先天性外中耳畸形的螺旋CT与手术对照观察

目的进一步提高螺旋CT及后处理技术诊断外中耳畸形的水平。资料与方法对22例(24耳)经手术治疗的先天性外中耳畸形病例,术前采用螺旋CT高分辨扫描,将原始扫描数据密集重组后进行多平面重组(MPR)(轴面、冠状面、斜轴面、斜冠状面)、曲面重组(CPR)及仿真内镜容积重组(VR)成像,与手术所见进行详细对照观察。结果手术治疗24耳,外耳道狭窄1耳,骨性闭锁18耳,膜性闭锁3耳。鼓室腔狭小12耳。锤骨畸形或缺如23耳,其中1耳CT见细小锤骨,而手术为缺如。砧骨缺如4耳,砧骨畸形16耳,其中有2耳手术见砧骨长脚长、砧骨粗大,而CT表现基本正常。镫骨细小畸形6耳,其他畸形7耳,镫骨缺如5耳;砧锤关节融合畸形14耳,轻度变形1耳,缺如4耳;砧镫关节融合1耳,不连5耳,缺如7耳;卵圆窗骨性封闭8耳,上述CT所见均与手术相符。手术见3耳圆窗骨性封闭,其中1耳CT表现正常。手术有3耳未见咽鼓管开口,其中1耳CT表现正常。手术见面神经管前位8耳,其中1耳CT表现正常。结论螺旋CT高分辨扫描及其多种后处理成像综合观察,多数可以反映外中耳畸形情况,有利于指导手术方案的制定。     

先天性外耳道狭窄的CT分析（附30例报告）

目的：分析先天性外耳道狭窄合并鼓室，听小骨畸形的ＣＴ表现，材料与方法，对经过电镜检查诊断为传时性耳聋者３０例４０耳进行横断及冠状位ＣＴ扫描，结果：４０耳中有３４耳呈骨性外耳道狭窄，６耳呈膜性外耳道狭窄，２６耳合并有鼓室狭窄，１９耳合并有面神经管乳突段前位２９耳合并有听小骨畸形。结论：经高分辨率ＣＴ对颞骨进行横断及冠状位扫描综合分析后即可获得外。内耳的三维造影资料，为临床提供影像学依据，     

颞骨-中内耳解剖变异畸形高分辨CT表现及临床意义

目的探讨先天性颞骨-中内耳解剖变异畸形的高分辨CT(HRCT)特征表现,为耳科诊治疾病提供有价值的参考依据。方法收集41例(76耳)病例采用HRCT横断面扫描+冠状位扫描,分析先天性颞骨-中内耳解剖变异畸形的HRCT表现。结果颈静脉高位20例(23耳)、鼓室盖不连续13例(15耳)、乙状窦前位8例(13耳)、岩鳞隔过长8例、中颅窝低位5例、颈静脉裸露5例、乳突窦未发育1例、Michel畸形1例、Mondini畸形3例(6耳)。结论 HRCT可清晰显示颞骨-中内耳解剖变异畸形的表现,能明确颞骨-中内耳解剖变异畸形的诊断并对临床诊疗及手术路径具有指导意义。     

颞骨低剂量CT扫描的应用研究

目的探讨颞骨高分辨率CT扫描时降低扫描mA值对其图像质量的影响及临床应用价值。方法将60例颞骨高分辨率冠状面CT扫描患者根据扫描mA值设置分为100mA和50mA组。全部图像行高分辨率骨密度算法重组,并利用多平面重建(MPR)技术重建轴面图像,得到2组不同mA值的直接扫描冠状面图像和与之对应的2组通过重建的轴面图像。分别评价不同扫描mA时直接冠状面及重建轴面图像质量。评价指标为:冠状面:鼓室盾板、Prussak’s腔、卵圆窗、鼓室盖、耳蜗底圈5个解剖结构。经MPR重建轴面:锤砧关节、水平半规管、鼓窦入口、锥隆起、面神经水平段5个解剖结构;评价标准为:清晰显示2分;显示、但不清晰1分;未显示0分。以左右两侧单独记分。结果当扫描mA值由100减至50时单次扫描加权CT剂量指数量(CTDIw)值由42.00mGy下降至21.00mGy,下降幅度达50.0%,而直接扫描冠状面图像质量无明显下降(P>0.05);并且颞骨低剂量高分辨率CT能基本达到图像向同性,经MPR重建的轴面图像能较好地显示颞骨细小解剖结构,保证病灶检出率。结论50mA的颞骨CT扫描能够提供较好诊断质量的影像信息。     

