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。     

中耳癌的CT表现(附6例报道)

目的:探讨中耳癌的CT表现和特征,为临床诊治提供依据。方法:对经手术病理证实的6例中耳癌患者术前CT表现进行回顾性分析。结果:中耳癌的CT特征:①表现为以中、下鼓室为中心的软组织密度灶,密度均匀,CT值50HU左右,外耳道及咽鼓管早期受累;②呈溶骨性骨质破坏,形态不规则,边缘无骨硬化表现,外耳道后壁破坏较前壁严重;③病灶侵入颞叶,形成肿块,灶周脑水肿不明显;④增强扫描见病灶有中度强化。结论:CT能确定中耳癌的存在及精确显示肿瘤累及范围。     

三维CT重建在血管瘤和血管畸形诊断及治疗中的价值

目的:评价三维CT重建在辅助血管瘤和血管畸形的诊断及治疗中的价值.方法:选取2006年1月～2007年8月在我科就诊的皮肤软组织血管性疾病的患者26例,均利用双源CT进行三维CT重建的检查.根据三维CT重建的检查结果制订治疗方案.所有患者都经过手术治疗,术中直视下记录病变情况,验证检查结果的准确性,同时观察术中及术后并发症,术后病理结果验证诊断结果.随访半年观察有无复发.结果:术后病理结果与三维CT重建诊断完全符合.其中8例患者为静脉畸形, 8例为动静脉畸形,10例为血管瘤.根据三维CT重建的诊断及病变结构的信息制订治疗方案.26例患者均治愈,无并发症,且随访半年无复发.根据术中直视结果与三维CT重建的影像表现,三维CT重建显示病变的准确率高,显示血管瘤、动静脉畸形、静脉畸形准确率之间无显著差异.结论:三维CT重建能够准确、直观的显示血管瘤及血管畸形的结构,对它们的诊断及治疗很有意义.这种技术可能成为一种有效的辅助诊断和治疗皮肤软组织血管性病变的方法.     

面神经静脉畸形的高分辨率CT及MRI特征分析

目的:分析面神经静脉畸形（FNVM）的高分辨率CT及MRI特征性表现。方法:回顾性收集2016年1月至2020年12月上海交通大学医学院附属第九人民医院经病理证实的23例FNVM患者。所有患者均行术前颞骨HRCT及平扫、扩散加权成像（DWI）和动态增强MRI（DCE-MRI）。观察病灶位置、病灶形态、信号特点、DCE-...     

256层CT血管成像诊断先天性冠状动脉畸形的价值

目的探讨256层CT血管成像(CTA)在先天性冠状动脉畸形(CCA)诊断中的临床价值。方法随机抽取300例256层CT检查的冠状动脉图像进行回顾性分析,分析结果由三名医生共同确定。结果 300例中,共发现CCA76例,其中:起源、分布异常3例;终止异常2例;结构异常71例。结论 MSCT能够无创、准确诊断CCA,尤其在评价起源、走行、结构异常方面,有很高的临床应用价值。     

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。     

正常中耳结构的螺旋CT扫描技术探讨

颞骨部尤其是中耳解剖结构精细复杂，只有了解正常中耳详细结构，才能正确认识中耳部异常改变，为临床提供较可靠的影像资料。常规检查常难以提供详细满意的解剖结构，而螺旋CT(SCT)可较清晰地显示中耳的解剖结构，本文主要探讨正常中耳结构的螺旋CT技术。     

MSCT在肾动静脉畸形诊断中的应用价值

【摘要】目的：探讨MSCT对肾动静脉畸形（rAVM）的诊断价值。方法：回顾性分析经DSA或术后病理证实的14例rAVM患者的MSCT及其后处理影像资料,后处理技术包括多平面重组（MPR）、最大密度投影（MIP）、容积再现（VR）等。结果：14例患者中8例畸形较小,病灶位于皮髓质交界处,MSCT及其后处理图像均可清晰显示供血动脉及引流静脉;4例畸形较大,大部分畸形血管位于肾轮廓外,少部分畸形血管位于皮髓质内;2例合并肾下极血管平滑肌脂肪瘤,其供血动脉及引流静脉显示清晰。结论：MSCT及其后处理图像可清晰显示rAVM的畸形血管团,具有很高的诊断价值,可作为该病无创性筛查的首选方法。     

