听骨链螺旋CT三维表面遮盖显示技术的临床应用

目的 探讨听小骨螺旋CT三维表面遮盖显示技术(SSD)的临床应用价值及相关的技术要点。资料与方法 对43例患者进行螺旋高分辨率CT扫描，利用密集放大的重建图像，采用手动编辑，先移去听小骨周围的骨质，仅保留听小骨，用经编辑的轴位图像进行SSD三维成像。结果 40侧正常耳的听小骨三维SSD显示了听小骨的细微结构，还反映了听小骨之间的关系。病变听小骨的三维SSD重建图像与轴位图像的表现基本相符；慢性中耳炎25耳中，22耳进行了听小骨SSD成像，10耳见有骨质破坏；先天性外、中耳畸形16耳均见有听小骨发育不良；外伤后听力下降5耳中，1耳锤砧关节脱位和1耳并有移位的锤骨骨折在听小骨三维SSD成像直观地显示。结论 螺旋CT扫描和三维SSD有利于听小骨的显示和病变的诊断。     

256层HRCT及重建技术在听骨链损伤术前评估中的应用

目的 探讨256层高分辨率CT(HRCT)及重建技术在听骨链损伤术前评估中的临床应用价值.方法 对106例颞骨外伤患者进行256层HRCT轴位扫描,收集其中听骨链损伤患者38例.用Philips工作站,行颞骨多平面重建(MPR)、听骨链的曲面重建(CPR)、3D容积再现(3D VR)观察分析听骨链损伤位置、类型及其相邻结构受累的情况,并进行随访.计算原始轴位(AX)、MPR、CPR、3D VR的显示率.结果 106例颞骨外伤患者中,38例(76耳)听骨链损伤,听小骨脱位43耳,其中锤砧关节脱位22耳,锤砧并砧镫关节脱位6耳,砧镫关节脱位3耳,听小骨转位11耳,镫骨前庭脱位1耳;听小骨骨折4耳,其中锤骨骨折2耳,砧骨骨折1耳,镫骨骨折1耳.38例听骨链损伤患者中11例行手术治疗,术后结果与影像诊断结果一致.AX、MPR、CPR、3D VR的显示率分别为97.87％、100％、97.87％、82.98％.结论 256层HRCT及重建技术能清晰显示听骨链损伤的情况,是术前评估的可靠方法.     

先天性耳畸形和正常颞骨的螺旋CT三维成像分析

目的：探讨螺旋CT扫描及三维重建成像技术在先天性耳畸形和正常颞骨的临床应用，方法：采用螺旋高分辨CT扫描技术，对16例先天性，中耳畸形及40例正常耳行多平面重建，曲面重建和三维表面成像，结果：16侧患耳畸形为：外耳道骨性闭锁，鼓室狭小，听小骨发育不育，面神经管异常等。小视野密集重建清晰显示了细微结构，多平面重建提供多位信息，三维表面成像立体直观地显示形态结构，结论：螺旋高分辨CT及三维重建成像技术有利于外，中、内耳正常结构的显示和先天畸形的诊断，三维重建成像技术能提供更多的诊断信息，建议临床选择应用。     

SCT对慢性化脓性中耳炎诊断分型价值的研究

目的　探讨螺旋CT检查在慢性化脓性中耳炎诊断分型及治疗中的价值。方法　对 65例 79耳慢性化脓性中耳炎行螺旋CT检查 ,将轴位HRCT、冠状位MPR及听骨链 3D重建图像与手术结果对比分析。结果　轴位HRCT、冠状位MPR图像对慢性化脓性中耳炎诊断分型能力基本相同 ,但对中耳细微结构的显示有一定差异。 3DCT对锤、砧骨破坏的显示能力优于轴位HRCT及冠状位MPR图像 ,对蹬骨细微结构的显示则较后两者差 ,3DCT不能单独用于中耳炎的诊断分型 ,需与 2DCT图像结合 ,三者结合对中耳炎诊断分型与手术结果比较符合率高 (89.9%～ 97.5 % ) ,误诊率 (2 .9%～ 6.0 % )及漏诊率 (0～ 14 .6% )低。结论　螺旋CT 3种图像相结合有助于慢性化脓性中耳炎诊断分型及手术方案的制定。     

内耳畸形的影像学诊断

内耳，又称迷路，位于颞骨岩部，位置深在，结构细小复杂，可分为耳蜗、前庭、前庭导水管、半规管、内耳道。过去内耳一直是影像学检查的盲区，X线平片无法显示其详细结构。高分辨率CT（HRCT）颞骨薄层扫描，能够清晰显示内耳的细微骨结构，螺旋CT三维重建还可将轴位的二维原始图像转换成三维立体图像，对内耳结构的显示更为直观，但只限于骨结构。     

