内耳道膜迷路磁共振三维快速液体衰减反转恢复序列检查在突发性聋中的应用

目的　评估内耳道膜迷路磁共振三维快速液体衰减反转恢复序列（three-dimensional fluid-attenated inversion recovery,3D-FLAIR）在突发性聋诊治中的应用。 方法　根据内耳道膜迷路3D-FLAIR结果,将2017年1月～2018年6月我科收治60例突发性聋患者分为3D-FLAIR阳性组和阴性组,对两组听力学特点、是否伴有眩晕等及预后进行分析和比较。结果　3D-FLAIR阳性组较阴性组眩晕发生率更高,差异有显著性（P =0.001）;3D-FLAIR阳性组听力曲线以全聋型频或平坦型为主,且阳性组较阴性组听力损失更严重,预后更差。结论　听力损失较重尤其伴眩晕的突发性聋,若其内耳道膜迷路3D-FLAIR显示内耳有可能存在延迟强化征象,其预后较阴性组欠佳。建议对所有突发性聋患者,常规行内耳道膜迷路3D-FLAIR检查,有助于判断预后。     

突发性聋患者内耳三维液体衰减反转恢复成像在预后评估中的价值

目的 探讨突发性聋患者内耳在三维液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)成像上的表现及其与疗效间关系.方法 23例突发性聋患者行三维FLAIR成像,观察内耳在FLAIR上的表现,并测定入院和治疗后的平均听阈,分析内耳信号与治疗结果之间关系.结果23例患者中8例患侧耳蜗在FLAIR上呈高信号,15例患侧及全部健侧耳蜗无信号.就诊时患侧耳蜗无信号组患者平均((x)±s,下同)听阈(听力级,下同)为(80±24) dB,耳蜗高信号组平均听阈为(92±18)dB,差异无统计学意义(t=1.245,P＞0.05);治疗后两组的平均听阈分别为(60±28)dB和(90±21)dB,有效率分别为60.0％和12.5％,差异均有统计学意义(P值均＜0.05).7例伴有眩晕患者中5例患侧半规管在FLAIR上呈高信号,此5例均治疗无效.结论三维FLAIR可显示突发性聋患者内耳淋巴液改变,呈高信号时疗效及预后差.     

磁共振成像在耳科疾病诊治中的应用

内耳疾病是导致耳聋的常见原因，严重影响着人们的身心健康和生活质量，因此对内耳疾病的诊治成为当务之急。然而内耳位置深在，结构细小复杂，耳科临床医师不能直观地发现内耳病变所在，从而极大地影响了对疾病的诊治。随着影像学技术的发展，高分辨率CT的出现为内耳疾病的诊治提供了许多客观信息。但是其只能帮助我们发现骨迷路异常，     

3D打印技术在鼻鼻窦恶性肿瘤外科中的应用

 目的探讨3D打印技术在鼻鼻窦恶性肿瘤切除及术后重建中的应用。方法回顾分析2015年1月~2017年6月我科收治的鼻鼻窦恶性肿瘤并进行手术治疗的10例患者临床病理资料。其中鳞癌4例,骨肉瘤1例,嗅神经母细胞瘤2例,腺样囊性癌2例,黏液表皮样癌1例。所有患者术前均行鼻鼻窦CT扫描,3D重建并打印出病变鼻窦模型,在模型上进行术前设计及模拟手术,确定肿瘤切除范围、需修复重建部位,确定手术方案后进行肿瘤切除及同期重建。术后均予以放疗并密切随访,通过CT复查与功能检查,对疗效、手术精准度及功能恢复进行评价。结果经3D打印术前设计,全部患者顺利完成肿瘤切除术,8例患者同期行缺损部位修复重建,其中6例患者上颌骨和眶壁骨质缺损植入钛网,2 例患者颅底骨质缺损较大行鼻中隔黏骨膜瓣修复,2例缺损较小且硬脑膜完整者未行骨性重建。术中能够明确肿瘤与解剖结构的位置关系并实现了全部切除、准确定位缺损并修复,精确度高。术后CT复查显示切除范围、骨缺损部位、重建外形与术前设计基本一致。10例患者术后愈合良好,无严重并发症。患者随访12~30个月,肿瘤无复发。结论3D打印技术在鼻鼻窦恶性肿瘤的外科治疗中可以实现术前设计、手术模拟及术后预测,具有较好的可行性和可靠性,有助于鼻鼻窦恶性肿瘤切除范围的确定、缺损重建,可提高鼻鼻窦恶性肿瘤手术治疗的精确性、临床治疗效果及患者术后生活质量。     

