应用三维图像分析研究梅尼埃病前庭小管外口

本研究从三维图像法获得的三维图像上测量梅尼埃病患者前庭小管外口的宽度,26个正常耳(年龄14～67岁,平均39.7岁)39个慢性中耳炎耳(年龄11～70岁,平均44.1岁)和36个梅尼埃病耳(年龄20～65岁,平均44.7岁)     

梅尼埃病的颞骨螺旋CT三维影像学研究

目的：通过观察梅尼埃病（Ｍéｎｉèｒｅ′ｓ ｄｉｓｅａｓｅ，ＭＤ）患者前庭小管（ｖｅｓｔｉｂｕｌａｒ ａｑｕｅｄｕｃｔ，ＶＡ）及其周围骨质发育情况，探讨ＭＤ的病理解剖学基础及其临床意义。方法：实验分为两组，正常耳组和ＭＤ组。对每个研究对象进行颞骨螺旋ＣＴ扫描。采用后颅窝内面观、表面法进行三维重建，仅保留颞骨岩部后面及乳突内面，其他骨质切掉，在三维方向上旋转切割后的图像，使前庭小管外口最为清晰，直接测量其宽度的最大径；在围绕外半规管的横向轴位二维重建图像上，选择显示外半规管及后半规管后外侧断面最清晰的层面，直接测量后半规管断面中心到颞骨岩部后面的最短距离，并在所有显示迷路的层面上观察迷路后有无气房。结果：所有研究对象ＶＡ外口均显示清晰，ＭＤ组（３７耳）ＶＡ外口宽度为３．９１±１．１７ｍｍ，正常耳组（６０耳）ＶＡ外口宽度为６．６２±１．６９ｍｍ，其差异具有非常显著性意义（ｔ检验Ｐ．＜０．０１＝；ＭＤ组Ｐ－Ｐ值为２．１６±１．０２ｍｍ，正常耳组Ｐ－Ｐ值为３．４１±１．５１ｍｍ，其差异具有非常显著性意义（ｔ检验Ｐ＜０．０１＝；ＭＤ组有迷路后气化者占１３．５％，正常耳组占７３．３％，其差异具有非常显著性意义（ｘ２检验     

用三维重建成像观察前庭小管外口

近年,影像学诊断技术迅速发展,高分辨CT可准确观察颞骨的解剖及病理改变,但只能显示平面图像。作者通过三维重建成像对58人的前庭小管外口进行观测,其中正常对照10人,慢性中耳炎23人,梅尼埃病25人。首先用高分辨CT行轴位连续15个层面的扫描,层厚1.5mm,层面间隔1mm,获得原始CT图像,然后再用Quantex 3-D成像软件重建三维图像,测量前庭小管外口的最大径。结果:对照组的前庭小管外口为4～10mm(平均6.43±1.89);慢性中耳炎组为3.6～9.5mm(平均6.56±1.54),与对照组无明显差别;梅尼埃病组为1.8～8.8mm(平均4.23±1.45),明显小于对照组(P<0.01)。以上结果与其他作     

梅尼埃病前庭导水管的发育

利用CT三维图象重建进行测量，对各年龄组正常耳和病耳的前庭导水管外口宽度进行了测量，并作了生长动态研究。正常耳前庭导水管外四宽度是6．41土2．00mm，慢性中耳炎是5．00土1．77mm，梅尼埃病是3．73土1．49mm，年轻受试者前庭导水管外口较小，随着年龄的19g4ta18H4An增加，外口趋向增大，而到成人以后不再增加。正常儿童外四是5．59土1．42mm，正常成人是6．79土2．12mm，两者之间无明显差异。患有慢性中耳炎的儿童平均外口宽度是6．05土1．slmm，两者之间亦无明显差异。由以上结果看出正常儿童和中耳炎患者导管外口稍小于正常成人。…     

螺旋CT三维重建前庭水管外口及其意义

螺旋ＣＴ扫描三维重建技术能够直观立体地对骨组织结构进行多方位揭示 ,其应用的范围越来越广泛。我们通过对健康人和梅尼埃患者耳部进行螺旋ＣＴ扫描三维重建前庭水管外口 ,取得非常满意的效果。一、技术方法应用日本东芝Ｘｖｉｓｏｎ ＧＸ螺旋ＣＴ机对健康人 30名 (6 0耳 ) ,梅尼埃病患者 30例 (37耳 )进行容积扫描。使用ＡｄｖａｎｔａｇｅＷｉｎｄｏｗｓ图像后处理工作站 ,采用表面重建法进行三维重建 ,并应用切割技术将颞骨岩部周围的结构切除 ,把获得的立体图像沿Ｘ轴及Ｚ轴旋转使前庭水管外口清晰显示。其扫描参数 :①通过定位片确定…     

