颞骨冠状切片和高分辨率CT定位圆窗区的邻近结构

背景：作者前期实验曾探讨了圆窗区及周围结构在横断面上的配布特点,虽有资料对颞骨中耳及邻近解剖结构的冠状位影像学特点进行了描述,但由于无统一的冠状扫描基线,导致相关研究结果存在差异。 目的：对比分析成人头部标本颞骨冠状切片和高分辨率CT冠状扫描图像上圆窗区及其周围结构的差异。 方法：15例(30侧)成人头部标本,以与眦耳线相垂直的直线为基线,获得间隔为1.00 mm,厚度为1.00 mm的CT冠状扫描图像,扫描后的头部标本按原定位截取以耳颞区为中心的组织块,并制成厚为1.00 mm的连续冠状薄层切片。标本切片与CT图像对照,对颞骨内听小骨、骨性半规管、前庭、耳蜗、圆窗、圆窗龛、蒲氏间隙以及面神经颞骨内段等结构进行观察。 结果与结论：圆窗龛的内外径、深度分别为(1.36±0.26)和(1.55±0.26) mm,面神经迷路段至弓状隆起的距离为(4.19± 0.52) mm,面神经水平段距鼓室盖、距耳蜗、距锤骨头、距盾板、距砧骨短脚间的距离分别为(5.27±0.92),(1.36±0.28),(3.19±0.85),(5.30±0.58)和(2.86±0.54) mm。提示耳颞区火棉胶冠状薄层断面标本能良好显示圆窗区及其周围结构的解剖位置和毗邻关系,可直接与高分辨率CT冠状`扫描图像进行对照分析,其结果对耳科疾病的影像诊断及手术治疗有参考价值。     

CT结肠造影二维和三维图像评价结肠病变的优势与不足☆

摘要 背景：随着多排探测器螺旋CT的广泛应用,已使胃肠道等空腔脏器的CT检查成为可能。 目的: 通过结肠充气CTC扫描,评价二维和三维图像对结肠病变检出的有效性以及各自的优势和不足。 方法: 38例患者导泻后经肛门注入适量空气,行多层螺旋CT扫描,再经工作站对扫描获得的容积数据进行后处理,获得多平面重建的冠、矢状面图像、表面重建、透明重建、仿真内窥镜和管腔展开图像,由2位有经验的影像科医师对上述图像进行分析,评价结肠病变的性质、位置、大小和肠外表现,并与电子结肠镜或手术病理结果对照。 结果和结论: 除1例为家族性息肉病变外,其余37例患者共检出17枚息肉、20个结肠肿块和5例结肠炎性病变。对三种类型病变的检出率,多平面重建分别为82.4%、100%和100%;仿真内窥镜分别为100%、100%和80%;表面重建分别为41.2%、90%和40%;透明重建分别为47.1%、90%和40%。管腔展开技术对所检病变的显示率达100%。二维图像可对结肠病变准确定位并精确测量大小,在显示结肠病变肠外表现方面的作用优势明显,仿真内窥镜的敏感性较高,管腔展开技术又进一步避免了检查盲区,表面重建和透明重建在显示结肠全景方面价值较高。 关键词: 体层摄影术,X线计算机;结肠息肉;结肠成像     

螺旋CT三维重建技术在骨盆骨折中的应用

背景：螺旋CT三维重建技术可以提供直观的三维图像，而且可以根据需要向任何方向旋转，使医生可以在任意设定的角度观察骨盆骨折移位情况，从而得到清晰直接的印象。 目的：观察螺旋CT三维重建技术在骨盆骨折中的应用价值。 方法：选择2007-11/2009-03遵义医学院附属医院骨科收治的骨盆骨折患者42例，男30例，女12例，分别进行X射线摄片和螺旋CT扫描，利用表面遮盖法(SSD)三维重建，同时利用三维成像软件进行多平面重建(MPR)，选择能最佳显示骨折的图像进行存储并进行摄片，比较两种方法的效果。 结果与结论：所有骨盆骨折患者经螺旋CT三维成像摄片均显示骨折，能较准确地描述出骨折分型和碎骨部位，其效果明显优于X射线摄片(P < 0.05)。提示螺旋CT三维成像技术在骨盆骨折的诊断中具有非常重要的作用，能较准确地显示骨折的情况，能为治疗方法的选择提供依据。     