磁共振内耳水成像在大前庭水管综合征诊断中的应用

目的：研究磁共振内耳水成像技术在大前庭水管综合征诊断中的作用。方法：应用三维高级快速自旋回波序列横断扫描大前庭水管综合征患者的整个颞骨岩部,将所有原始图像传给网上工作站,应用最大密度投影法将图像进行三维重建,获内耳立体像。结果：患者的磁共振内耳水成像表现为：后颅窝乙状窦前方、内听道后方硬脑膜外的高信号强度结构膨大,呈长条形,边缘光整。患者内淋巴囊骨内部分中点的最大宽度为2．470mm,远大于MRI诊断内淋巴囊扩大的标准。结论：磁共振内耳水成像是诊断大前庭水管综合征的有效方法,临床上可以用此技术做最终诊断。     

血浆长链非编码RNA NEAT1和H19及MALAT1在鼻咽癌中的表达及临床意义

 目的探讨长链非编码RNA（long non coding RNA, lncRNA）3个分子NEAT1和H19及MALAT1在鼻咽癌患者血浆中的表达水平及其在鼻咽癌诊断中的价值。方法收集91例病理确诊的鼻咽癌患者和100例健康体检者血浆作为研究对象。采用定量逆转录PCR检测上述3个lncRNA分子在鼻咽癌患者及健康者血浆中的表达水平。统计分析鼻咽癌患者血浆lncRNA NEAT1、H19和MALAT1 的表达水平与临床因素之间的关系,受试者工作特征（ROC）曲线和曲线下面积（AUC）评估血浆这3个lncRNA分子诊断鼻咽癌的效能。结果鼻咽癌患者血浆lncRNA NEAT1、H19和MALAT1的相对表达量均显著高于对照组（P<0.001）。MALAT1表达水平与N分期相关。血浆NEAT1、H19和MALAT1检测诊断鼻咽癌的AUC分别为0.715、0.708和0.704;NEAT1与H19联合,诊断鼻咽癌AUC增加至0.734。结论鼻咽癌患者血浆lncRNA NEAT1、H19和MALAT1有可能成为鼻咽癌辅助诊断的标志物。     

磁共振内耳成像及钆造影技术在内耳相关疾病中的运用

内耳结构相当复杂、深在,当其出现病变时只依靠临床体征及临床表现去判断,缺少客观的评判指标,尤其对膜迷路积水的情况.随着磁共振成像技术和内耳钆造影技术的发展,内耳的精细结构已经可以显像.本文就磁共振内耳成像及钆造影技术的原理及在内耳相关疾病的应用做一综述.     

以筛前动脉为蒂的鼻腔外侧壁黏膜瓣在额窦后壁缺损重建中的应用

 目的介绍一种以筛前动脉为血管蒂的鼻腔外侧壁黏膜瓣应用于额窦后壁缺损修复重建的新方法,并总结其疗效和初步应用体会。方法回顾性分析应用带蒂鼻腔外侧壁黏膜瓣修复15例额窦后壁脑脊液鼻漏病例,其中男12例,女3例,年龄12~51岁,平均年龄32岁,均为外伤引起的颅底骨折、术前均经过至少1个月保守治疗无效的脑脊液鼻漏患者。采用内镜下DrafIIB型额窦开放+上方带蒂的鼻腔外侧壁黏膜瓣进行颅底修复。结果所有病例均一次性重建成功,术后1个月拔除填充物后无脑脊液鼻漏发生,随访1~3年,无脑脊液鼻漏和颅内感染发生,额窦及上颌窦均引流通畅,上皮化好。主要副反应为鼻腔干燥结痂。结论以筛前动脉为血管蒂的鼻腔外侧壁黏膜瓣取材方便,应用于额窦后壁颅底缺损修复疗效满意,该术式有创新性。     