梅尼埃病患者内耳内淋巴间隙的比值与正常受试者的比较

目的通过无创性经咽鼓管中耳腔导入造影剂钆行内耳3D-FLAIR MRI扫描的方法,对梅尼埃病患者组受试者进行研究,得到该年龄组耳蜗及前庭内耳内淋巴间隙的比值,并与20~55岁组正常值进行比较。方法在鼻内窥镜引导下,将稀释的钆喷酸葡胺注射液通过咽鼓管注入患耳中耳腔,给药1 d后行3D-FLAIR MRI扫描,得到内耳内淋巴间隙的显影,并对内耳内淋巴间隙、总淋巴间隙进行测量和计算,得到内耳内淋巴间隙与总淋巴间隙的比值,并与正常受试者组数据进行比较。结果在患者3D-FLAIR MRI扫描图像中可见耳蜗及前庭部内耳内淋巴间隙显影。对患者组3D-FLAIR MRI图像进行总淋巴间隙面积和内淋巴间隙面积的测量和计算,内淋巴间隙与总淋巴间隙面积之比为内耳内淋巴间隙的比值(前庭为RV,耳蜗为RC)。前庭内耳内淋巴间隙的比值为0.39±0.07,耳蜗内耳内淋巴间隙的比值为0.16±0.05。与20~55岁正常受试者组比较,两组RV差异有统计学意义(t=-6.07,P0.05);两组的RC无统计学差异(t=0.783,P0.05)。依据刘芳等提出的内耳内淋巴积水的诊断标准(RV39%,RC27%),梅尼埃病患者组前庭内淋巴间隙积水阳性率为42.9%,耳蜗内淋巴积水阳性率为9.52%。处于梅尼埃病发作期的两位患者RV值测量均为阳性。结论梅尼埃病患者组与正常受试者组相较,两组RV值有显著差异,患者组RV值明显大于正常受试者组;两组RC值无明显差异。前庭内淋巴积水诊断阳性率为42.9%,2例发作期患者均存在前庭内淋巴积水阳性;耳蜗内淋巴积水诊断阳性率为9.52%。     

梅尼埃病内淋巴积水影像学测定

目的采用经咽鼓管鼓室内导入造影剂钆喷酸葡胺稀释液、内耳三维快速液体衰减反转恢复磁共振扫描（three dimensional fluid attenuated inversion recovery magnetic resonance imaging,3D-FLAIR MRI）,探讨梅尼埃病内淋巴液截面积的测定方法。方法 5例梅尼埃病患者和10名健康受试者经咽鼓管鼓室内导入钆喷酸葡胺稀释液、24h后行内耳3D-FLAIR MRI。耳蜗部采用斜矢位蜗轴截取平面,测量耳蜗底转内淋巴间隙和总淋巴间隙面积;前庭部采用冠状位前庭长轴垂直截取平面,测量前庭部内淋巴间隙（椭圆囊和球囊的面积之和）和总淋巴间隙。结果 5例梅尼埃病患者单侧患耳和10名健康受试者受试耳的内耳3D-FLAIR MRI显示内耳的耳蜗、前庭和（或）半规管的外淋巴间隙广泛可见造影剂钆增强区影,可以区分内、外淋巴间隙的边界和清晰显像内淋巴间隙的情况。5例梅尼埃病患者的耳蜗和前庭部的内淋巴间隙评定值分别为0.36±0.08和0.40±0.12;全组梅尼埃病患者（5例）和健康受试者（10名）之间耳蜗的内淋巴间隙评定值比较有统计学差异（P〈0.05）。结论经咽鼓管鼓室内导入造影剂钆、内耳3D-FLAIR MRI,采用客观统一的内淋巴间隙核磁采集和测定方法可以评定梅尼埃病内淋巴积水的情况。     

短纯音在胸锁乳突肌诱发的肌源电位

强短声可在胸锁乳突肌上诱发肌源电位,该电位可能源于前庭球囊,在前庭神经切断后,即使保留听力,该电位也消失,故称前庭诱发肌源电位(vestibularevokedmyogenicpotential)。该作者研究短纯音(shorttoneburst,STB)在正常人及前庭耳蜗病患者中的诱发肌源电位,并分析其来源。受试者分正常组9人和病人组30人34耳,其中梅尼埃病11例,听神经瘤8例,良性阵发性位置性眩晕3例,感音神经性聋3例,迟发性内淋巴积液2例,Hunt综合症1例,测试时受试者仰卧头转向对侧,记录受试耳侧胸锁乳突肌上段的肌电反应。参考电极置于胸骨外上缘。正常组6人次测试0.5、1、…     