16排移动CT脑血管造影的初步结果报告

目的探讨国产16排移动CT在脑血管造影（CTA）的稳定性、成像质量及其螺旋扫描容积范围内的辐射剂量指数（CTDIvol）等情况。 方法选取陆军总医院附属八一脑科医院的4例志愿者,于2018年7月至8月采用16排移动CT行脑血管增强螺旋扫描,获得原始断层图像,利用Anythink CT Plus图像处理软件,以容积重建（VR）和最大密度投影（MIP）技术显示三维脑血管图像,分析其成像质量;并与8排移动CT的CTA结果作对比,分析二者CTA成像的稳定性和扫描容积范围内的CTDIvol。 结果16排移动CT颅内血管成像稳定,可清晰显示Willis环、大脑前动脉、大脑中动脉和大脑后动脉及其分支血管,16排移动CT在扫描容积范围内的CTDIvol[（20.600±0.087）mGy]低于8排移动CT[（29.300±0.335）mGy],差异有统计学意义（P<0.05）。 结论16排移动CT螺旋扫描可以获得稳定的CTA成像,清晰显示CTA图像,扫描容积范围内CTDIvol显著低于8排移动CT。     

CT三维重建图像在颅骨嗜酸性肉芽肿诊断中的应用价值

目的探讨CT平扫及三维重建在颅骨嗜酸性肉芽肿中的临床应用价值。方法回顾性分析5例经病理证实的颅骨嗜酸性肉芽肿的CT平扫及三维重建图像资料。结果嗜酸性肉芽肿多发2例,单发3例,共9个病灶;其中额骨病灶4个,颞骨3个,顶骨2个。CT主要表现:病变密度不均匀,起源于颅骨板障并侵犯内、外颅板,病灶内残留小骨片(钮扣骨)、脂质和周围软组织改变,硬脑膜受侵情况显示清晰。CT三维重建图像可清晰显示病变大小、边缘范围、病灶内有无死骨及边缘骨质的受损程度。结论CT平扫与三维重建图像结合,能提高颅骨嗜酸性肉芽肿的诊断水平。     

CT血管造影评价静脉血栓栓塞的特征★

目的：介绍多排螺旋CT血管造影诊断静脉血栓栓塞的扫描技术和影像学征象，评价其在静脉血栓栓塞早期诊断中应用价值和优势。 方法：应用计算机检索Medline 1998-01/2007-10与静脉血栓栓塞和肺血栓栓塞的诊断相关的英文文章，检索词“venous thromboembolism，pulmonary thromboembolism，CT angiography”；同时通过手工和计算机检索万方数据库2000-01/ 2007-10相关中文文章，检索词“静脉血栓栓塞，CT血管造影，诊断”。通过检索得到228篇相关文献，纳入24篇完全符合要求的文献。 结果：多排螺旋CT利用多排采集技术，结合高质量的三维重建图像，能清晰地显示肺动脉远端分支，使肺栓塞的诊断进一步达到了亚段水平。薄层螺旋CT诊断肺栓塞的敏感性与肺动脉血管造影相比没有显著差异，其敏感性和特异性都高于肺通气/灌注核素扫描，且在排除急性肺栓塞时，螺旋CT有可能替代核素扫描成为检查的首选。 结论：螺旋CT扫描速度快，图像清晰，不遗漏小病灶。螺旋CT血管造影是静脉血栓栓塞安全、迅速、无创伤的有效诊断方法。     

伴脑脊液耳鼻漏的Common cavity畸形的临床特征分析(附一例报告)

目的 掌握common cavity畸形的临床特征,提高对伴有脑脊液耳鼻漏的Common cavity 畸形在临床诊断中的认识水平.方法 对1例伴有脑脊液耳鼻漏的Common cavity畸形患者的临床特征、影像学表现及诊疗过程等临床资料进行整理并结合文献分析.结果 Common cavity畸形自幼听力下降,可伴有脑脊液耳鼻漏或脑脊液耳漏,自幼常反复发作脑膜炎;常误诊为分泌性中耳炎、化脓性中耳炎、脑脊液鼻漏、化脓性脑膜炎,因此容易导致漏诊.结论 自幼进行性听力下降或全聋,反复发作不明原因的脑脊液耳鼻漏,伴反复发作脑膜炎者应疑及此病,颞骨CT或MRI检查可以确诊.     

