多层螺旋CT后处理技术在蜗神经管及听骨链病变诊断中的应用

发布时间：2018-04-17 20:53

本文选题：骨性蜗神经管 + 体层摄影术　；参考：《山东大学》2012年博士论文

【摘要】：第一部分CT仿真内窥镜在诊断骨性蜗神经管发育不良中的初步应用研究目的：回顾性评价螺旋状结构消失做为CT仿真内窥镜诊断骨性蜗神经管发育不良的可行性。研究方法：病例组包括14例骨性蜗神经管发育不良患者(平均年龄5.5岁,1-15岁,6男,8女),共20耳。对照组由没有内耳及内听道疾患的50例(平均年龄6.6岁,1-15岁,29男,21女)受试者组成,共100耳。3例病人和9例对照组受试者采用4排多层螺旋CT(MX8000)扫描；11例病人和41例对照组受试者应用16排多层螺旋CT (Somatom Sensation16)或64排多层螺旋CT (Somatom Sensation Cardiac64)扫描。每个受试者仰卧位,头放在中立位置,下颏无旋转,扫描基线为瑞德基线。扫描方向：从上到下；双侧颞骨均扫描。扫描参数如下：MX8000多层螺旋CT：电压120kV；电流150mAs；层厚0.6mm；准直0.5mm；螺距0.875；重建间隔50%；骨算法重建；视野250mm。Sensation16和Sensation64多层螺旋CT：电压120kV；电流150mAs；层厚0.6mm；准直0.6mm；螺距0.5；重建间隔50%；卷积核B70；视野250mm。仿真内窥镜观察骨性蜗神经管采用Fly through技术(Fly Through,3D)。视轴垂直于检查平面,仿真内窥镜视点放在内听道底的前下象限处,指向蜗轴,调整视点位置、视轴方向,如果仿真内窥镜阂值设置如下：下限阈值850-1150,上限阈值3071,在蜗区会出现与螺旋孔列相对应的螺旋状结构。中央管指的是位于横嵴前下方的孔；螺旋状结构指的是位于蜗区的,中央管周围的螺旋状裂隙。阳性结果指螺旋状结构或者中央管的消失；阴性结果指螺旋状结构或者中央管的存在。两个放射科医师独立评价螺旋状结构是否存在。以临床及常规影像诊断结果作为骨性蜗神经管发育不良的诊断金标准。计量资料用Mann-Whitney U检验,计数资料用卡方检验或Fisher确切检验。计算观察者间一致性及CT仿真内窥镜诊断骨性蜗神经管发育不良的敏感性、特异性、准确率、Youden指数。结果：病例组及对照组在年龄(P=0.335)、性别(P=0.314)、左右侧(P=0.683)上无统计学差异。诊断为骨性蜗神经管发育不良的20耳(右11,左9)中,17例未显示螺旋状结构,3例显示螺旋状结构,对照组中均显示螺旋状结构。观察者间有大量一致性(K=0.773)。以螺旋状结构消失做为征象诊断骨性蜗神经管发育不良的敏感性、特异性、准确率、Youden指数分别为85%,100%,98%,0.85。螺旋状结构消失在病例组及对照组之间有明显的统计学差异(P0.001)。诊断为骨性蜗神经管发育不良的20耳中,5例未显示中央管,对照组中均显示中央管。以中央管消失做为征象诊断骨性蜗神经管发育不良的敏感性、特异性、准确率、Youden指数分别为25%,100%,88%,0.25。中央管消失在病例组及对照组之间有明显的统计学差异。虽然螺旋状结构消失和中央管消失在诊断骨性蜗神经管发育不良有相似的特异度,但是前者有更好的敏感性和准确率。结论：以螺旋状结构消失做为征象诊断骨性蜗神经管发育不良有高的敏感性、特异性、准确率和观察者间一致性,螺旋状结构消失可以作为诊断骨性蜗神经管发育不良的有用征象。第二部分听骨链连接关系层面诊断锤砧复合体中断的临床价值研究目的：评价听骨链连接关系层面诊断锤砧复合体中断的价值。研究方法：收集经手术证实锤砧复合体中断的患者74例(共85耳),男45例,女29例,年龄3-75岁,平均年龄35.7岁,其中11例双耳患病。所有患者均应用16排多层螺旋CT (Somatom Sensation16)扫描。受试者仰卧位,头放在中立位置,下颏无旋转,扫描基线为瑞德基线。横轴位扫描参数：电压120kV；电流350mAs；层厚0.6mm；螺距0.8；重建间隔0.3mm；视野12cm；卷积核B70。听骨链连接关系层面由两个放射科医师独立制作,选择MIP重建,层厚3mm,各解剖结构的定位在轴位及冠状位上确认。听骨链连接关系层面的制作：在轴位图像上参考线平行于锤骨颈和砧磴关节的连线,在冠状位图像上参考线平行于砧骨长脚。放射科医师阅读这些层面,判断下列各段(锤骨头、锤骨颈、锤骨柄、锤砧关节、砧骨短脚、砧骨体、砧骨长脚)是否连续(阴性)或中断(阳性)。同时判断锤砧复合体各组成部分及其中断部位能否在同一个听骨链连接关系层面显示。两个放射科医师独立评价,不一致的协商解决达成一致做为最后的结果。以手术证实的上述各段的连续或中断做为评价的金标准。分类资料用McNemar检验。计算敏感性、特异性、准确率、Youden指数、观察者间一致性。结果：直接轴位图像诊断锤砧复合体中断结果如下：锤骨头(n=21)、锤骨颈(n=20)、锤骨柄(n=23)、锤砧关节(n=7)、砧骨短脚(n=25)、砧骨体(n=35)、砧骨长脚(n=63)。听骨链连接关系层面诊断锤砧复合体中断结果如下：锤骨头(n=20)、锤骨颈(n=19)、锤骨柄(n=26)、锤砧关节(n=10)、砧骨短脚(n=28)、砧骨体(n=34)、砧骨长脚(n=66)。手术证实锤砧复合体中断结果如下：锤骨头(n=22)、锤骨颈(n=21)、锤骨柄(n=27)、锤砧关节(n=11)、砧骨短脚(n=26)、砧骨体(n=35)、砧骨长脚(n=68)。85耳的锤骨头、锤骨颈、锤骨柄、锤砧关节、砧骨体及砧骨长脚及其中断部位均可在同一个听骨链连接关系层面显示。85耳的砧骨短脚及其中断部位需要在多个听骨链连接关系层面上显示。在诊断锤砧复合体中断中听骨链连接关系层面和轴位图像没有统计学差别。听骨链连接关系层面诊断锤砧复合体中断的敏感性：锤骨头90.9%、锤骨颈90.5%,、锤骨柄96.3%、锤砧关节90.9%、砧骨短脚71.4%、砧骨体94.3%、砧骨长脚97.1%；特异度：锤骨头100.0%、锤骨颈100.0%,、锤骨柄100.0%、锤砧关节100.0%、砧骨短脚89.5%、砧骨体98.0%、砧骨长脚100.0%；阴性预测值：锤骨头96.9%、锤骨颈97.0%,、锤骨柄98.3%、锤砧关节98.7%、砧骨短脚86.4%、砧骨体96.1%、砧骨长脚89.5%；Youden指数：锤骨头0.909、锤骨颈0.905、锤骨柄0.963、锤砧关节0.909、砧骨短脚0.609、砧骨体0.923、砧骨长脚0.971。在评价锤骨、锤砧关节、砧骨体、砧骨长脚时Youden指数较高；在评价砧骨短脚时Youden指数较低。评价锤骨时,Youden指数最高的是锤骨柄,次之的是锤骨头,最低的是锤骨颈。评价锤砧关节、砧骨体、砧骨长脚的Youden指数也较高。两个放射医师用听骨链连接关系层面诊断锤砧复合体中断的观察者间一致性如下：锤骨头0.90、锤骨颈0.94、锤骨柄0.95、锤砧关节0.89、砧骨短脚0.75、砧骨体0.85、砧骨长脚0.93。结论：听骨链连接关系层面可以代替直接轴位图像诊断锤砧复合体中断；听骨链连接关系层面可在同一个层面上显示锤砧复合体的大部分结构和病变,有较高的临床价值。
[Abstract]:Preliminary application of first part CT virtual endoscopy in the diagnosis of dysplasia of the cochlear nerve canal