前庭小管周围骨质发育与梅尼埃病关系的螺旋CT影像学研究

目的通过观察梅尼埃病(Meniere's Disease,MD)患者前庭小管(VestibularAqueduct,VA)及其周围骨质发育情况,探讨MD的病理解剖学基础.方法实验分为两组:正常耳组和MD组.对每个研究对象进行颞骨螺旋CT扫描.在围绕外半规管的横向轴位二维重建图像上,选择显示外半规管及后半规管后外侧断面最清晰的层面,直接测量:①后半规管断面中心到颞骨岩部后面的最短距离(PP值);②前庭到颞骨岩部后面的最短距离(VP值);③后半规管至水平半规管的最短距离(PL值),并在所有显示迷路的层面上观察迷路后有无气房.结果 MD组PP值为2.16±1.02mm,正常耳组PP值为3.41±1.51mm,其差异具有非常显著性意义(t检验,P<0.01);MD组VP值为4.28±1.06mm,正常组为5.87±1.21mm,其差异具有显著性意义(t检验,P<0.01);MD组PL值为2.72±1.12mm,正常组为3.14±1.04mm,两者差异无显著性意义(t检验,P>0.05);MD组有迷路后气化者占13.51%,正常耳组占73.33%,其差异具有非常显著性意义(t检验,P<0.01).结论 MD患者VA周围骨质发育障碍,岩骨迷路后气化不良.     

梅尼埃病的球囊功能

目的 :通过记录、分析梅尼埃病患者的前庭诱发的肌源性电位 (VEMP) ,了解球囊的功能。方法 :15例确诊为梅尼埃病的患者行VEMP检查 ,分析梅尼埃病VEMP的不同表现形式 ,并将该结果与冷热试验结果比较。结果 :正常双侧短声刺激p13波和n2 3波出现率为 10 0 % ,梅尼埃病受试者VEMP 30 %不能正常引出 ,有 3种表现形式 :VEMP双侧无反应、患侧反应振幅正常和VEMP患侧反应低振幅。结论 :梅尼埃病患者膜迷路积液可影响球囊功能 ,VEMP检查有助于梅尼埃病的诊断     

Practical 3DCT imaging of the vestibular aqueduct for Meniere’s disease

Conclusion: Radiographic visualization of the vestibular aqueduct (VA) from a lateral inside view was effective in assessing patients with Meniere’s disease (MD). There were no VA shapes specific to MD on radiography, except for an obliterated VA. This technique could yield more accurate images and functional assessment of the VA for MD evaluation in a clinically useful and convenient manner, without requiring morphologic measurement. Objective: To visualize the detailed images of the VA using three-dimensional (3D) computed tomography (CT) and discuss its clinical utility in assessing MD. Subjects and methods: The VAs in 13 healthy subjects and 25 MD patients, who were definitely diagnosed according to criteria described by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), were imaged from the medial and lateral sides using 3DCT and compared to conventional CT images. Results: Examination of the VA from both the lateral outside and inside views on 3DCT yielded more precise images than generated by conventional CT and could be useful to estimate the VA function. The estimated VA function in the MD ears was significantly abnormal compared to the function in healthy ears. An obliterated VA was characteristic of affected MD ears.     

Clinical analysis of 95 patients with large vestibular aqueduct syndrome]

OBJECTIVE: To investigate the occurrence, genetic inheritance, and hearing loss conditions of large vestibular aqueduct syndrome (LVAS), and to measure the width of external aperture of vestibular aqueduct (VA) of LVAS, and to analyze the relationship between the hearing loss and the width of external aperture. METHODS: A retrospective review was conducted by the history, auditory, and vestibular function examinations in 95 patients (190 ears) of LVAS. The width of VA was measured by CT scanning criterion of each LVAS patients in the past 10 years (from 1992 to 2002). RESULTS: In 95 patients, there were male 65 cases and female 30 cases. The male cases was more than the females by a ratio of 2.2:1. Twelve cases (12.6%) would have familial genetic history. The average of the consult age was 7.6 years (range from 1.2 to 39 years). The most patients were misdiagnosed, the hearing deterioration originated from mild head trauma in 21 cases (22.1%), the hearing loss after common cold in 13 cases (13.6%). Nine cases (9.5%) misdiagnosed as sudden hearing loss, 5 cases (5.3%) as ototoxic hearing loss of Aminoglycoside antibiotic. The profound hearing loss was found in 172 ears (92.4%). The average width of external aperture of LVAS was 7.5 mm +/- 1.2 mm (mean +/- s, 77 cases, 154 ears). The level of hearing loss did not proportional to the width of VA. The hearing impairment could be derived from protein-rich endolymph refluxed into the cochlear and vestibule. CONCLUSION: The LVAS is distinct clinical entity characterized by fluctuate and progressive SNHL. The diagnosis depends upon the CT scan and MR image. If the hearing fluctuated and subsequently improved, the children were kept under conservation treatment. If the significantly decreased of hearing effected school performance, the cochlear implant might be considered.     

