先天性感音聋幼儿的内耳形态学研究及听觉传导通路的DTI评估

发布时间：2018-06-06 09:32

本文选题：弥散张量成像 + 先天性感音神经性耳聋　；参考：《天津医科大学》2011年硕士论文

【摘要】：目的：探讨先天性感音神经性耳聋(CSNHL)患儿的蜗神经(CN)及内耳道(IAC)是否存在发育异常,并探讨CN发育与年龄及IAC大小的关系。应用磁共振扩散张量成像(DTI)技术评价CSNHL患儿中枢听觉传导通路的完整性及损伤情况,探讨听觉传导通路脑白质微观结构改变。方法：应用德国Siemens公司Magnetom Trio Tim MR 3.0T扫描仪对43例CSNHL患儿及15例听力正常对照(NC)者进行全脑的常规T1WI、T2WI扫描,、T2-SPACE及DTI扫描。T2-SPACE序列参数为：[TR/TE 1000/132ms,矩阵200×200]。DTI序列参数[TR/TE 10500/103ms,空间分辨率1.8×1.8×1.8LP/mm,b值分别取0、1000 s/mm2,方向20个]。测量所有研究对象双侧CN的水平径、横截面积、横截面周长及双侧内耳道的水平径、垂直径径线；并测量听觉传导通路上的斜方体(TB)、上橄榄核(SON)、下丘(IC)、内侧膝状体(MGB)、颞横回下白质(WTG)的部分各向异性(FA)、表面扩散系数(ADC)、横向扩散系数(λ(?))及纵向扩散系数(λ⊥)。用r检验,比较左右侧各径线有无统计学差别。将患儿按两个标准分组,①内耳结构是否异常②是否能感知声音。用LSD检验对组间CN径线进行比较。采用Pearson积差相关法对CN和IAC大小进行相关性分析。用t检验,比较左右侧两组间5个兴趣区(ROI)4个DTI参数值有无差异。将患儿按是否能感知声音分组。用LSD检验对组间5个兴趣区(ROI)4个DTI参数值进行比较。采用Pearson积差相关法对最敏感参数和年龄进行相关性分析。结果：1.43例患儿中,16例内耳畸形,其中大前庭9例,大前庭导水管8例。耳蜗螺旋畸形12例。2.CSNHL组、NC组CN左右侧横径、横截面积、横截面周长及IAC水平径、垂直径分别比较,均无统计学差异(P0.05)。3.CN横径、横截面积及横截面周长在内耳结构正常组患儿(Ⅰ组)、内耳结构异常组患儿(Ⅱ组)与正常对照组(Ⅲ组)间进行方差分析,存在统计学差异(P0.05)。Ⅰ组、Ⅱ组CSNHL患儿的CN横径、横截面积及横截面周长小于Ⅲ组对照组；Ⅰ组左侧CN面积大于Ⅱ组,均有统计学差异(P0.05)。4CN横径、横截面积及横截面周长在带助听器患儿组(甲组)、不带助听器患儿组(乙组)及正常对照组(丙组)间进行方差分析,存在统计学差异(P0.05)。甲组、乙组CSNHL患儿的CN横径、横截面积及横截面周长小于丙组对照组,差别有统计学意义(P0.05)。5. CSNHL患儿的CN横截面积和周长相对于NC组和年龄无明显的线性关系。6.CSNHL左侧IAC水平径与CN横截面积有线性关系。7.CSNHL组下丘及颞横回下白质的FA、ADC、λ∥、λ⊥左右侧比较差异有统计学意义(P0.05)。NC组下丘左右FA、ADC、λ∥、λ⊥有统计学差异(P0.05)。8.除斜方体外其他4个ROIs,甲组、乙组CSNHL患儿的FA与丙组之间均存在统计学差异(P0.05),且均小于丙组对照组；除颞横回下白质其他4个ROIs,甲组、乙组CSNHL患儿的λ⊥与丙组之间均存统计学差异(P0.05),且均大于丙组对照组。两组CSNHL患儿之间各参数均无统计学差异(P0.05)。9.正常对照组的FA值在5个ROIs都随着年龄的增长而增大,CSNHL组患儿5个ROIs的FA值与年龄并未存在相关。结论：本研究发现CSNHL患儿的CN大小比正常组略小。内耳结构可能会影响听神经的发育。CN横截面积为测量CN大小最敏感指标。幼儿左、右脑FA值不对称是先天形成的。CSNHL组4个ROIs的FA值下降,λ⊥升高,而ADC值和λ″没有改变,说明听神经纤维束有所破坏,但纤维束依然完整。下丘是对声音刺激影响最敏感部位。微弱的声音刺激对脑内听觉传导通路发育没有显著的影响。
[Abstract]:Objective: To investigate the developmental abnormalities of the cochlear nerve (CN) and the inner auditory canal (IAC) in children with congenital sensorineural deafness (CSNHL), and to explore the relationship between the development of the CN and the size of IAC. The integrity and damage of the central auditory pathway in children with CSNHL were evaluated by magnetic resonance diffusion tensor imaging (DTI), and the auditory conduction was discussed. The microstructural changes of the white matter in the brain of the road.
Methods: 43 children with CSNHL and 15 cases of normal hearing control (NC) were used to perform routine T1WI, T2WI scanning, T2-SPACE and DTI scanning sequence parameters of 43 children with CSNHL and 15 cases of normal hearing control (NC), using the Magnetom Trio Tim MR 3.0T scanner in Germany. .8LP/mm, b values were 01000 s/mm2, 20 directions, respectively. The horizontal diameter, cross section area, cross section circumference, horizontal diameter and vertical diameter line of the bilateral inner ear were measured in all the subjects, and the trapezoid (TB), the upper olivary nucleus (SON), the inferior colliculus (IC), the medial geniculate body (MGB), and the white matter (WTG) part of the temporal gyrus were measured. Anisotropy (FA), surface diffusion coefficient (ADC), transverse diffusion coefficient ([lambda] (?)) and longitudinal diffusion coefficient ([lambda]). By R test, there is no statistical difference between the left and right sides. The children are divided into two criteria, (1) whether the structure of the inner ear is abnormal and whether the sound can be perceived. The CN diameter between the groups is compared with the LSD test. The Pearson product difference phase is used. Correlation analysis of the size of CN and IAC. Using t test, comparing the 4 DTI parameters of 5 interest areas (ROI) between the left and right sides of the two groups. The children were grouped according to whether they could perceive sound. The 4 DTI parameters of the 5 interest areas (ROI) between the groups were compared with LSD test. The most sensitive parameters and age were compared by the Pearson product difference correlation method. The analysis of customs.
