正常人内耳内淋巴显像的研究

发布时间：2018-04-20 19:00

本文选题：内耳内淋巴显像 + 梅尼埃病　；参考：《山东大学》2010年硕士论文

【摘要】： 研究背景：梅尼埃病(Meniere's disease)是一种特发性内耳病,表现为反复发作的旋转性眩晕,波动性感音性听力损失,耳鸣和耳胀满感。梅尼埃病的基本病理改变为内耳膜迷路积水。由于无法对梅尼埃病患者进行活体病理检查,现阶段也无法通过检查手段证实内耳内淋巴积水,所以目前梅尼埃病的临床诊断主要依赖于典型症状,以及耳蜗电图(electrocochleography, EcochG)、前庭诱发肌源性电位(vestibular evoked myogenic potential, VEMP)、甘油试验和前庭功能检查等辅助推测内耳内淋巴积水的存在,缺乏影像学的客观诊断依据。特别是梅尼埃病的早期症状多不典型,难以与其他疾病进行鉴别,对梅尼埃病的早期诊断和治疗造成困难。因此内耳内淋巴显像对内淋巴积水的诊断具有重要意义。目前国际上对内耳内淋巴显像关注很多。近年来核磁增强造影剂的应用,使得人体的内耳内淋巴间隙得以显影。造影剂的给药方法也实现了由全身给药到局部给药,由有创给药方法到无创给药方法的发展,但是目前尚缺乏关于正常内耳内淋巴显像的研究。目的：本研究旨在通过无创性给药技术,即经咽鼓管中耳腔导入造影剂钆、行内耳MRI扫描,以健康正常受试者为研究对象证明内耳内淋巴显像的可行性及这种给药方法的安全性。方法：将28例正常受试者随机分成A组14人、B组14人,采用经咽鼓管置管中耳腔给药的方法,在耳内窥镜监视下A组给入稀释的钆喷酸葡胺,B组给地塞米松、钆喷酸葡胺混合稀释溶液,给药24小时后行内耳3D-FLAIR和2D-FLAIR MRI(3T核磁共振机)扫描。对A9志愿者分别在给药8小时和24小时后行内耳MRI扫描。给药前对受试者进行纯音测听、声阻抗测试、耳蜗电图、VEMP检查和耳部、鼻部检查,给药后1-2周、1个月时进行纯音测听和声阻抗测试。结果：1.给药时,A组9例正常受试者、B组8例正常受试者耳内窥镜下可见鼓室内液平面随给药进行而上升。 2.上述A组9例正常受试者、B组8例正常受试者内耳3D-FLAIR和2D-FLAIR MRI扫描图像可见耳蜗及前庭部外淋巴间隙增强显影,中阶和椭圆囊球囊呈暗性区域。编号A9的正常志愿者左耳给药8小时和24小时后分别扫描,可见给药24小时后较给药8小时后造影剂弥散范围更广。全组正常受试者中,经咽鼓管置管中耳腔造影剂导入行内耳MRI扫描成功率(内耳得到较强增强显影)为61%,其中研究初期的18例受试者成功率为44%,后期10例受试者成功率为90%。 3.28例正常受试者咽鼓管内置管时出现一过性刺痛,6例正常受试者给药过程中出现一过性旋转性眩晕,19例正常受试者出现耳胀闷感,6例正常受试者出现听力下降,20例正常受试者给药时出现流水样耳鸣,1例正常受试者出现咳嗽。上述症状均在给药结束后5分钟内消失。 4.给药后1-2周,共随访到25例正常受试者,其中24例复查纯音测听和声阻抗测试都在正常范围,与受试前纯音测听结果相较未见明显差异。B5正常受试者复查纯音测听听力图示气、骨导差,但声阻抗测试结果正常。给药1月后,共随访到24例正常受试者,24例受试者复查纯音测听和声阻抗测试都在正常范围,与受试前纯音测听和声阻抗测试结果相较未见明显差异。其中包括B5受试者。结论：经咽鼓管置管中耳腔造影剂导入是一种安全、有效、可行、痛苦和副反应较小的无创操作。经咽鼓管置管中耳腔造影剂导入行内耳MRI扫描能够得到内耳外淋巴间隙的增强显影,通过对比可显像内耳内淋巴间隙。造影剂随时间由耳蜗起始部和前庭向耳蜗顶转和半规管扩散。地塞米松对内耳的显影程度无明显影响。本研究为进一步以内淋巴积水为主要病理特征的一系列内耳病的内淋巴积水客观诊断的研究奠定了必要的基础。
[Abstract]:Background: Meniere's disease is a type of idiopathic internal ear disease, characterized by recurrent vertigo, recurrent hearing loss, tinnitus, and fullness of the ear. The basic pathological changes of Meniere's disease are intravastric labyrinthine hydrops. There is no current stage of biopsy for patients with Meniere's disease. The method of examination confirmed the inner ear lymphatic hydrops, so the clinical diagnosis of Meniere's disease mainly depends on the typical symptoms, electrocochleography (EcochG), the vestibular evoked myogenic potential (vestibular evoked myogenic potential, VEMP), the glycerol test and the vestibular function examination to conjecture the internal ear drenching. The existence of hydrocephalus is lack of an objective diagnostic basis for imaging. Especially, the early symptoms of Meniere's disease are mostly untypical. It is difficult to identify with other diseases and make it difficult for the early diagnosis and treatment of Meniere's disease. Therefore, internal ear lympho imaging is of great significance for the diagnosis of endolymphatic hydrops. The application of NMR contrast media in recent years has made the internal auditory space of the inner ear of the human body developed. The method of administration of the contrast agent has also realized the development of the local administration from the whole body to the local drug, from the invasive method to the noninvasive method, but there is still a lack of research on the normal inner ear lympho imaging.
Objective: the purpose of this study was to demonstrate the feasibility of internal auditory lympho imaging and the safety of this method by introducing the contrast agent gadolinium through the middle ear cavity of the eustachian tube through the noninvasive technique, that is, the MRI scan of the inner ear.