儿童先天性感音神经性聋的影像学评估

目的:研究先天性感音神经性聋(SNHL)患儿的颞骨影像,分析内耳畸形的发生率及其类型,了解内耳畸形与耳蜗神经发育的关系,探讨部分患者是否仅行CT检查即可而无需进行MRI检查.方法:回顾性分析101例临床拟诊先天性SNHL的儿童颞骨CT和MRI影像资料,观察其内耳、蜗神经的结构.101例中,95例为重度或极重度双侧性SNHL,6例为单侧性SNHL.结果:196例患耳中,内耳畸形66耳:耳蜗不发育3耳;耳蜗发育不良5耳;不完全分隔I型7耳,不完全分隔II型10耳;前庭导水管扩大24耳;蜗神经不发育或发育不良19耳.10耳内听道狭窄均伴有蜗神经畸形.单侧性聋的6例患者中,均有蜗神经畸形.130例CT示内耳正常者,MRI也示蜗神经正常.结论:影像学诊断先天性重度或极重度双侧性SNHL内耳畸形发生率(31.6%)较单侧性SNHL者(100%)低,较为常见的畸形是前庭导水管扩大和耳蜗畸形,内耳畸形严重程度与蜗神经发育异常的发生率有一定相关性;对于双侧性耳聋者,CT诊断有严重内耳畸形者必须行MRI扫描,以排除蜗神经发育畸形;CT示耳蜗结构正常且内听道无狭窄者可无需行MRI扫描;单侧性耳聋者必须同时行CT和MRI扫描.     

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。     

先天性感音神经性耳聋患儿的CT病因分析

目的：探讨先天性感音神经性聋儿患者的CT诊断价值及可能的病因分析。方法：收集120例先天性感音神经性耳聋患儿高分辨率CT图像,对内耳结构行MPR重组最佳显示层面,观察其形态结构、大小、位置有无异常。结果：120例患者中有21例（33耳）内耳发育畸形,其中共同腔畸形2例（3耳）,耳蜗发育不全3例（4耳）,耳蜗不完全分隔Ⅱ型9例（17耳）,半规管畸形7例（10耳）。结论：多层螺旋CT能准确显示先天性骨性内耳畸形的部位和程度,为先天性感音神经性聋儿的病因分析及临床制定正确的治疗方案提供重要的参考依据。     

面神经管及其与周围结构解剖关系的CT研究

目的 探讨16层螺旋CT多平面重组(MPR)技术对面神经管与周围结构解剖关系的显示能力及其CT表现,为诊断面神经病变及相关手术操作提供可靠信息.资料与方法 选取2006年3月至2006年9月来我院行副鼻窦螺旋CT检查且无颞骨病变的患者70例,其中成人50例(100耳),儿童20例(40耳);均行副鼻窦横断面螺旋CT扫描,骨算法重组成像,将原始图像传至后处理工作站,采用MPR图像后处理技术进行重组.在重组出的MPR斜矢状面、斜横断面上观察面神经管的正常形态,在MPR常规横断面、冠状面上对各段面神经管与周围重要结构的距离进行测量,比较不同年龄组间上述测量值有无差异.结果 (1)面神经管乳突段内缘与颈静脉窝外缘最突出点的距离在侧别以及不同年龄组间差异有统计学意义(P＜0.05),右侧距离小于左侧,儿童距离小于成人;性别之间差异无统计学意义(P＞0.05).乳突段后缘距乙状窦前缘距离在成人测量值大于儿童(P＜0.05),侧别及性别之间无明显差异.乳突段前缘距外耳道后壁、圆窗龛后外缘、鼓岬外缘最突出点垂直距离在侧别、性别、不同年龄组间差异均无统计学意义(P＞0.05).鼓室段下缘位于前庭窗下缘水平上方者占33.57%,位于其下方者占19.29%,与该水平平行者占47.14%.鼓室段内缘距前庭窗上缘、下缘的垂直距离在侧别、性别、不同年龄组间差异均无统计学意义(P＞0.05).鼓室段下缘距鼓岬外缘最突出点、圆窗龛后下缘的垂直距离在侧别、性别、不同年龄组间差异均无统计学意义(P＞0.05).(2)人工耳蜗植入术面隐窝径路相关结构关系的研究:鼓岬外缘最突出点距圆窗中点、圆窗龛后外缘、锥隆起顶点、面隐窝后缘、面隐窝前外缘顶点的距离在侧别、性别、不同年龄组间差异均无统计学意义(P＞0.05).结论 多层螺旋CT MPR技术是研究面神经管与周围结构影像解剖的良好方法,可为面神经病变的诊断及避免术中的意外伤害提供可靠信息.     