Objective : To retrospectively evaluate the feasibility of spiral structure disappearance as CT virtual endoscopy for diagnosing the dysplasia of the cochlear nerve canal .

Methods : A total of 50 cases ( mean age of 5.5 years , 1 - 15 years old , 6 male , 8 female ) were included in the case group . The control group consisted of 50 cases ( mean age of 6.6 years , 1 - 15 years old , 29 male , 21 female ) who had no inner ear and internal auditory canal disease , and the control group consisted of 100 ears . 3 patients and 9 control subjects were scanned with 4 rows of multi - slice spiral CT ( MX8000 ) ;
11 patients and 41 control subjects were scanned with 16 - row multi - slice spiral CT ( Somatom Sensation16 ) or 64 - row multi - slice spiral CT ( Somatom sensationcardioac64 ) . Each subject was supine , the head was placed in a neutral position , the chin did not rotate , and the scan baseline was from the baseline . The scan direction : from top to bottom ;
The scanning parameters are as follows : MX8000 multi - slice spiral CT : voltage 120kV ;
current 150mAs ;
the thickness of the layer is 0.6mm ;
collimation 0.5mm ;
Pitch 0.875 ;
the reconstruction interval is 50 % ;
Reconstruction of bone algorithm ;
Field of view 250mm . Sensation16 and Sensation64 multi - slice spiral CT : voltage 120kV ;
current 150mAs ;
the thickness of the layer is 0.6mm ;
collimation 0.6mm ;
Pitch 0.5 ;
the reconstruction interval is 50 % ;
convolution kernel B70 ;
The field of view is 250mm .