HRCT轴位加薄层冠状位扫描及容积重建对鼻骨骨折的诊断价值

目的探讨高分辨率CT（HRCT）对鼻骨骨折的诊断价值。方法25例鼻外伤患者均经HRCT轴位扫描及冠状位薄层加三维重建（VR）,对检查结果与数字X线摄影（DR）进行对比分析。结果25例患者中,12例DR侧位X线平片显示鼻骨骨折,而HRCT图像22例显示鼻骨骨折线,其中,粉碎性骨折14例,线性骨折8例;单侧骨折15例,双侧骨折7例;横型骨折11例,纵形骨折2例,斜形骨折9例;合并上颌骨额突骨折12例。容积重建（VR）及冠状位像显示全部患者鼻骨骨折线。结论轴位HRCT扫描加冠状面重律对鼻骨骨折的诊断晶可靠．其敏感性显著优于DR。     

多向调整多平面重组在听小骨显示中的作用评价

目的探讨多向调整多平面重组（MPR）技术全程显示听小骨及其关节的方位和方法。方法对50侧正常中耳行高分辨率CT各向同性扫描后再行多向调整MPR后处理，确定听小骨同层全程显示的基础显示方位、重组基线旋转中心点和旋转方向的定向解剖标志，测量重组基线旋转角度，对听小骨在轴面、冠状面、矢状面及多向调整MPR全程显示位4种方位上的全程显示程度进行分级，做Ridit分析和x^2检验。结果多向调整MPR锤骨、砧骨、镫骨的同层全程显示率均为100％（50侧中耳），多向调整MPR对于听小骨全程显示率明显高于轴面（镫骨6侧、锤骨0侧、砧骨0侧）、冠状面（锤骨3侧、镫骨0侧、砧骨0侧）、矢状面（锤骨0侧、砧骨0侧、镫骨0侧），差异有统计学意义（P〈0．01）。结论（1）各向同性扫描基础上的多向调整MPR技术提供了具有诊断意义的听小骨全程显示方法，具有重要临床应用价值。（2）只需1次扫描多次MPR后处理，就可取代多次多方位扫描，是听小骨多方位整体观察的必要途径之一。     

听骨链螺旋CT三维重建技术及初步临床应用

目的探讨听骨链螺旋CT三维重建技术的临床应用及局限性.方法采用螺旋CT薄层扫描(层厚1.0mm),Pitch1.5,小视野(FOV=9.0cm),密集重建(间隔0.5mm).观察22例,其中10例正常,12例耳部病变患者,所有病例均采用表面遮盖法(SSD)行听骨链三维重建成像.正常及异常耳的观察阈值分别为-200～-500HU和100～300HU.结果10例正常耳听骨链重建能直观显示锤、砧骨的大小、形态及相互关系,砧镫关节呈"L”形,镫骨前后脚及底板显示欠佳.12例患者中,3例胆脂瘤型及1例肉芽肿型中耳炎患者,3D图像显示有不同程度听小骨破坏,与手术所见基本相符.1例肉芽肿型、2例单纯型中耳炎及2例颞骨骨折患者听骨链3D图像均显示正常.2例中耳畸形显示听骨链发育异常.1例神经鞘瘤病显示听小骨被肿瘤组织破坏.结论螺旋CT三维重建技术能很好显示正常及异常听骨链的立体影像,有利于中耳炎、中耳畸形及其它耳部病变的诊断.     

螺旋CT几种图像后处理功能在骨关节外伤中的临床应用价值

目的：探讨螺旋CT多平面重建（MPR），最高密度投影（HDMIP），容积再现（VR）在骨关节外伤中的临床应用价值。方法：对24例骨关节外伤患者进行螺旋CT常规轴位容积扫描，随后进行MPR，HDMIP，VR成像，结合轴位图象观察这三种图象在显示不同部位骨折线，骨碎片，关节脱位的效果。结果：MPR可选择感兴趣区进行任意方向和平面的重建，大大地增加了诊断信息量。HD，MIP取每个象素的最大CT值进行投影，反映组织的密度差异，对比度高。具有一次扫描后重建可多方位观察．显示细微骨折较好，可提示死骨，嵌顿性骨折存在。24例骨折忠者均发现骨折，图像重叠欠清晰。VR图象直观，逼真。可以任意方向旋转，通过VRpresets，VRopacity，VRcolors技术的应用，使影像达到实体标本的效果。显示细微结构较MPR，HDMIP差。结论：螺旋CT的MPR技术应用，能较好全面地发现复杂关节的骨质病变，可准确测量碎骨片大小，显示移位方向，程度，不直观。HDMIP应用于骨质密度较高的区域，显示细微结构清晰。VR技术运用为临床医生提供了直观三维实体标本效果的图像资料。     