内耳钆造影磁共振成像技术在梅尼埃病诊疗中的应用

随着内耳钆造影磁共振成像技术的出现,为多种内耳疾病的诊断提供了新方法,也为梅尼埃病的诊断提供新契机,甚至有望成为其诊断的金标准。论文围绕国内外鼓室钆造影技术的发展现状,归纳了钆造影的磁共振成像技术特点、给药方式、评估方法及与传统检查方式进行了对比,总结了内耳钆造影磁共振成像技术在梅尼埃病诊疗中的研究现状。     

磁共振动脉自旋标记技术在缺血性疾病中的应用研究

磁共振动脉自旋标记技术(ASL)是一种非侵入性的影像学技术, 无需造影剂即可定量分析组织的血流灌注情况, 可重复性高, 对血流动力学相关指标敏感。本文主要介绍ASL在缺血性眼病及脑病中的应用, 并与眼部、脑部其他常用的血管造影等检查进行比较。ASL能够对脑部血流状态变化进行监测, 可预测脑部缺血性事件的发生, 目前已广泛应用于缺血性脑病的研究。研究表明ASL能够直接反映脉络膜视网膜组织的供血状况, 可作为定量眼部血流灌注的可靠方法, 同时对脉络膜视网膜疾病的病理生理研究具有一定意义, 可对缺血性眼病进行早期诊断。目前ASL在眼部的应用尚少, 尚需进一步研究以明确ASL在缺血性眼病中的效用。     

Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings and prognosis in sudden sensorineural hearing loss

Objectives/Hypothesis: Three‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging (MRI) has recently been developed to detect high concentrations of protein or hemorrhage. We have previously reported that 50% of patients with sudden sensorineural hearing loss (SNHL) show high signals in the affected inner ear on 3D‐FLAIR MRI. However, the relationship between 3D‐FLAIR findings and hearing prognosis is unclear. Our objective was to evaluate the relationship between the results of 3D‐FLAIR MRI at 3 Tesla and prognosis in sudden SNHL. Study Design and Methods: We used 3D‐FLAIR at 3 Tesla with and without gadolinium enhancement to evaluate the pathologic conditions in the inner ears of 48 patients with sudden SNHL. Results: Thirty‐one of 48 patients with sudden SNHL showed high signals in the affected inner ear on precontrast 3D‐FLAIR. Hearing improvement in patients with high signals in the affected inner ear on precontrast 3D‐FLAIR (25 ± 19 dB) was significantly worse than that in patients with no signal (45 ± 27 dB; P < .05). Our analysis suggests that high signals in the affected inner ear on precontrast 3D‐FLAIR MRI is a new prognostic factor for sudden SNHL. Conclusions: 3D‐FLAIR findings show that high signals in the cochlea on precontrast 3D‐FLAIR are related to a poor hearing prognosis. These signals may reflect minor hemorrhage or an increased concentration of protein in the inner ear, which has passed through blood vessels with increased permeability or has originated in disrupted cells in the inner ear.     

Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings in patients with sudden sensorineural hearing loss

OBJECTIVE: To evaluate the inner ear in sudden sensorineural hearing loss (SNHL) using three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) at 3 Tesla (T). BACKGROUND: 3D-FLAIR MRI has recently been developed to detect high concentrations of protein or hemorrhage. Application of this method to sudden SNHL has not been described. METHODS: We used 3D-FLAIR at 3 T with and without gadolinium enhancement to evaluate eight patients with sudden SNHL. RESULTS: In four of eight ears with idiopathic sudden SNHL, high precontrast signals were observed within the inner ear on 3D-FLAIR. The high-signal areas observed on 3D-FLAIR were not detected by T1- or T2-weighted MRI in any of these patients. In one of these four ears, significant gadolinium enhancement was observed on 3D-FLAIR. CONCLUSION: Half the patients with sudden SNHL examined had high signals in the SNHL-affected ear on 3D-FLAIR at 3 T. High precontrast signals in the inner-ear fluid space may reflect minor hemorrhage, or an increased concentration of protein that had passed through blood vessels with increased permeability, or had originated from disrupted cells in the inner ear. Gadolinium enhancement in one ear suggested the breakdown of the blood-labyrinth barrier. 3D-FLAIR MRI should contribute markedly to the elucidation of pathologic conditions in the inner ears of patients with idiopathic sudden SNHL.     

Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings in a patient with cochlear otosclerosis

A 51-year-old man had progressive hearing loss over more than 15 years. He had bilateral sensorineural hearing loss (SNHL). Computed tomography (CT) showed extensive bilateral demineralization of the cochlear capsule, which is characteristic of diffuse cochlear otosclerosis. Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) of magnetic resonance imaging before enhancement revealed high signals in the cochlea and vestibule. Postcontrast 3D-FLAIR revealed enhancement of the basal turn of the left cochlea. This is the first published case of the breakdown of the blood–labyrinth barrier in a patient with cochlear otosclerosis. Our findings suggest that the breakdown of the blood–labyrinth barrier is associated with a part of SNHL in cochlear otosclerosis.     

Efficacy of diffusion-weighted magnetic resonance imaging in the diagnosis of middle ear cholesteatoma

Objective

This study evaluated the usefulness of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis of middle ear cholesteatoma.

Methods

We performed DWI on 73 patients suspected of having middle ear cholesteatoma, including 21 revision cases. Magnetic resonance imaging was performed with 1.5 T units using diffusion-weighted spin-echo-type echo planar imaging (DWI).

Results

Of 73 subjects, 59 had cholesteatoma that consisted of 41 primary acquired cholesteatoma, 13 had residual and/or recurrent cholesteatoma, four had congenital cholesteatoma, and one had iatrogenic cholesteatoma. Positive DWI findings were observed in 42 subjects and negative findings in 31 subjects. The sensitivity, specificity, and positive and negative predictive values of DWI for cholesteatoma were 69.4%, 92.8%, 97.5%, and 41.9%, respectively. In the case of 34 patients who were positive for cholesteatoma on both otoscopic and CT examinations, 33 were diagnosed with cholesteatoma. Of the remaining 39 subjects with one or both negative results for cholesteatoma, the sensitivity, specificity, positive predictive value, and negative predictive value of DWI were 57.6%, 92.3%, 93.7%, and 52.1%, respectively. Cholesteatoma mass diameters were less than 5 mm in 10 out of 18 subjects with both cholesteatoma and negative DWI findings. Of the 21 subjects who received revision surgery, the sensitivity, specificity, and positive and negative predictive values of DWI for residual or recurrent acquired cholesteatoma were 71.4%, 100%, 100%, and 63.6%, respectively.

Conclusions

Since DWI clearly showed high specificity and positive predictive value, it is useful for diagnosing middle ear cholesteatoma, including postoperative recurrent cholesteatoma of 5 mm diameter or larger. DWI could sufficiently detect cholesteatoma with one or both negative results on otoscopic and CT examinations, but it was difficult to detect cholesteatoma of less than 5 mm diameter using DWI owing to the tiny mass and small volume of debris.     

Accuracy of 3.0 Tesla magnetic resonance imaging in the diagnosis of intracochlear schwannoma

Intracochlear schwannomas (ICSs) are rare tumors. The diagnosis of ICS is based on high-resolution magnetic resonance imaging (MRI), which should be used for the accurate determination of the location of tumors. Recent advancements in imaging technologies and software enable the precise regional diagnosis of ICS. We experienced a case of intracochlear schwannoma with a diagnosis of progressive hearing loss and tinnitus. Audiometry revealed severe hearing loss in the right ear with remaining low-frequency hearing. MRI showed an abnormal lesion in the cochlea. Three-dimensional real inversion recovery (3D rIR) and constructive interference in steady state (CISS) MRI revealed the size and shape of the tumor via identification of the cochlear nerve and cochlear fluid space. CISS and 3D rIR sequences provide useful information regarding the boundaries of tumors and the tissues that surround them.     

