MSCT后处理技术显示中耳炎听骨链完整性及其与听力水平相关性的研究

发布时间：2018-05-04 15:22

  本文选题：MPR + VR　； 参考：《蚌埠医学院》2017年硕士论文

【摘要】：研究目的通过MSCT常用的三种后处理技术:多平面重组(MPR)、容积再现(VR)及最大密度投影(MIP)观察正常中耳听骨链的形态结构;并基于此三种重建技术观察慢性中耳炎患者病耳听骨链的骨质破坏情况,将影像学诊断结果与术中所见进行对比,观察两者的一致性,从而探讨MSCT三维重建技术对中耳炎患者听骨链完整性显示的价值;同时评价听骨链破坏程度与听力水平的相关性。资料与方法选取蚌埠医学院第一附属医院耳鼻喉科收治的中耳炎、突聋、耳后瘘管及梅尼耳埃病患者(所选病例均剔除双侧耳病变患者),详细记录其临床症状、术前听力情况,应用64层螺旋CT,进行颞骨薄层螺旋扫描,按照纳入标准从受检者中选出正常组及疾病组共计63例将其数据传至ADW4.4工作站(Advanced Workstation 4.4),应用相关软件进行听骨链的三维重建。正常对照耳观察听骨链的形态结构;病变耳观察听骨链的改变及骨质破坏情况并和手术结果所见进行对比。选用SPSS21.0统计软件完成所需的统计学分析。结果(1)正常组锤骨头、锤骨颈、锤骨柄、锤砧关节、砧骨体、砧骨长脚、砧骨短脚这七个结构均能在MPR、VR及MIP上很好地显示,它们的显示率无明显差异,当把豆状突、砧镫关节和镫骨头看成一个整体时,这三种显示方式亦无明显差异。对镫骨前、后弓的显示,MPR与MIP之间无明显差异,都优于VR,且MPR在显示镫骨前弓上更好。VR和MIP都不能很好显示镫骨足板,MPR在显示镫骨足板上有较大优势。(2)病变组锤骨头、锤骨柄、砧骨长脚、砧骨短脚及锤砧关节骨质破坏MSCT诊断与手术结果比较,Kappa值均0.75,表明两者的一致性较好,砧镫关节及镫骨骨质破坏的比较,Kappa值分别为0.529, 0.538,表明两者的一致性一般。(3)中耳炎听小骨的破坏中,砧骨的破坏率最高;听力损失程度与听骨链的破坏呈正相关关系(rs'=0.824 , P0.01),听骨链破坏的程度越重,听力下降越严重,当听小骨破坏程度达到Ⅲ期时,气导听力损失一般在62dB以上。结论1. .MSCT后处理技术对正常听小骨大部分细微结构能够很好的显示,尤其是MPR技术对镫骨底板的显示;VR技术则不适用于镫骨的显示;MIP技术能够呈现出三维立体效果,操作起来省时,简单同时又能达到较高的显示效能,值得影像医生在实际工作中常规使用。2.对于鼓室内伴有软组织病灶的中耳炎患者,综合MSCT后处理技术可以准确的评估听小骨的破坏,为临床医生提供有价值信息。3.砧骨更容易受到破坏,听骨链的破坏程度与听力损失密切相关。
[Abstract]:Objective to observe the morphologic structure of the auditory chain of the normal middle ear by using three kinds of post-processing techniques commonly used in MSCT: multiplanar recombination, volumetric reconstruction and maximum density projection. The bone destruction of ossicular chain in patients with chronic otitis media was observed on the basis of these three reconstruction techniques. The imaging diagnosis results were compared with those during operation, and the consistency between the two methods was observed. To explore the value of MSCT three-dimensional reconstruction in displaying the ossicular chain integrity in patients with otitis media, and to evaluate the correlation between the degree of ossicular chain destruction and hearing level. Materials and methods patients with otitis media, sudden deafness, retroauricular fistula and Meniere's disease were selected from the Otolaryngology Department of the first affiliated Hospital of Bengbu Medical College. A total of 63 cases of normal group and disease group were selected according to the inclusion criteria to transmit their data to ADW4.4 workstation and Advanced Workstation 4.4 to reconstruct the auditory ossicular chain by using the relevant software. The morphological structure of ossicular chain was observed in normal control ears and the changes of ossicular chain and bone destruction in diseased ears were observed and compared with the results of operation. Use SPSS21.0 software to complete the required statistical analysis. Results 1) the seven structures of the mallet bone, the neck of the malleus, the stalk of the malleus, the anvil joint, the incus, the long foot of the incus and the short foot of the incus could be well displayed on MPR-VR and MIP. There was no significant difference in the display rate of these seven structures. When the stirrup joint and head of stapes were regarded as a whole, there were no significant differences among the three display modes. For the anterior stapes, there was no significant difference between MPR and MIP in the posterior arch, and MPR was better than MIP in displaying the stapes anterior arch. VR and MIP could not well display the malleus bone and pedicle of the stapes pedis in the lesion group. The results of MSCT diagnosis and operation of long foot, short foot of incus and malus anvil joint were 0.75, which indicated that the consistency of the two methods was good. The comparison of the destruction of the incudrup joint and the stapes bone showed that the Kappa value was 0.529 and 0.538 respectively, which indicated that the destruction rate of the incus was the highest in the small auditory bone of otitis media. There was a positive correlation between the degree of hearing loss and the destruction of ossicular chain. The more severe the damage of auditory chain was, the more serious the hearing loss was. When the damage degree of small auditory bone reached stage 鈪，

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