多层螺旋CT曲面重建在先天性外耳道闭锁中面神经管异常的研究

目的用多层螺旋CT(MSCT)曲面重建(CPR)技术研究先天性外耳道闭锁中面神经管的异常。方法对15例(17耳)先天性外耳道闭锁患者进行多层螺旋高分辨率CT(HRCT)扫描,图像后处理在Philips Mx8000工作站进行。结果17耳中,外耳道狭窄2耳,外耳道膜性闭锁2耳,骨性闭锁13耳。外耳道先天性胆脂瘤及耳后瘘管1耳。鼓室畸形3耳。听小骨先天畸形7耳。内耳畸形1耳。面神经管异常17耳。其中面神经管总长度变短11耳,面神经管走行异常5耳,面神经管位置异常9耳,面神经管管径变细1耳,面神经管分叉1耳。结论MSCT高分辨率扫描加CPR技术能清晰显示先天性外耳道闭锁患者中面神经管的异常,有利于临床医生术前详尽了解面神经管的行程,减少不必要的面神经意外损伤。     

多层CT对先天性内耳畸形的诊断价值

目的：探讨多层CT（MDCT）对先天性内耳畸形的诊断价值。材料和方法：对50例感音神经性耳聋（SNHL）患者行MDCT螺旋扫描，原始数据采集完后，按层厚0．625mm，重建间隔0．3mm，单侧FOV9．6cm放大重建，再传至工作站行多平面重建（MPR）并利用最小密度投影（MinIP）、容积漫游（VR）及其叠加技术等后处理方法观察内耳结构。结果：50例感音神经性耳聋患者中有20例37耳先天性内耳畸形，其中耳蜗未发育1耳、共同腔畸形1耳、不完全分隔Ⅰ型1耳、不完全分隔Ⅱ型即Mondini畸形8耳、前庭和半规管畸形22耳、前庭导水管扩大20耳、内耳道畸形8耳，伴内耳道底发育不全3耳、外耳道骨性闭锁2耳、面神经管异常4耳、前庭窗闭锁2耳、蜗窗闭锁1耳。结论：MDCT螺旋扫描结合后处理技术能清楚显示先天性内耳畸形的部位和程度并明确其分类，为电子耳蜗的植入提供依据。     

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.     

Review of congenital inner ear abnormalities on CT temporal bone

The aetiology of profound hearing loss in children is complex and multifactorial. Congenital inner ear abnormality is a major cause of hearing loss in children. CT temporal bone imaging is the modality of choice in the investigation of hearing loss. Recognising the congenital abnormalities of the inner ear guides the clinician's management of the condition. This pictorial essay illustrates the congenital abnormalities of the inner ear on high resolution CT temporal bone images and correlation with developmental arrest during embryology.     

Computer tomography in children and adolescents with suspected malformation of the petrous portion of the temporal bone

Purpose: To demonstrate HRCT findings and their therapeutic relevance in suspected congenital hearing disorders. Material and Methods: It was checked in 96 young patients if HRCT findings of the temporal bone could explain functional findings. Furthermore, the therapeutic consequences were noted. Results: Normal CT and normal functional findings were obtained in 49 temporal bones (TB). In conductive hearing loss (41 TB), dysplasias of the conducting apparatus (37 TB) and inflammatory changes (3 TB) were found. Combined hearing loss (18 TB) was clarified completely or partially in half the cases. There were 22 dysplasias of the inner ear, 3 dysplasias of the middle ear, 1 abandoned examination (2 TB), and 55 normal CT findings in senorineural hearing disorders (82 TB). 1 retardate had a malformation of the inner ear and, contralaterally, inflammatory middle ear. In cases of vestibular disorders (24 TB), 14 malformations of the inner ear were detected. An indication for an operation was given in 23 TB. In 22 TB, it was contraindicated. The CT was one preliminary examination to a cochlea implant in 19 patients. The therapy was carried on with hearing devices in the other patients. Conclusion: HRCT is an important method in diagnosis and therapeutic planning of suspected malformations of the temporal bone.      