Magnetic resonance imaging of the inner ear in patients with idiopathic sudden sensorineural hearing loss

Although gadolinium-enhanced magnetic resonance imaging (Gd-MRI) has been used to indicate the presence of a subclinical labyrinthitis in patients with idiopathic sudden sensorineural hearing loss (ISSHL), its sensitivity in daily clinical practice is unknown. We describe Gd-MRI findings in 27 ISSHL patients taking part in a prospective multicenter clinical trial. MRI findings were related to the severity of the hearing loss, vestibular involvement and the time interval between the occurrence of ISSHL and imaging. Pathological enhancement of the cochlea indicating a labyrinthitis was found in one patient with ISSHL. In 26 cases, no pathological enhancement could be established. Study results indicate that the present sensitivity of Gd-MRI is low for detecting subclinical viral labyrinthitis in patients with ISSHL. To improve the sensitivity of MRI in ISSHL, we recommend that imaging is performed as early as possible, preferably before treatment is started. Received: 17 November 1997 / Accepted: 8 May 1998     

A perspective from magnetic resonance imaging findings of the inner ear: Relationships among cerebrospinal, ocular and inner ear fluids

Visualization of endolymphatic hydrops has been performed using magnetic resonance imaging (MRI) after intratympanic or intravenous gadolinium (Gd) injection. Our recent findings indicate that just as the prevalence of asymptomatic glaucoma is greater than that of symptomatic glaucoma, there are also many cases of asymptomatic endolymphatic hydrops. It is assumed that the asymptomatic endolymphatic hydrops that precedes Ménière's disease is found more frequently using MRI than with other techniques. Gd in the inner ear moves into the cerebrospinal fluid (CSF) via the internal auditory meatus. Gd enhancement is also recognized in the ocular fluid after the intravenous Gd administration. In this paper, the relationships between CSF, ocular fluid and inner ear fluid are reviewed. The central nervous system, eye and inner ear contain specialized extracellular fluids that are essential for maintaining their function: CSF, ocular fluid consisting of vitreous humor and aqueous humor, and inner ear fluid consisting of perilymph and endolymph. Abnormal accumulation of or pressure elevation in these fluids is associated with hydrocephalus, glaucoma and Ménière's disease, respectively. The dura mater and the arachnoid membrane of the optic nerve canal and inner ear meatus are very close to the eye and the inner ear, respectively. It has been reported that low CSF pressure is associated with glaucoma and endolymphatic hydrops. In glaucoma and Ménière's disease, nerve damage to ganglion cells rather than damage of the sensory cells is directly associated with progression of the disease. Retinal ganglion cells in glaucoma and spiral ganglion cells in Ménière's disease are targets of the abnormal accumulation of, or increased pressure in, the extracellular fluid, just as neurons are damaged in hydrocephalus. Studies on hydrocephalus, glaucoma and Ménière's disease as a group may deepen our understanding of each disease.     

3D-FLAIR magnetic resonance imaging in the evaluation of mumps deafness

A 6-year-old boy suffered acute profound right side deafness after his classmates had mumps. Although his salivary glands were not swollen, he had high levels of anti-mumps IgM and IgG antibodies. The three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) procedure applied to magnetic resonance imaging (MRI) showed high signals in the right cochlea and vestibule. This indicated hemorrhage or a high concentration of protein in the right inner ear. This is the first case demonstrating a high 3D-FLAIR MRI signal of the inner ear in a patient with mumps deafness. Our findings suggest that 3D-FLAIR MRI may help to identify and define labyrinthitis in mumps deafness.