高分辨率CT在外耳及中耳畸形诊断中的应用

目的 探讨高分辨率CT(high resolution CT,HRCT)对外耳及中耳先天性畸形的诊断价值.方法 收集经HRCT检查诊断为外耳及中耳先天性畸形病人34例,评价中耳及外耳畸形的类别.结果 34例先天性耳畸形病人中,单纯外耳畸形11例,单纯中耳畸形7例,外耳畸形合并中耳畸形16例.外耳、中耳畸形的发病率并无明显差异;外耳、中耳畸形单侧、同时发生常见;外耳畸形中先天性外耳道闭锁常见;中耳畸形中听骨链异常常见,单纯中耳畸形中常见镫骨畸形.结论 HRCT可清晰显示外耳及中耳畸形.     

外中耳先天畸形的HRCT研究

目的 研究外中耳先天畸形的高分辨CT（HRCT）表现,为临床诊断和治疗提供准确信息。资料与方法 对临床诊断的外、中耳先天畸形35例行HRCT扫描,单纯横断位扫描5例,横断位加冠状位扫描30例。结果 （1）外耳畸形32例共42耳,其中外耳道骨性闭锁30耳,显示闭锁板为完全性26耳,不完全性4耳。膜性闭锁5耳。双侧分别为不同类型闭锁1例。外耳道狭窄7耳,其中狭窄合并对侧闭锁1例。合并畸形中,面神经管垂直段明显前移22耳,下颌髁状突明显后上移25耳,乙状窦前移4耳,均见于骨性外耳道闭锁。伴发的中耳畸形主要为小鼓室及不同程度的听骨发育不全或缺如。合并内耳发育不全1例。（2）单纯性中耳畸形3例共6耳,均表现为听小骨异常。合并小鼓室1例,耳咽管和鼓室窦畸形扩大1例。结论 HRCT能准确显示外中耳先天畸形的类型、程度以及合并畸形,为临床治疗方案的正确制定提供重要的参考依据。     

Virtual CT endoscopy of ossicles in the middle ear.

The purpose of this study is to evaluate how virtual computed tomography (CT) endoscopy may help in assessing ossicles in the middle ear. Our series consisted of 96 ears of 68 consecutive patients with conducting hearing loss. All examinations were performed with a high-resolution spiral CT using axial and direct coronal planes of the temporal bone. Perspective virtual endoscopy was processed using the virtual endoscopic software. Superstructure of the stapes was difficult to evaluate on the virtual endoscopy; however, virtual endoscopy of the middle ear provides further information on the pathological conditions including congenital anomaly, posttraumatic, and inflammatory processes.     

333例先天性外中耳畸形的CT分析

目的：分析先天性外中耳畸形的各种ＣＴ特征。材料与方法：对高分辨率ＣＴ确诊为外中耳畸形的３３３例４０４耳的病变部位和类型进行分析。结果：４０４耳中３６４耳外耳道闭锁，４０耳外耳道狭窄，３７７耳有听小骨畸形，３８２耳鼓室狭窄，３３３耳面神经管乳突段前位。结论：颞骨高分辨ＣＴ可获得外、中、内耳畸形类型的影像资料，可为临床制定治疗方案提供依据。     

Computed tomography and magnetic resonance imaging of congenital abnormalities of the temporal bone

Congenital abnormalities of the temporal bone are mostly accompanied by conductive or sensori-neural hearing loss. Before any therapeutic procedures are done high resolution CT (HRCT) and magnetic resonance imaging (MRI) should be performed to establish the correct diagnosis and to plan the potentially surgical intervention. HRCT best depicts osseous changes especially those of the external auditory canal and the middle ear containing the ossicles and the osseous structures of the temporal bone and the petrous bone containing the inner ear. MRI excellently shows soft tissue changes of the inner ear especially on the high resolution 3DT2-weighted sequences which give a superb contrast between the nerves and the cerebro-spinal fluid. Malformations of the external auditory canal consists of aplasia or hypoplasia and those of the middle ear range form extreme hypoplasia or aplasia to very mild deformations of the ossicles. Malformations of the inner ear also range form complete aplasia to very mild hypoplasia of the organs of the inner ear as well as malformations concerning the nerves in the internal auditory canal range from aplasia to hypoplasia. Malformations of the temporal bone can either occur isolated or in combination in which malformations of the external and middle ear may be accompanied by those of the inner ear. Furthermore, malformations of the temporal bone may also occur in otofacial, otocervical or otoskeletal syndromes. These syndromes may be accompanied by certain malformations of the temporal bone. HRCT and MRI are both excellent methods to depict congenital abnormalities of the temporal bone and of the inner ear and should be used as complementary methods because HRCT best depicts osseous changes and MRI superbly depicts soft tissue changes. Both methods are important to establish the correct diagnosis to plan the therapeutic procedures.     