Observation of the external aperture of the vestibular aqueduct using three-dimensional surface reconstruction imaging

Observation of the external aperture of the vestibular aqueduct was hitherto possible only in cadavers or dry temporal bones; however, by applying three-dimensional surface reconstruction imaging, it is now possible to observe solid-looking images of this structure in living humans. When the width of the external aperture of the vestibular aqueduct was measured in 58 people, it was found to be significantly narrower in the affected ears of patients with Meniere's disease than in normal ears.     

Evaluation of the vestibular aqueduct in Ménière's disease using multiplanar reconstruction images of CT

Objective

Previous studies, in which the vestibular aqueduct (VA) was determined using axial CT, have indicated that the VA sizes in patients with Ménière's disease were smaller than those in the subjects of the control group and that 25–35% of ears with Ménière's disease were “non-visible type.” In this study, in addition to obtaining the axial size, we measured the VA size along the vertical plane by using vertical multiplanar reconstruction (MPR) images.

Methods

The VA size of both ears of patients with unilateral Ménière's disease (n = 34) and of subjects of the control group (n = 30) was measured by using the vertical MPR and the axial CT images.

Results

The VA size was measured along the axial and vertical planes in all subjects. The parameters measured on the axial image of the VA correlated with each other; however, the parameters on the vertical MPR image did not correlate with those on the axial image. Values of parameters in the affected and nonaffected ears with Ménière's disease tended to be smaller than those in the control ear. The external aperture areas of the VA fenestra of the affected and nonaffected ears of patients with Ménière's disease were significantly smaller than that for the control ears.

Conclusion

Our findings suggest that the vertical parameters of the VA yield information that is independent of that provided by the axial parameters. In both ears of patients with unilateral Ménière's disease, the VA tended to be thinner than those in the control ear.     

Sensorineural hearing loss in patients with large vestibular aqueduct

In examining 181 patients (327 ears) with sensorineural hearing loss of unknown etiology and 25 people (50 ears) with normal hearing by high-resolution computed tomography (CT), the image of the large vestibular aqueduct (VA) was defined as being a visible large aperture (≥4 mm), and small distance between vestibule and traceable part of the VA nearest to the vestibule (≥1 mm). The large VA was found in 13 patients (23 ears, 7.0%); it was relatively frequent following hypoplastic cochlea (33 ears, 10.1%) in all the inner ear anomalies detected. In patients with large VA, high-frequency hearing was affected more than low frequency, and history of sudden hearing loss was observed frequently (61% of ears with large VA), which was found to be triggered by characteristic episodes such as minor head trauma, etc. Those clinical features were observed more in those without cochlear anomaly than in those accompanying cochlear anomaly. Pathogenesis of sensorineural hearing loss and characteristic fluctuation of hearing in those patients are discussed.     

人前庭小管显微观察及三维结构重建

对初生婴儿和正常成人前庭小管（Ｖｅｓｔｉｂｕｌａｒａｑｕｅｄｕｃｔ，ＶＡ）行连续切片显微观察及计算机辅助的三维结构重建。结果表明，二者ＶＡ有明显差异：前者骨化不完全，近似直管形，峡部不明显；后者骨化完全，行程弯曲似倒“Ｊ”形，峡部明显。婴儿ＶＡ的容积、内表面积、长度及外口径均显著小于成人，其内口径则大致相等。表明婴儿幼稚型的ＶＡ必须在出生后经逐渐发育才能转变为成熟型的ＶＡ。ＶＡ的狭窄是其发育受阻的病理现象，其内含物内淋巴管及内淋巴囊发育不良，为易发生膜迷路积水的病理解剖因素之一。ＶＡ外口宽窄与整个ＶＡ发育一致，它是临床影像学检查ＶＡ以外口为标志的解剖学基础     