多层螺旋CT在小儿先天性心血管畸形中的应用

目的 探讨多层螺旋CT (MSCT)对小儿先天性心血管畸形的应用价值.资料与方法 对22例临床诊断为心血管畸形的患者进行胸部CT扫描.结果 在手术证实的39处心腔外大血管畸形中, MSCT与手术的符合率为94.8%,经胸超声心动图的诊断符合率为82.1%;对手术证实的28处心腔内畸形,MSCT的诊断符合率89.3% ,超声心动图的诊断符合率为100%.MSCT与经胸心动超声图在诊断心腔外大血管畸形时有显著性差异(P<0.05),而在诊断心腔内畸形时差异无显著性意义(P>0.05).结论 MSCT能直观地显示主动脉、肺动脉等大血管及其分支的走行、形态,为心外大血管畸形的诊断提供了客观依据,MSCT结合经胸超声心动诊断先天性心血管畸形已基本取代心血管造影.     

双能CT在中耳及外耳道胆脂瘤诊断和精准定位中的应用价值

目的:探讨双能CT(DECT)在中耳及外耳道胆脂瘤诊断及精准定位中的应用价值。方法:选取临床初步怀疑胆脂瘤并接受术前DECT检查的患者40例(44耳)。以术后结果为参考标准评估DECT对胆脂瘤的诊断效能,寻找鉴别胆脂瘤组与非胆脂瘤组差异有统计学意义的客观定量参数,采用受试者工作特征(ROC)曲线分析诊断效能最好的定量参数,评估DECT对胆脂瘤病变组织的定位准确性。结果:胆脂瘤组24耳,非胆脂瘤组20耳。DECT诊断胆脂瘤的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)分别为95.8%、80.0%、85.2%、94.1%,DECT与手术结果的一致性Kappa值为0.768。Water(Hap)浓度值为诊断胆脂瘤效能最高的参数,当Water(Hap)浓度值取最佳截断值1040.8 mg/cm³时,对应的曲线下面积为0.898,敏感度、特异度、PPV和NPV分别为91.67%、80%、84.6%和88.9%。DECT对胆脂瘤病变的精准定位总体准确率为91.7%。结论:DECT新技术可用于胆脂瘤定性、定量诊断和精准定位评估,有助于临床医师合理选择手术方案。     

CT and MRI of the middle ear

Summary High-resolution computed tomography (HRCT) provides excellent contrast between osseous structures, air and soft tissue in conjunction with high spatial resolution. Therefore, thin-section HRCT with bone window setting is the method of choice for the examination of the middle ear structures. The indications are acute and chronic inflammatory changes, cholesteatoma and tumor, the “postoperative middle ear”, and malformations. In most cases, HRCT enables differentiation between inflammatory changes, cholesteatoma, and tumor. The excellent depiction of subtle osseous details enables the identification of erosions of the ossicles or of the bony walls of the mastoid cells, of osseous defects of the tegmen, of the bony labyrinth, and of the tympanic course of the facial canal. In addition, HRCT enables excellent depiction of reconstructions of the ossicles or prosthesis of the ossicles. Although HRCT is the first method of choice, magnetic resonance imaging (MRI) may provide additional information and lead to a more accurate diagnosis in some cases. This is explained by the excellent soft tissue contrast provided by MRI. In addition, MRI offers the possibility of using various pulse sequences and the administration of IV contrast material. Therefore, MRI may allow the differentiation between inflammatory changes, cholesteatoma, and tumor in those cases in which accurate diagnosis cannot be made by HRCT. The differentiation between a meningocele or meningoencephalocele and other entities such as tumors or cholesteatoma can be established by MRI. Furthermore, MRI can accurately depict cases of labyrinthitis or of neuritis of the facial nerve or of intracranial disease caused by middle ear processes, while this is not always possible by HRCT. In summary, HRCT of the middle ear is the method of choice, but MRI may provide supplementary information in those cases in which accurate diagnosis cannot be established by HRCT.      

Congenital malformations of the external and middle ear

With the focus on imaging, this paper gives a summarized view of the present knowledge on fields, which are necessary to know for a profound understanding of congenital malformations of the external and middle ear. Typical and less typical combinations of malformed parts of the ear can be derived from the embryogenesis. Clinical signs and audiometric findings lead to diagnosis in congenital aural atresia. Isolated middle ear malformations can be clinically mixed up especially with otosclerosis and tympanosclerosis. Imaging is needed for exact morphological information. In malformations of the external and middle ear, CT is the imaging modality of choice. Requirements on CT-technique as well as radiological findings including classification and pre-surgical rating are described. Morphological CT-correlates of congenital malformations and their differential diagnoses are enlisted and illustrated. The impact of CT-results on therapy is explained and actual therapeutic concepts are briefly presented.     

