水的病理机制。方法10例DEH患者行双鼓室钆造影剂注射24小时后行三维快速液体衰减反转恢复（three dimensional fluid－attenuated inversion recovery ，3D －FLAIR）序列和三维实时反转恢复（three dimensional real inversion recovery ，3D－real IR）序列扫描成像，分析患者内淋巴积水的范围及严重程度。结果10例DEH患者中9例为同侧型，1例为对侧型，均显示单侧或双侧内淋巴积水征象，其中9例同侧型DEH患者中仅1例（11．1％）患侧耳前庭内淋巴显示轻度积水，其余8例（88．9％）均显示患侧前庭内淋巴重度积水；8例（88．9％）同侧型DEH患者患侧耳蜗内淋巴积水，而1例（11．1％）同侧型DEH患者患侧耳蜗内淋巴无积水，9例同侧DEH患者对侧耳均未见前庭、耳蜗内淋巴积水。1例对侧型DEH患者的双侧前庭内淋巴重度积水，右侧耳蜗内淋巴轻度积水，而左侧耳蜗未见积水。结论内淋巴积水是DEH的主要病理因素，鼓室内钆注射后内耳显影能直观地反映出DEH患者内淋巴积水的范围及严重程度。
목적：명학고실내구조영제주사후내이현영대지발성막미로적수（delayed endolymphatic hydrops ， DEH）진단적림상개치，탐토지발성막미로적수적병리궤제。방법10례DEH환자행쌍고실구조영제주사24소시후행삼유쾌속액체쇠감반전회복（three dimensional fluid－attenuated inversion recovery ，3D －FLAIR）서렬화삼유실시반전회복（three dimensional real inversion recovery ，3D－real IR）서렬소묘성상，분석환자내림파적수적범위급엄중정도。결과10례DEH환자중9례위동측형，1례위대측형，균현시단측혹쌍측내림파적수정상，기중9례동측형DEH환자중부1례（11．1％）환측이전정내림파현시경도적수，기여8례（88．9％）균현시환측전정내림파중도적수；8례（88．9％）동측형DEH환자환측이와내림파적수，이1례（11．1％）동측형DEH환자환측이와내림파무적수，9례동측DEH환자대측이균미견전정、이와내림파적수。1례대측형DEH환자적쌍측전정내림파중도적수，우측이와내림파경도적수，이좌측이와미견적수。결론내림파적수시DEH적주요병리인소，고실내구주사후내이현영능직관지반영출DEH환자내림파적수적범위급엄중정도。
Objective To investigate the pathological mechanism of delayed endolymphatic hydrops(DEH) , and clarify the clinical value of endolymphatic space imaging after intratympanic injection of gadolinium in the diag_nosis of delayed endolymphatic hydrops .Methods Twenty -four hours after bilateral intratympanic injection of gadolinium ,the locations and severity of endolymphatic hydrops of all patients were evaluated by using three dimen_sional fluid-attenuated inversion recovery (3D -FLAIR) and three dimensional real inversionrecovery (3D -real IR) .ResuIts All patients had unilateral or bilateral endolymphatic hydrops .Among 9 ipsilateral DEH patients , only 1 (11 .1% ) patient was identified as mild endolymphatic hydrops and the rest (88 .9% ) examined had signifi_cant endolymphatic hydrops in vestibule of their affected ears ;Endolymphatic hydrops appeared in cochlea of the af_fected ear in 8 (88 .9% ) patients ,except for 1 patient .Endolymphatic hydrops were not observed in the contralater_al ears of 9 ipsilateral DEH patients .Mild endolymphatic hydrops in bilateral vestibule ,severe in right cochlear and none in left cochlea of contralateral DEH patient were identified .ConcIusion Endolymphatic hydrops is the primary pathological factors of DEH .Endolymphatic space imaging after intratympanic injection of gadolinium can intuitively reflect the locations and severity of endolymphatic hydrops in DEH patients .