低浓度低剂量碘对比剂多层螺旋CT犬颈部动脉的三维成像*

背景：随着碘对比剂在CT增强检查中的大量应用,其不良反应亦受到广泛关注。在不影响图像诊断质量的前提下,使用低浓度低剂量碘对比剂降低人体毒副反应具有重要的研究价值。 目的：验证低浓度低剂量碘对比剂在犬颈部动脉成像中的可行性。 方法：将3种不同浓度碘对比剂(370,350,300 mgI/mL)分别分成高、中、低剂量组(1.50,1.25,1.00 mL/kg),共9个实验组。对3只家犬进行多层螺旋CT颈部动脉成像重复扫描,每组扫描8次。原始数据进行三维成像,包括容积重现、多平面重建;二维成像包括最大密度投影和曲面重建。由两名放射科医师对血管边缘及血管分支显影情况进行评分。 结果与结论：各实验组多层螺旋CT犬颈部动脉CT血管成像血管边缘及分值情况评分结果显示,血管边缘显示良好(评分>2分),血管分支显示良好(评分>3分)。犬颈部动脉边缘显影情况及分支显影情况的评分结果具有较强的一致性,其Kappa值分别为0.799,0.733。9个实验组间动脉边缘及分支显影两两比较差异均无显著性意义(P > 0.05)。提示应用低浓度低剂量碘对比剂可获得良好的多层螺旋CT犬颈部动脉CT血管成像图像。 关键词：碘对比剂;颈动脉;CT血管成像;动物实验;低浓度;低剂量     

16层螺旋CT血管造影评价颈动脉狭窄影像学研究

目的探讨16层螺旋CT血管造影诊断颈动脉狭窄的准确性及应用价值。方法对49例经颈动脉多普勒超声筛选的颈动脉狭窄及闭塞患者进行CT血管造影检查,对比剂总剂量为60～100ml,注射流率3.5～4.0ml/s;成像包括原始横断面图像和重建最大密度投影、多平面重建、容积显示及CT仿真内窥镜图像。依据北美症状性颈动脉内膜剥离术临床试验标准犤轻度狭窄(10%～29%),中度狭窄(30%～69%),重度狭窄(70%～99%),闭塞(100%)犦,比较CT血管造影和脑血管造影检查结果。结果49例共98支颈动脉,CT血管造影检查显示正常者12支,轻度狭窄26支,中度狭窄32支,重度狭窄19支,闭塞9支;与脑血管造影诊断颈动脉狭窄的总符合率为96.94%(95/98),其中闭塞和重度狭窄符合率为100%(28/28),轻度和中度狭窄符合率分别为96.15%(25/26)和93.75%(30/32)。CT血管造影能够较好地显示血管腔内的粥样硬化斑块,依靠CT值可区分钙化斑块、纤维斑块及软斑块,钙化斑块的CT测量值为(489±113)HU,纤维斑块(51±19)HU,软斑块(6±28)HU。结论CT血管造影检查不仅对颈动脉狭窄程度的诊断有较高的直观性和准确性,而且能更为直观、确切地评价粥样硬化斑块,有望取代脑血管造影在颈动脉狭窄诊断中的地位。     

颅脑损伤合并迟发性面瘫临床诊治

目的探讨颅脑损伤合并迟发性面瘫的发病机理、诊断及治疗方法。方法回顾分析24例颅脑损伤合并迟发性面瘫的临床资料。结果24例中22例采取非手术治疗，21例有效，有效率87．5％，1例无效；2例手术治疗，均有效。结论外伤性迟发性面瘫可在伤后3d时出现；颅脑CT对颞骨骨折所致迟发性面瘫的诊断有重要参考价值；治疗早期采取保守治疗，两个月无效可行经乳突后鼓室切开、上鼓室进路面神经膝状神经节减压术治疗。     

Study of the middle ear. Value of multiplanar reconstructions in spiral tomodensitometry

We point out the interest of computed tomographic reconstructions from spiral acquisition--particularly sagittal reconstructions--in the study of middle ear anatomy and adjacent structures: the facial canal and the chorda tympani. The reference reconstructions are axial and coronal reconstructions. So, we demonstrate the superiority of sagittal reconstructions for the visualization of the lateral process of the malleus, the body and long process of the incus, the third portion of the facial canal, and the chorda tympani. For the other structures of the middle ear and the other parts of the facial canal, these sagittal reconstructions are complementary. Besides, the best type of reconstruction to visualize the stapes and the vestibular window is the axial plane parallel to the stapes axis.     