Methods: 28 normal subjects were randomly divided into group A 14 people, group B 14 people, using eustachian tube in the middle ear cavity administration method, under the ear endoscopy under the monitoring of A group to dilute gadolinium gadolinium acid meglumine, B group dexamethasone, gadolinium dexamethasone mixed dilution solution, after 24 hours, the internal ear 3D-FLAIR and 2D-FLAIR MRI (3T MRI) scan. The A9 volunteers were treated with MRI scan for 8 hours and 24 hours after administration. Before administration, the subjects were given pure tone audiometry, acoustic impedance test, cochlear electrogram, VEMP examination and ear, nasal examination, 1-2 weeks after administration and 1 months of pure tone audiometry and acoustic impedance test.
Results: 1. of the 9 normal subjects in group A and 8 normal subjects in group B, the fluid level in the tympanic cavity increased with drug administration.
2. of the 9 normal subjects in group A, 8 cases of normal subjects in group B showed enhanced imaging of the cochlea and the vestibule lymph space in the inner ear of the normal subjects. The middle and the oval sacs showed a dark area. The normal volunteers in the B group were given the left ear of the normal volunteers for 8 hours and 24 hours after 24 hours, and the drug was given 8 hours after the administration of the drug for 24 hours. In the whole group of normal subjects, the successful rate of MRI scan in the inner ear of the middle ear cavity through the eustachian tube catheterization was 61%. The success rate of the 18 subjects in the early study was 44%, and the success rate of the later 10 subjects was 90%..
3.28 cases of normal subjects had an excessive stabbing pain in the tube of eustachian tube, 6 normal subjects were given a sexual rotatory vertigo in the course of the administration, 19 normal subjects had ear distention, 6 normal subjects had hearing loss, 20 normal subjects were given the flow of water like tinnitus and 1 normal subjects had coughing. The symptoms disappeared within 5 minutes after the end of the administration.
4. after 1-2 weeks, a total of 25 normal subjects were followed up to 25 normal subjects, of which 24 cases of pure tone audiometry and acoustic impedance test were in normal range. There was no significant difference compared with the results of pure tone audiometry before the test..B5 normal subjects reviewed pure tone audiometry, bone conductance, but the results of acoustic impedance test were normal. After January, a total of 24 cases were followed up to 24 cases. In the subjects, 24 subjects were examined in the normal range of pure tone audiometry and acoustic impedance test. There was no significant difference compared with the results of pure tone audiometry and acoustic impedance test before the test, including B5 subjects.
Conclusion: the introduction of the middle ear cavity contrast agent through the eustachian tube is a safe, effective, feasible, noninvasive operation with less pain and side effects. The enhanced development of the inner ear lymphatic space can be obtained by MRI scan through the eustachian tube catheterization, and the internal auricular lymph space can be scintid by contrast. The contrast agent can be followed by the ear with the ear. The initial part of the cochlea and the vestibule to the cochlear apex and the semicircular canal diffused. Dexamethasone has no significant influence on the development of the inner ear. This study lays a necessary foundation for the objective diagnosis of endolymphatic hydrops in a series of internal ear diseases which are the main pathological features of the lymphatic water.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764.04

【参考文献】