成人面神经管螺旋CT曲面重建图像的解剖学研究

目的探讨螺旋CT曲面重建图像对面神经管解剖学研究的参考价值.方法对50例正常成人(100侧)面神经管进行螺旋CT曲面重建,描述正常成人面神经管曲面重建图像的解剖特征,并进行测量.结果 50例正常人的轴位和冠状位曲面重建图像,可在一幅图像上清晰显示双侧面神经管结构,显示率100%,矢状位曲面重建图像只能完整显示单侧面神经管结构;三个方位曲面重建图像上能较准确测得面神经管长径和宽径,测量值差异无显著性意义(P>0.05),而对弯曲部的显示、测量和对毗邻结构的显示,不同方位有各自价值和限度.结论螺旋CT面神经管曲面重建图像具有简便、实用、准确、直观等优点,是目前研究面神经管影像解剖的良好方法.对面瘫定位诊断具有重要指导意义.     

64层螺旋CT三维重建在气管支气管异物诊断中的应用价值

目的：探讨64层螺旋CT三维重建成像技术在小儿气管、支气管异物诊断中的应用价值。方法对35例疑诊气管、支气管异物的患儿,行64层螺旋CT扫描后三维重建,与硬质支气管镜手术中情况比对,评价各种重建技术对支气管异物的位置、大小等情况判断及诊断价值。结果35例患儿经扫描后重建,均获清晰图像,其中32例诊断为气管、支气管异物,异物位于主气管5例、右侧支气管16例、左侧支气管11例,行硬质支气管镜检查与CT诊断异物部位一致,且均一次成功取出;异物咳出后CT检查1例未见异物,另2例重建成像未见异物,均未行硬质支气管镜检查,予抗炎治愈。螺旋CT多平面重建（MPR）、CT仿真内窥镜（CTVE）等技术均能明确异物的有无、位置、大小、形态等及异物所致气管、支气管狭窄的部位、严重程度等。结论螺旋CT多平面重建及后处理技术对明确气管、支气管异物的诊断以及是否需行硬质气管镜有创检查有重要指导意义。     

Three-dimensional reconstruction based on images from spiral high-resolution computed tomography of the temporal bone: anatomy and clinical application

The aim of this study was to investigate the usefulness of a three-dimensional (3D) reconstruction of computed tomography (CT) images in determining the anatomy and topographic relationship between various important structures. Using 40 ears from 20 patients with various otological diseases, a 3D reconstruction based on the image data from spiral high-resolution CT was performed by segmentation, volume-rendering and surface-rendering algorithms on a personal computer. The 3D display of the middle and inner ear structures was demonstrated in detail. Computer-assisted measurements, many of which could not be easily measured in vivo, of the reconstructed structures provided accurate anatomic details that improved the surgeon's understanding of spatial relationships. A 3D reconstruction of temporal bone CT might be useful for education and increasing understanding of the anatomical structures of the temporal bone. However, it will be necessary to confirm the correlation between the 3D reconstructed images and histological sections through a validation study.     

External aperture of the vestibular aqueduct in Meniere's disease

OBJECTIVE: To study the relationship of the length of the external aperture of the vestibular aqueduct and the ratio of the summating potential and action potential (SP:AP) in patients with Meniere's disease. STUDY DESIGN: Retrospective case study. SETTING: Neurotology referral center. PATIENTS: Fifty-four patients with Meniere's disease and nine control subjects without Meniere's disease. INTERVENTION: The external aperture of the vestibular aqueduct was measured from a three-dimensional surface reconstruction computed tomography scan. Transtympanic electrocochleography was performed on patients with Meniere's disease. MAIN OUTCOME MEASURE: The length of the external aperture of the vestibular aqueduct in the Meniere's disease ears was related to the SP:AP ratio in the Meniere's disease ears and compared with controls. RESULTS: The average length of the external aperture was 3.79 +/- 2.92 mm in Meniere's disease ears and 5.35 +/- 1.73 mm in the control ears (p < 0.05). An enlarged SP:AP ratio was found in 95% of ears in the group with nonvisible external apertures of the vestibular aqueduct, 91% of ears in the <5 mm group, 58% of ears in the 5-7 mm group, and 29% of ears in the >7 mm group (chi-square = 24.814; p = 0.000). CONCLUSIONS: The length of the external aperture of the vestibular aqueduct in patients with Meniere's disease is significantly shorter than in those without Meniere's disease. Endolymphatic hydrops, evidenced by an enlarged SP:AP ratio, was related to the length of the external aperture of the vestibular aqueduct. The shorter the external aperture, the more often the SP:AP ratio was enlarged. A short or nonvisible external aperture of the vestibular aqueduct is a predisposing factor to the development of Meniere's disease.