感音神经性耳聋的DTI及MRI的研究

发布时间：2018-02-09 21:44

本文关键词： 双侧感音神经性耳聋磁共振扩散张量成像磁共振内耳水成像感音神经性耳聋内耳畸形磁共振内耳水成像人工耳蜗植入　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：第一部分 DTI在评价双侧感音神经性耳聋患儿听觉通路的价值目的利用磁共振扩散张量成像(diffusion tensor imaging,DTI)技术对双侧感音神经性耳聋(bilateral sensorineural hearing loss,BSNHL)患儿的听觉传导通路进行研究,比较不同程度BSNHL患儿与正常儿之间听觉传导通路是否存在差异;观察BSNHL患儿、正常儿的听觉传导通路随年龄的变化。资料与方法本实验采用西门子3.0T skyra磁共振(Magnetic Resonance Imaging,MRI)对21例共42耳经听力学检查确诊为BSNHL的患儿及24例共48耳正常婴幼儿进行DTI数据采集,同时进行磁共振内耳水成像扫描以排除内耳畸形病例。所纳入实验组中的患儿双耳听力受损程度相同,男10例,女11例,年龄为2-12月龄儿,平均年龄为6.3±3.2月;对照组为来我院行MRI颅脑检查的且常规MRI检查未见任何脑部异常的婴幼儿,这些被检查者在出生3天及42天均通过了听力筛查,男14例,女10例,年龄为2-14月龄,平均年龄为8.5±3.6月龄。分组情况根据纯音听力测试听阈值将BSNHL患儿划分为甲乙丙三组,分别为轻度、中度、重度(本研究中包括极重度)感音神经性耳聋,具体划分标准依据国际卫生组织(WHO-1997)的定义,我们将双耳听阈在26-40d B的轻度感音神经性耳聋患儿定义为甲组;双耳听阈在41-60d B的中度感音神经性耳聋患儿患儿定义为乙组;将双耳听阈"g61d B的重度及极重度感音神经性耳聋患儿定义为丙组。本实验选取下丘、内侧膝状体为感兴趣区(ROI),测量下丘及内侧膝状体部位的部分各向异性(fractional anisotropy,FA)。结果1、甲组与对照组各感兴趣区之间的FA值的差异无统计学意义(P0.05);2、乙组、丙组与对照组在下丘、内侧膝状体间的FA值的差异存在统计学意义(P0.05),且均小于对照组;3、正常对照组的FA值在2个ROIs都随年龄的增长而增大。结论1、中度、重度BSNHL患儿下丘、内侧膝状体的FA值下降,说明髓鞘化有所破坏;2、FA值在正常儿及轻度BSNHL的诊断中价值有限。3、正常儿童下丘及内侧膝状体部位的FA值随年龄的增长而增加,说明髓鞘化过程随年龄增长而不断进行。第二部分 MRI在感音神经性耳聋患儿耳蜗植入术中的价值目的对于重度、极重度由内耳畸形引起的感音神经性耳聋患儿最有效的治疗方法是人工耳蜗植入,但是Michel畸形、Mondini畸形、耳蜗未发育是耳蜗植入术禁忌症,且不同的内耳畸形对于手术开窗位置有着不同的影响,如果提前对患儿内耳结构不了解极易造成失误,从而给手术增加难度。本研究通过回顾性分析的方法探讨MRI在人工耳蜗植入术前的诊断价值,并通过与CT的检查结果相比探究MRI的优势所在。材料与方法收集我院2014年3月至2016年12月间在我院进行人工耳蜗术前筛查并拟行人工耳蜗植入术的150例(共300耳)患者的影像学资料,均被诊断为感音神经性耳聋。所有被检者均行颞骨CT扫描及后期重建、MRI颅脑平扫及内耳水成像及内耳三维重建,被检者年龄在8月龄至5岁之间,平均年龄为2.1±0.8岁,其中男98例,女52例。结果1、在150例共300耳患者中,Mondini畸形、Michel畸形、共同腔畸形及IP-I型、半规管畸形CT与MRI的检出率差异无统计学意义,而内听道狭窄、LAVS、蜗神经异常MRI的检查率高于CT,差异有统计学意义。2、MRI检出14例脑白质异常病例,检出率为9.3%。结论1、MR在内听道狭窄、LAVS、蜗神经异常的检出率方面优于CT。2、MRI有助于发现脑白质病变。
[Abstract]:Objective to evaluate the value of DTI in the first part of bilateral sensorineural hearing loss in children with auditory pathway using diffusion tensor magnetic resonance imaging (diffusion tensor, imaging, DTI) technology for bilateral sensorineural hearing loss (bilateral sensorineural hearing loss, BSNHL) of auditory pathway were studied and compared between different degrees of BSNHL children and normal hearing children whether there are differences in pathway BSNHL were observed; and the auditory pathway of normal children with age changes. Materials and methods this experiment adopts SIEMENS 3.0T skyra magnetic resonance (Magnetic Resonance Imaging, MRI) in 21 cases of 42 ears were diagnosed by audiological examination for BSNHL patients and 24 cases of 48 ears of normal infants DTI data at the same time acquisition, magnetic resonance imaging scans to exclude water inner ear malformations of inner ear cases. The experimental group included in the same degree of binaural hearing impaired children , male 10 cases, female 11 cases, aged 2-12 months old, the average age was 6.3 + 3.2 months; the control group in our hospital underwent brain MRI examine and conventional MRI examination showed no abnormal infants, these were born in 3 days and 42 days have passed the hearing screening, male in 14 cases, female 10 cases, aged 2-14 months old, the average age was 8.5 + 3.6 months. According to the grouping audiometery thresholds of BSNHL were divided into three groups, respectively, mild, moderate, severe (in the study include severe sensorineural hearing loss), specific classification standard according to the World Health Organization (WHO-1997) definition, we will define the binaural hearing threshold in mild