高场强磁共振成像对儿童感音神经性耳聋的诊断价值

发布时间：2018-02-03 00:41

  本文关键词： 耳聋 感音神经性 儿童 磁共振成像　出处：《山东大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的： 探讨MRI在儿童感音神经性耳聋(sensorinueral hearing loss,SNHL)中的成像特点及诊断价值。 材料与方法： 1.一般材料：应用Philips Achieva1.5T超导型磁共振扫描仪、头部正交线圈,对经临床初诊为双耳感音神经性耳聋的52例儿童患者及24例无听力损失儿童(对照组)分别进行颅脑常规磁共振成像和T2W-3D-DRIVE序列轴位水成像。所有患儿检查前家长均签署知情同意书。检查前对不能保持平静呼吸的患儿口服5%水合氯醛镇静。 2.方法： 扫描序列：轴位T1WI序列(TE/15ms,TR/550ms,层厚/4mmm,层间距/0.4mm,层数/20层)；T2WI序列(TE/150ms,TRshortest,层厚/4mm,层间距/0.4mm,层数/20层)；T2-FLAIR序列(TE/120ms, TR/6000ms, TI/2000ms,层厚/4mm,层间距/0.4mm,层数/20层)；弥散加权成像(DWI:TE/50ms,TRshortest,b值/1000,层厚/4mm,层间距/0.4mm,层数/20层)。T2W-3D-DRIVE序列(TE/200ms, TR/2000ms, Flip/90°,层厚0.5mm,无间距连续扫描,FOV130～180mm,矩阵/256×256；NSA/2次)。MRI水成像扫描方法：为了获得精确的内耳解剖结构及其位置关系,使进床的定位线尽量能通过双侧耳廓的相同位置(眦耳线),以T2WI显示的内耳为定位中心进行高分辨三维快速自旋回波(3D/DRIVE)的轴位扫描,扫描范围准确包括全部的内耳结构。后期在工作站进行各方位MIP和MPR重组,部分进行VRT重组,获得各个方位(包括冠状位、斜矢状位)的迷路图像,利用MIP重组方法多角度多方位旋转分别测前庭最大径、前庭垂直径、3个半规管最大径和管径、蜗高。 3.统计学处理：采用SPSS17.0统计软件对测量结果进行两样本均数比较t检验或t’检验或u检验,P0.05为差异有统计学意义。同时计算对照组儿童上述内耳各观察结构MRI测量值的95%双侧医学参考值范围。 结果： 1.常规颅脑MRI可以清晰显示脑内病变。T2-DRIVE-HR SENSE图像及多平面重组(MPR)可清晰显示内耳膜迷路、内听道内的精细解剖结构及微小病变,52例SNHL儿童及对照组儿童耳蜗前庭神经显示率达到100%,内耳道内血管(迷路动脉或小脑下动脉)显示率为38.5%。最大信号强度投影(MIP)重组可获得明了可观的膜迷路三维立体图像。 2.52例SNHL患儿中发现19例异常(阳性率36.5%),其中双侧脑白质病8例,双侧脑白质病并右侧大脑半球发育不良1例；双耳前庭导水管扩大综合征(large vestibular aqueduct syndrome, LVAS)6例(图5)；双耳半规管发育不良2例(1例伴有前庭及前庭导水管扩大,图6)；Mondini畸形2例(耳蜗发育不全仅有1.5圈,伴有前庭小、半规管发育不全,图7)；依据以上测量前MRI检查结果,将52例SNHL患儿分为四组：脑白质病变组(9例18耳)、LVAS组(6例12耳)、内耳复杂畸形组(4例8耳),MRI阴性组(33例66耳)。 3.MIP重组图像上：参照对照组各内耳结构测量值界定的95%双侧医学参考值范围,脑白质病变组、LVAS组所有内耳结构测量值均超过半数以上属95%双侧范围；MRI阴性组除前庭垂直径外,其他内耳结构测量值均超过半数以上属95%双侧范围；而内耳复杂畸形组大部分测量值在95%双侧范围外。SNHL组和对照组的前庭最大径垂直径、后半规管最大径和管径、水平半规管最大径和管径、蜗高的测量值有统计学差异；脑白质病变组和对照组的前庭最大径和垂直径、后半规管最大径和管径、水平半规管管径及蜗高的测量值有统计学差异；LVAS组和对照组的前庭最大径、后半规管管径、水平半规管最大径及蜗高的测量值有统计学差异；内耳复杂畸形组例数较少,各内耳结构测量均值如表2,未做统计比较；MRI阴性组和对照组的前庭最大径和垂直径、上半规管的最大径和管径、后半规管和水平半规管最大径、蜗高的测量值有统计学差异。 结论： 1.3D-DRIVE内耳水成像序列能够清晰显示内耳膜迷路、内听道神经及部分微小血管,弥补了CT只能显示骨迷路的不足,对LVAS及内耳复杂畸形的检出有重要意义。 2.常规颅脑MRI对显示脑白质病等脑内病变有重要意义,联合内耳水成像对诊断儿童感音神经性耳聋有着重要的临床价值,是SNHL患儿进行人工耳蜗术前的必要检查。 3.与对照组比较,MRI阴性组存在内耳不同结构MRI测量值均值的差异,其与SNHL是否存在病因学相关性,有待进一步研究。
[Abstract]:Objective:
To explore the imaging features and diagnostic value of MRI in sensorinueral hearing loss (SNHL).
Materials and methods:
1. general materials: Philips Achieva1.5T superconducting magnetic resonance scanner head orthogonal coil of clinically diagnosed as 52 cases of children with bilateral sensorineural hearing loss and 24 cases without hearing loss in children (control group) were conventional brain magnetic resonance imaging and T2W-3D-DRIVE weighted axial water imaging with parents before checking. Signed informed consent. Unable to keep quiet breathing check before oral 5% chloral hydrate sedation.
The 2. method:
Scanning sequence: axial T1WI sequence (TE/15ms, TR/550ms, thickness /4mmm, spacing /0.4mm, layer /20 layer); T2WI sequence (TE/150ms, TRshortest, thickness /4mm, spacing /0.4mm, layer /20 layer); T2-FLAIR sequence (TE/120ms, TR/6000ms, TI/2000ms, thickness /4mm, spacing /0.4mm, number /20 layer); diffusion weighted imaging (DWI:TE/50ms, TRshortest, b value /1000, thickness /4mm, spacing /0.4mm, layers of /20 layer).T2W-3D-DRIVE sequence (TE/200ms, TR/2000ms, Flip/90, 0.5mm thickness, gapless continuous scanning, FOV130 ~ 180mm, matrix /256 * 256; NSA/2).MRI water imaging scanning method in order to obtain accurate anatomic structure and position of the inner ear, the positioning line into the bed as much as possible through the same location of the bilateral auricular (canthomeatal line), with T2WI display of the inner ear as location center for high resolution 3D fast spin echo (3D/DRIVE) axial scan, scan range In the inner ear structures. Accurate including later each range MIP and MPR recombination in the workstation, part of VRT recombination and obtain all directions (including coronal, oblique sagittal) of the lost image, using MIP recombination method of multi angle rotation were measured in vestibular maximum diameter, vertical diameter 3 vestibule, semicircular canal maximum the diameter and diameter of worm.
3. statistical analysis: the results were two samples were compared with t test or t test or u test using SPSS17.0 statistical software P0.05, the difference was statistically significant. At the same time calculation of the 95% bilateral medical reference group of children above the inner ear structure observation MRI measurement range of the control.
Result锛，

本文编号：1485919