64排螺旋CT中耳仿真内窥镜和听骨链的三维重建临床应用

目的:探讨64排螺旋CT仿真内窥镜、听骨链三维重建及镫骨前后脚斜面重建在病变中耳中的临床应用价值。方法:33例66耳行颞骨GE Lightspeed64排螺旋CT容积扫描,正常组35耳,病变组31耳,用GE Advantage工作站行中耳CTVE、听骨链SSD及镫骨前后脚的斜轴位重建与冠、轴位CT及手术所见进行对照。结果:24耳慢性化脓性中耳炎中CTVE显示锤骨柄、砧骨长脚骨质破坏与手术所见的符合率为91.7%(22/24),显示锤骨头骨质破坏的符合率为95.8%(23/24),显示砧骨短脚骨质破坏的符合率为100%(24/24),显示镫骨脚骨质破坏的符合率为87.5%(21/24)。中耳CTVE、听骨链SSD、镫骨前后脚斜轴位重建显示听小骨骨质破坏与手术符合率与冠、轴位图像的符合率差异无显著性,但符合率(CTVE平均93.3%、SSD平均95%、镫骨前后脚斜轴位重建91.7%)稍高于冠、轴位图像(平均90%)。结论:64排螺旋CT中耳CTVE、听骨链SSD及镫骨前后脚的斜轴位重建显示听骨链及骨壁的骨质破坏与手术所见符合率较冠、轴位图像稍高,且图像更立体、清晰,耗时不长,可以用于临床常规使用。

Clinical Application of 64-detector CT as Middle-ear Virtual Endoscipy and Three-dimensional Reconstruction of Ossicular Chain

Objective To assess the application of 64-detector CT for the virtual endoscopy(VE) ,the reconstruction of ossicular chain and the oblique reconstruction of stapes. Methods 33 patients were examined by GE Lightspeed 64-detector CT. The 66 ears include 31 chronic suppurative otitis media. All lesions were confirmed by clinical examination and operation. The data was transferred to a workstation via an internal Dicom network for post-processing. CTVE, SSD of ossicular chain and the oblique reconstruction of stapes were processed on 66 ears. CTVE, SSD of ossicular chain and the oblique reconstruction of stapes of normal ears were compared with anatomy and coronal and axial CT film, and that of ill ears were compared with operation and coronal and axial CT film. Results The representation of the structures of ill ears on CTVE and its comparison with coronal and axial CT film and operation: In 24 purulent otitis media, CTVE had a coincidence of 91.7% with operation of handle of malleus, 95.8% of head of malleus,95.8% of long limb of incus ,100% of short limb of incus, 87.5% of limbs of stapes. There were no significant differences between the rate of coincidence of CTVE and that of coronal and axial CT film, but CTVE、 SSD and the oblique reconstruction of stapes had a higher coincidence (average 93.3%、95%、91.7%) than coronal and axial CT film (average 90%). Conclusion CTVE, SSD of ossicular chain and the oblique reconstruction of stapes can wholely show the ossicular chain, and have a high coincidence of the destruction of ossicular chain. The imaging of CTVE, SSD of ossicular chain and reconstruction of stapes of 64-detector CT is clear and tridimensional with a short time, and can be applied in clinical examination.