sensorineural hearing loss in children with 26-40d B in group A; binaural hearing threshold in children with moderate sensorineural hearing loss in children with 41-60d B for the definition of group B; g61d B "binaural hearing threshold will be severe and very severe sensorineural Deaf children is defined as C group. In this experiment, inferior colliculus, medial geniculate body for the region of interest (ROI), part of the anisotropy of the position measurement of inferior colliculus and medial geniculate body (fractional, anisotropy, FA). The results of the 1, there was no significant difference between the observation group and control group in each region of interest FA value (P0.05); 2, group B, group C and control group in the inferior colliculus, statistically significant differences between the FA value of the medial geniculate body (P0.05), and there were smaller than the control group; 3 normal control group, the FA value in 2 ROIs increase with age. Conclusion: 1, moderate and severe BSNHL children the inferior colliculus, medial geniculate body of FA decreased, indicating the damage of myelin sheath; 2, FA value in the diagnosis of normal and mild BSNHL value in.3 Co., part of the normal children inferior colliculus and medial geniculate body FA value increases with the increase of age, illustrate the process of myelination with age increasing. The second part MRI in the sense of value of nerve deafness in children with cochlear implantation in severe and extremely severe caused by a sense of inner ear malformation treatment of sensorineural deafness in children with cochlear implantation is the most effective, but Michel malformation, Mondini malformation, cochlear aplasia is cochlear implantation surgery contraindications, and for different inner ear malformation the operation position of the window has a different effect, if the children do not know in advance of the inner ear structure is easy to cause errors, so as to increase the difficulty of operation. Through the review of the value of MRI in diagnosis before cochlear implantation method of this study, and with the CT test results of MRI materials and advantages are compared. Methods 150 patients in our hospital from March 2014 to December 2016 in our hospital were cochlear preoperative screening and undergoing cochlear implantation (300 ears) with imaging, were A diagnosis of sensorineural hearing loss. All subjects underwent temporal bone CT scan and post reconstruction, brain MRI scan and three-dimensional reconstruction imaging of inner ear and inner ear water, subjects aged 8 month old to 5 years old, the average age was 2.1 + 0.8 years old, male 98 cases, female 52 cases. Results 1 in 150 cases, a total of 300 ears in patients with Mondini malformation, Michel malformation, common cavity malformation and type IP-I, CT and MRI were of semicircular canal malformations were not statistically significant, while the internal auditory canal stenosis, LAVS, cochlear abnormal MRI examination was higher than CT, there was a significant difference between the.2 and MRI were detected in 14 cases of brain white matter abnormalities, the detection rate was 9.3%. conclusion 1, MR, LAVS, stenotic, the detection rate is better than that of CT.2 cochlear nerve abnormalities, MRI helps to detect cerebral white matter lesions.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.43;R445.2

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