Fly Through ( 3D ) was used to observe the bone cochlear nerve canal . the visual axis is perpendicular to the inspection plane , the simulated endoscope viewpoint is positioned at the front lower quadrant of the inner auditory canal bottom , points to the scroll axis , adjusts the viewpoint position and the optic axis direction , and if the simulated endoscopic threshold value is set as follows : the lower limit threshold value is 850 - 1150 and the upper limit threshold value 3071 , the spiral structure corresponding to the spiral hole column appears in the scroll region .
The spiral structure refers to the spiral fracture around the central tube in the cochlear area . The positive result refers to the disappearance of the spiral structure or the central tube ;
The negative result refers to the presence of a helical structure or a central tube .

Two radiologists independently evaluated the existence of spiral structures . The diagnostic results of clinical and conventional imaging were used as the diagnostic criteria for dysplasia of the cochlear nerve . The statistical data was examined by Mann - Whitney U . The statistics were examined by Chi - square test or Fisher ' s exact test . The sensitivity , specificity , accuracy and Youden index were calculated by using the Mann - Whitney U test .

Results : There was no statistical difference between the case group and the control group at age ( P = 0.335 ) , sex ( P = 0.314 ) , left and right sides ( P = 0.683 ) .

The sensitivity , specificity , accuracy and Youden index were 25 % , 100 % , 88 % and 0.25 respectively .

Conclusion : The disappearance of spiral structure is a useful sign for the diagnosis of dysplasia of the cochlear nerve canal with high sensitivity , specificity , accuracy and inter - observer agreement .

The clinical value of diagnosis hammer anvil complex interruption in the second part of icular chain connection relation level

Objective : To evaluate the value of the disruption of the hammer anvil complex at the level of the connection relationship between the auditory and the icular chain .

Methods : 74 patients ( 85 ears ) , 45 male , 29 female , aged 3 - 75 years , with a mean age of 33.7 years , were collected . All patients were scanned with 16 - row multi - slice spiral CT ( Somatom Sensation16 ) .
Current 350mAs ;
the thickness of the layer is 0.6mm ;
Pitch 0.8 ;
the reconstruction interval is 0.3 mm ;
the field of view is 12 cm ;
Convolution kernel B70 .

The relationship level of the icular chain connection was made by two radiologists , MIP reconstruction was chosen , the thickness of the layer was 3mm , the location of each anatomical structure was confirmed at the axial position and coronal position .

Results : The results were as follows : hammer head ( n = 21 ) , malleolar neck ( n = 20 ) , malleus stem ( n = 23 ) , hammer anvil joint ( n = 7 ) , short foot ( n = 25 ) , anvil body ( n = 35 ) and foot ( n = 63 ) .

The sensitivity of the diagnosis hammer anvil complex was 90.9 % , 90.5 % , 95.3 % , 90.9 % , 71.4 % , 94.3 % and 97.1 % respectively .
specificity : 100.0 % of hammer head , 100.0 % of hammer neck , 100.0 % of malleus stem , 100.0 % of hammer anvil joint , 89.5 % of short foot of anvil , 91.0 % of incus body and 100.0 % of the long foot of the anvil ;
The negative predictive value was 96.9 % of the hammer bone , 97.0 % of the hammer ' s neck , 98 . 3 % of the malleus , 98 . 7 % of the anvil joint , 86.4 % of the short foot of the anvil , 96.1 % of the anvil body and 89.5 % of the long foot of the anvil ;
Youden index : hammer head 0.909 , hammer neck 0.905 , hammer stem 0.9963 , hammer anvil joint 0.909 , anvil short foot 0.609 , anvil body 0.923 , anvil long leg 0.9971 .

Youden index was higher when evaluating malleus , hammer anvil joint , incus body and anvil .
The Youden index was lower during the evaluation of the rootstocks . When the malleus was evaluated , the Youden index was the highest in the malleolus , the lowest was the hammer head , and the lowest was the malleolus . The Youden index of the anvil joint , the anvil and the anvil was also higher .

The inter - observer agreement between the two radiologists to diagnose the interruption of the hammer anvil complex was as follows : the weight of the hammer was 0.90 , the malleolus was 0.94 , the malleolus was 0.95 , the hammer anvil joint was 0.89 , the short leg of the anvil was 0.75 , the anvil body was 0.85 , and the length of the anvil was 0.93 .

Conclusion : It is possible to replace the direct axial position image diagnosis hammer anvil complex with the connection relation level of the icular chain link ;
At the same level , the structure and the lesion of the anvil complex can be displayed at the same level , which has higher clinical value .

【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R764

【参考文献】