Mouse models of induced otitis media

The mouse has seen limited use as a model for experimental otitis media, due primarily to the small size of its middle ear. However, the genetic resources of this species offer substantial potential benefits. These include detailed genomic information, a wealth of genetic models, and gene arrays that represent virtually all mouse genes. This has led to the development of methods for inducing otitis in mice. These include surgical approaches to the middle ear, documentation of the murine middle ear response to various pathogens and inflammatory factors, as well as characterization of induced otitis media in several mouse strains. The results indicate that induced otitis media in the normal mouse is in most respects comparable to that observed in other animal models and in humans. They further suggest that the considerable genetic resources of this species can be harnessed to increase our understanding of this disease.     

Pediatric neurotology

Pediatric neurotology is a subspecialty encompassing the medical and surgical treatment of conditions involving the middle ear, inner ear and lateral skull base. Multiple otologic and neurotologic diseases exist. In the pediatric patient the most common neurotologic conditions are vertigo, complications of otitis media, cholesteatoma, hearing loss and facial paralysis. Vertigo is differentiated into peripheral and central vestibular abnormalities. Peripheral vestibular causes include Meniere’s disease, benign paroxysmal positional vertigo, vestibular neuronitis, otitis media and labyrinthitis. The predominant lesions in our field causing central vestibular disorders are brainstem and posterior fossa tumors. Mastoiditis, meningitis, petrositis, sigmoid sinus thrombosis, extradural abscess, brain abscess, otitic hydrocephalus, cholesteatoma and cholesterol granuloma are complications of otitis media and middle ear disease. Sensorineural hearing loss is now readily treated with cochlear implantation. Facial nerve paralysis may result from infectious and other etiologies.     

New Growth of Axons in the Cochlear Nucleus of Adult Chinchillas after Acoustic Trauma

This study determined the effect of acoustic overstimulation of the adult cochlea on axons in the cochlear nucleus. Chinchillas were exposed to an octave-band noise centered at 4 kHz at 108 dB sound pressure level for 1.75 h. One chinchilla was never exposed to the noise, and several others had one ear protected by an ear plug or prior removal of the malleus and incus. Exposure of unprotected ears caused loss of inner and outer hair cells and myelinated nerve fibers, mostly in the basal half of the cochlea. Cochlear nerve fiber degeneration, ipsilateral to the exposed ears, was traced to regions of the cochlear nucleus representing the damaged parts of the cochlea. In silver impregnations of a deafferented zone in the posteroventral cochlear nucleus, the concentration of axons decreased by 43% after 1 month and by 54% after 2 months. However, by 8 months, the concentration of thinner axons, with diameters of less than 0.46 μm, increased by 46–90% over that at 2 months. The concentration of axons with larger diameters did not change. Between 2 and 8 months small axonal endings appeared next to neuronal cell bodies. This later increase of thinner axons and endings is consistent with a reactive growth of new axons of relatively small diameter. The emergence of small perisomatic boutons suggests that the new axons formed synaptic endings, which might contribute to an abnormal reorganization of the central auditory system and to the pathological changes that accompany acoustic overstimulation.     

Acoustically evoked short latency negative responses in hearing loss patients with enlarged vestibular aqueduct

This study aims to assess the diagnostic value of the acoustically evoked short latency negative response (ASNR) during the auditory brainstem response (ABR) test for enlarged vestibular aqueduct (EVA). The ABR test was performed on 175 subjects with severe and profound hearing loss from July 2008 to August 2011. Patients were submitted to high-resolution computed tomography scans for the temporal bone of the inner ear, and were diagnosed with EVA (EVA group; n = 24 cases, 46 ears), no inner ear deformity (no deformity group; n = 136 cases, 272 ears), or other inner ear deformity (other deformities group; n = 15 cases, 29 ears). The prevalence of ASNR was 26/46 ears (56.52 %) in the EVA group, 10/272 ears (3.67 %) in the no deformity group, and 3/29 ears (10.34 %) in the other deformities group. The rate of ASNR in the EVA group was higher than that in other groups (p < 0.05). The rate of ASNR is positively correlated with EVA. Therefore, the recording of ASNRs could be a valuable method for discovering EVA.     