磁共振内耳成像在先天性内耳发育畸形中的诊断应用

目的:探讨磁共振内耳成像在先天性内耳发育畸形中的临床应用价值。方法:18例先天性感音神经性耳聋患者行MRI扫描并进行后处理,主要方法包括多平面重组(MPR)、最大密度投影(MIP)及客积再现技术(VRT)。结果:18例34耳存在内耳畸形。1例2耳Michel畸型;2例3耳共同腔畸形;4例8耳Mondini畸型;8例16耳前庭导水管扩大;3例5耳显示内听道畸形。MRI MPR、MIP及VRT重组图像可以清晰地显示内耳畸形的部位和程度。结论:磁共振内耳成像能清楚、立体显示正常膜迷路和内听道内神经结构,对于内耳畸形的诊断及人工耳蜗植入术前评价有重要价值。     

外伤性面瘫的多层螺旋CT研究

目的探讨多层螺旋CT(MSCT)在外伤性面瘫中的应用价值。方法用MSCT对41例外伤性面瘫的颞骨行高分辨率轴面扫描。用Ph ilipsMx8000MSCT工作站,行岩锥感兴趣区的多平面重建(MPR)及面神经管的曲面重建(CPR)。观察骨折类型,骨折线的走行,中耳腔、乳突积血及外耳、中耳、内耳和面神经管的受累情况。结果41例患者中,39例颞骨有不同部位、不同类型的骨折,其中岩骨纵行骨折34例,横行骨折2例,混合型2例,1例岩骨无骨折,但颞骨鳞部骨折,2例未发现骨折。其中2例为双侧岩骨骨折。面神经管的CPR及MPR显示21例患者面神经管受累,9例可见骨碎片。结论MSCT扫描及重建技术能清晰显示面神经管的全貌及其损伤,对外伤性面瘫的诊断有重要意义。     

High-resolution CT of the temporal bone in dysplasia of the auricle and external auditory canal.

PURPOSETo determine CT findings in the external, middle, and inner ear of patients with microtia and external auditory canal dysplasia.METHODSWe used high-resolution CT, with multiplanar or axial 1-mm continuous sections, coronal or sagittal reformations, or low-dose spiral acquisitions, to examine 184 temporal bones of children with microtia.RESULTSIn cases of minor microtia, auditory canal stenosis was the most common associated abnormality; in those with major microtia, atresia was predominant. Middle ear malformations depended on the severity of the auricular anomalies. Inner ear changes could also be noted. Ossicle dysplasias occurred in 98% of patients (stapes, 72%), absence of the oval window in 36%, labyrinthine malformations in 13%, closed round window in 6%, facial canal displacement in up to 75%, and aberrations of the vascular canal in 38% of patients with third-grade auricular deformity.CONCLUSIONA variety of external, middle, and, less frequently, inner ear changes were detected in connection with microtia.     

Cerebrospinal fluid otorhinorrhea in patients with defects through the lamina cribrosa of the internal auditory canal.

We describe three patients with bilateral cerebrospinal fluid (CSF) otorhinorrhea with unilateral progressive hearing loss in whom CT showed the defect to be located in the lamina cribrosa of the internal auditory canal. CT cisternography showed the CSF fistula in two of the three patients who had Mondini malformation, whereas the CSF fistula was obvious on the plain high-resolution temporal bone CT study in the third patient, who had a posttraumatic (nonsurgical) fracture of the lamina cribrosa. Fast spin-echo T2-weighted coronal MR cisternography also showed the site of leakage in the third patient. In the presence of an intact tympanic membrane, the CSF egressed to the nose via the eustachian tube in all three patients.