Computed tomography and magnetic resonance tomography of the normal temporal bone

The normal anatomy of the temporal bone and the inner ear will be described in detail on high resolution computed tomography (HRCT) and magnetic resonance images. The imaging technique of computer tomography--either single detector or multi detector CT--is normally obtained in an axial plane without the intravenous application of contrast material. The images are reconstructed in a high resolution bone window level setting. The coronal images are reconstructed either if used single detector or multi detector CT. Only in some cases a scan in the coronal plane is directly obtained using a single detector CT. MR imaging of temporal bone is usually performed in a head coil. Axial high resolution 3D-T2-weighted sequences either in fast spin echo technique or gradient echo technique--for example CISS-sequence--are obtained, then an axial high resolution T1-weighted sequence before and after the application of gadopentate dimiglumine is performed. HRCT excellently demonstrates the osseous structures of the temporal bone as well as of the inner ear, while MRI excellently depicts soft tissue structures especially those of the inner ear. Due to the susceptibility artifacts MRI is not very suitable for imaging the external auditory canal or the middle ear or the pneumatic system. In conclusion HRCT is so far excellent to delineate the osseous structures of the temporal bone and inner ear while MRI excellently depicts the soft tissue structures of the inner ear, the internal auditory canal and the cerebellopontine angle. Reissner's membrane, the cochlear duct, and the organ of Corti cannot be visualized even using high-resolution MRI. HRCT and MRI are therefore used as complementary methods for imaging the temporal bone.     

正常耳部解剖结构的高分辨率CT表现

目的：研究正常耳部解剖结构的高分辨率ＣＴ（ＨＲＣＴ）表现及轴位,冠状位ＨＲＣＴ的临床价值及选用原则。方法：收集８０例经临床专科检查证实无耳患的耳部轴、冠扫ＨＲＣＴ图像资料,与耳局部解剖标本对照分析。结果：逐层总结了正常耳部解剖结构的ＨＲＣＴ表现特点以及耳部轴、冠扫ＨＲＣＴ的不同临床价值及其选用原则。结论：耳部ＨＲＣＴ可清晰显示绝大部分耳部解剖结构及其病变,可对耳部疾病的诊断及指导临床制定正确的治疗方案提供可靠和重要的帮助。耳部ＣＴ检查应以轴位扫描为主、冠状扫描为辅。     

颞骨鼓部发育不良所致外耳道畸形的CT分析

目的 分析84耳外耳道畸形的高分辨率CT（HRCT）表现，探讨颞骨鼓部发育畸形与外耳道畸形的关系。资料与方法 临床诊断84耳外、中耳畸形患者均行HRCT检查，重点观察骨性外耳道鼓部发育的形态。结果 鼓部完全未发育、骨性外耳道未形成43耳(43／84)；鼓部重度发育不良、鼓部为不规则形态、未形成骨性外耳道27耳(27／84)；鼓部中度发育不良、鼓部形成不典型的“U”结构、外耳道形态不良14耳(14／84)。结论 骨性外耳道发育不良与颞骨鼓部发育不全有重要关系。     

The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas

The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas will be described in this paper. The pre- and postoperative imaging of the temporal bone was performed with HRCT and MRI.HRCT and MRI were performed in the axial and coronal plane. MRI was done with T2 weighted and T1 weighted sequences both before and after the intravenous application of contrast material. All imaging findings were confirmed clinically or surgically. The preoperative cholesteatoma-caused complications depicted by HRCT included bony erosions of the ossicles, scutum, facial canal in the middle ear, tympanic walls including the tegmen tympani, and of the labyrinth. The preoperative cholesteatoma-caused complications depicted by MRI included signs indicative for labyrinthitis, and brain abscess. Postoperative HRCT depicted bony erosions caused by recurrent cholesteatoma,bony defects of the facial nerve and of the labyrinth, and a defect of the tegmen tympani with a soft tissue mass in the middle ear. Postoperative MRI delineated neuritis of the facial nerve, labyrinthitis, and a meningo-encephalocele protruding into the middle ear. HRCT and MRI are excellent imaging tools to depict either bony or soft tissue complications or both if caused by acquired cholesteatomas. According to our findings and to the literature HRCT and MRI are complementary imaging methods to depict pre- or postoperative complications of acquired cholesteatomas if these are suspected by clinical examination.