Results: of the 1.43 children, there were 16 cases of inner ear malformation, including 9 large vestibule, 8 cases of large vestibular aqueduct, 12 cases of cochlear spiral malformation,.2.CSNHL group, NC group CN lateral transverse diameter, cross section area, cross section circumference and IAC horizontal diameter, and there were no statistical differences (P0.05).3.CN transverse diameter, transverse area and cross section circumference were in the inner ear structure. Children (group I), children with abnormal structure of inner ear (Group II) and normal control group (Group III) carried out variance analysis, there was statistical difference (P0.05). Group I, group II, CSNHL children's CN transverse diameter, cross section area and cross section circumference less than group III control group, the left CN area in group I was larger than group II, there were statistical differences (P0.05).4CN transverse diameter, transverse The sectional area and the circumference of cross section in children with hearing aids (Jia Zu), without hearing aids children group (group B) and normal control group (Bing Zu) analysis of variance analysis, there were statistical differences (P0.05). Jia Zu, group B CSNHL children's CN transverse diameter, cross section area and cross section circumference is less than the control group, the difference is statistically significant (P0.05).5. CSNHL There was no significant linear relationship between the CN cross section area and the perimeter of the children compared with the NC group and the age..6.CSNHL left IAC horizontal diameter and the CN cross sectional area had a linear relationship with the FA, ADC, lambda and the left and right side of the white matter in the inferior colliculus and the temporal transverse gyrus of the.7.CSNHL group (P0.05), and there was a statistically significant difference between the left and right sides of the.NC group (P0.05), ADC, [lambda], and there were statistical differences. .05).8. except the other 4 ROIs in the orthopulse, there were statistical differences between group A and group B CSNHL (P0.05) between group B and group C (P0.05), and all were smaller than those in group C. The statistical difference between group A and group B CSNHL children except the other 4 ROIs, group a and group B CSNHL children was larger than that of group C (P0.05), and the two groups of CSNHL were in the two group. There was no statistical difference between the parameters of the children (P0.05) the FA value of the.9. normal control group increased with the age of 5 ROIs, and the FA value of 5 ROIs in the children of CSNHL group was not associated with age.
Conclusion: This study found that the size of CN in children with CSNHL was slightly smaller than that in the normal group. The inner ear structure may affect the.CN transverse area of the auditory nerve development as the most sensitive indicator of the measurement of the size of the CN. The FA value of the left and right FA in the left and right brain of young children is a decrease in the FA value of the 4 ROIs in the congenital.CSNHL group, and the ADC value and the lambda "are not changed, indicating the auditory nerve fiber. The vascular bundle is damaged, but the fiber bundle remains intact. The hypothalamus is the most sensitive part of the sound stimulation. Weak sound stimulation has no significant effect on the development of the auditory pathway in the brain.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764

【参考文献】