Carcinoma de células escamosas del conducto auditivo que infiltra al hueso temporal: a propósito de un caso

Squamous cell carcinoma of the ear canal is an entity that arises from the stratum spinosum; it is a rare neoplasm, with a low incidence presenting 1 to 6 cases per million inhabitants, so there is little literature on this pathology. The clinical presentation of temporal bone cancer is usually nonspecific, meaning that its diagnosis is always a late-stage discovery. The definitive diagnosis requires biopsy of the lesion for histopathological and immunohistochemical study to establish the behaviour and the degree of differentiation. We present the case of an adult female patient with a clinical history of osteoporosis, diagnosed with chronic otitis media of the left ear of years of evolution, accompanied by purulent secretion of the same ear that did not respond to multiple treatment regimens. The patient also presented with a headache of left temporal predominance refractory to conventional analgesia. Cranial CT scans showed an osteolytic lesion of the left temporal bone with dural invasion. After resection and biopsy of the lesion, moderately differentiated squamous cell carcinoma was confirmed.     

Lasting auditory attention impairment after persistent middle ear infections: a dichotic listening study

Dichotic listening performance was studied in children who at an early age had undergone a myringotomy with insertion of ventilating tubes for persistent middle ear infections (otitis media with effusion; OME) and compared with age-equivalent children who had no history of otitis media or hearing problems. The OME group consisted of 19 children with a median age of 9 years; 15 of whom were right-handed, and 14 were boys. The comparison sample comprised 18 children with a median age was 9 years 4 months. Hand preference and sex were matched with the OME group. Both groups were tested with dichotic listening to consonant-vowel syllables and additional forced-attention tasks. The comparison sample showed a weak right-ear advantage, and age-adequate attentional modulations. The children in the OME group showed a strong right-ear advantage, but were not able to modulate the ear advantage during directed-attention tasks. Models for interpreting the result are discussed.     

Chronic suppurative otitis media with intracranial complication

A complication of otitis media is defined as a spread of infection beyond the pneumatized area of the temporal bone and the associated mucosa. Complications can be classified as intra temporal or intra cranial, which includes extradural abscess, brain abscess, subdural abscess, sigmoid sinus thrombophlebitis, otic hydrocephalus, and meningitis. Since the introduction of antibiotics, intra cranial complications in otitis media are less common, however, the occurrence should not be underestimated due to their associated morbidity and mortality. Herein, we report a case of chronic suppurative otitis media (CSOM) with intra cranial complication (brain abscess) in a 25-year-old male patient with ear discharge, severe headache, and vomiting. Computerized tomography scan confirmed the diagnosis. The patient was managed by a combined neurosurgical and otologic approach. Surgery of the abscess includes aspiration through a bur hole or craniotomy and by radical mastoidectomy for CSOM.     

Tympanoplasty: an up-to-date pictorial review

The indications for tympanoplasty are mainly chronic ear pathologies, such as cholesteatoma, atelectasis and chronic tympanosclerotic otitis. Usually, modification of the mastoid and temporal tissues in general mostly involves bone work, which means bone removal by burs or appropriate bone curettes. It is for this reason that, in both the pre- and postoperative periods, the computed tomography (CT) scan is the primary radiological tool for studying the middle-ear, and temporal bone structures and pathologies. The aim of this review is to illustrate the most up-to-date postoperative results for tympanoplasty, including the emerging endoscopic techniques. The present work focuses on the five types of tympanoplasty that are likely to be encountered by the radiologist: radical surgery; open tympanoplasty; closed tympanoplasty; closed endoscopic tympanoplasty; and open endoscopic tympanoplasty. Understanding and interpreting temporal bone images in relation to the different types of surgery are important, especially at the postoperative stage, because of the high risk of recurrence of middle-ear pathologies, and a good working knowledge of surgical changes is fundamental for distinguishing iatrogenic bone demolition from complications and new pathological foci.     

三维CT重建成像在创伤性寰枢椎失稳治疗中的应用

背景：CT三维重建的运用对于复杂的解剖结构如头颈、脊柱、骨盆、四肢的精确评价有确切的作用。 目的：观察三维CT重建成像在诊断和治疗创伤性寰枢椎失稳的作用。 方法：选择解放军沈阳军区总医院骨科收治的创伤性寰枢椎失稳患者21例,三维CT重建检查,以明确诊断及损伤类型,并依据损伤类型,进行植骨融合内固定治疗。 结果与结论：三维CT重建成像可清楚观察寰枢椎失稳惰况,并依据进行内固定,所有病例未出现脊髓、椎动脉及神经根损伤等并发症。全部病例均获得有效随访,随访时间6~15个月,平均9个月。寰枢椎获得骨折愈合和骨性融合,寰枢椎不稳现象均获得有效纠正。提示三维CT重建成像对诊断寰枢椎失稳有较大帮助,并有助于制定恰当的手术方式。