Congenital malformations of the external and middle ear: high-resolution CT findings of surgical import

The external auditory canal, middle ear, and bulk of the ossicular chain develop from the first branchial groove, first and second branchial arches, and first pharyngeal pouch. Embryologic development of these structures is complex and only rarely are two anomalies identical. Development of the inner ear structures occurs independently of external ear structures, and concomitant involvement is unusual. This study includes 11 cases of unilateral external auditory canal atresia and two cases of bilateral atresia. Eight cases (four bilateral) of isolated congenital ossicular anomalies are also included. Emphasis is placed on findings of surgical import. All patients were studied with computed tomography only, because it was believed that the bony and soft-tissue detail achieved is superior to that with conventional multidirectional tomography.     

侵及颈静脉孔区的原发性中耳癌的CT、MRI诊断

目的 探讨侵及颈静脉孔区的原发性中耳癌的CT、MRI特点.方法 回顾性分析7例经手术病理证实的侵及颈静脉孔区原发性中耳癌患者的CT、MRI资料,其中6例行高分辨率CT(HRCT)扫描,1例行常规CT增强扫描,7例均行MR平扫+增强.结果 HRCT显示鼓室、鼓窦、外耳道深部及颈静脉孔区软组织病灶伴不规则虫蚀样骨质破坏,涉及颈静脉孔(7例)、咽鼓管骨性段(7例)、面神经管(4例)、颈动脉管(4例)、外耳道前后壁(3例)、听小骨(2例)及前庭窗、水平半规管(1例)等结构的破坏.4例病变密度较均匀,CT值约30～55 HU,2例肿块内见少许小片状高密度影.1例CT增强显示中度较均匀强化.MR平扫示边界不清软组织肿块,与脑灰质相比,T1WI呈等、略低信号,T2WI呈等、略高信号,其中5例信号较均匀,2例肿块内见少许小片状T1WI、T2WI低信号灶,增强扫描5例呈中度较均匀强化,2例不均匀强化,内见小片状无强化区.MRI显示4例侵及颈内动脉,1例侵及乙状窦.结论 原发性中耳癌可广泛侵及颈静脉孔区,易造成误诊.HRCT可准确显示中耳癌骨质破坏特点及范围,咽鼓管骨性段破坏可帮助减少误诊;MRI能更清楚显示病变范围,肿瘤信号及强化方式有一定特点.     

多层螺旋CT对先天性耳畸形的诊断价值

目的 探讨先天性耳畸形多层螺旋CT(MSCT)的表现,为临床诊断、评估和治疗提供准确信息.方法 回顾性分析先天性耳畸形患者36例46耳,行MSCT容积扫描及MPR、CPR、MIP、VR、VE等重建.结果 36例46耳中,双侧10例,单侧26例;外中耳联合畸形43耳,合并内耳畸形3耳;外耳畸形中,骨性闭锁38耳,膜性闭锁5耳,骨性狭窄3耳;中耳畸形中,听小骨缺如4例,发育不全42耳,小鼓室45耳;合并畸形中,垂直外耳道19耳,下颌骨髁突及颞颌关节异常31耳,面神经管乳突段前位28耳,鼓室段低位7耳,颈静脉窝高位5耳,乙状窦前位3耳,中颅窝低位2耳;合并中耳炎6耳.结论 MSCT后处理重建能准确诊断先天性耳畸形的外、中、内耳异常解剖结构及合并畸形,并为临床提供参考.     

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。     

外耳道胆脂瘤的CT表现

外耳道胆脂瘤是原发于外耳道的含有胆固醇结晶脱落上皮团块所致的外耳道疾病。本文回顾性分析2001年1月至2008年4月本院收治的20例（24耳）经手术和术后病理证实外耳道胆脂瘤的CT表现。     

Three-dimensional CT of the middle ear and adjacent structures

Summary Three-dimensional (3D) computed tomography of the middle ear and adjacent structures has been carried out in two cadaveric heads from axial and coronal high-resolution images. The structures shown on the images of the walls of the tympanic cavity are illustrated. The usefulness and limitations of the technique, in this region, are discussed: use of grey level volumes at the surface of the slices and the inclusion of structural landmarks is emphasized. The 3D representations show the anatomical spacial relationships of the small structures in and around the middle ear to advantage. The information may be of use in surgical orientation.