本文關(guān)鍵詞： 雙側(cè)感音神經(jīng)性耳聾 磁共振擴(kuò)散張量成像 磁共振內(nèi)耳水成像 感音神經(jīng)性耳聾 內(nèi)耳畸形 磁共振內(nèi)耳水成像 人工耳蝸植入　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分 DTI在評價雙側(cè)感音神經(jīng)性耳聾患兒聽覺通路的價值目的利用磁共振擴(kuò)散張量成像(diffusion tensor imaging,DTI)技術(shù)對雙側(cè)感音神經(jīng)性耳聾(bilateral sensorineural hearing loss,BSNHL)患兒的聽覺傳導(dǎo)通路進(jìn)行研究,比較不同程度BSNHL患兒與正常兒之間聽覺傳導(dǎo)通路是否存在差異;觀察BSNHL患兒、正常兒的聽覺傳導(dǎo)通路隨年齡的變化。資料與方法本實驗采用西門子3.0T skyra磁共振(Magnetic Resonance Imaging,MRI)對21例共42耳經(jīng)聽力學(xué)檢查確診為BSNHL的患兒及24例共48耳正常嬰幼兒進(jìn)行DTI數(shù)據(jù)采集,同時進(jìn)行磁共振內(nèi)耳水成像掃描以排除內(nèi)耳畸形病例。所納入實驗組中的患兒雙耳聽力受損程度相同,男10例,女11例,年齡為2-12月齡兒,平均年齡為6.3±3.2月;對照組為來我院行MRI顱腦檢查的且常規(guī)MRI檢查未見任何腦部異常的嬰幼兒,這些被檢查者在出生3天及42天均通過了聽力篩查,男14例,女10例,年齡為2-14月齡,平均年齡為8.5±3.6月齡。分組情況根據(jù)純音聽力測試聽閾值將BSNHL患兒劃分為甲乙丙三組,分別為輕度、中度、重度(本研究中包括極重度)感音神經(jīng)性耳聾,具體劃分標(biāo)準(zhǔn)依據(jù)國際衛(wèi)生組織(WHO-1997)的定義,我們將雙耳聽閾在26-40d B的輕度感音神經(jīng)性耳聾患兒定義為甲組;雙耳聽閾在41-60d B的中度感音神經(jīng)性耳聾患兒患兒定義為乙組;將雙耳聽閾"g61d B的重度及極重度感音神經(jīng)性耳聾患兒定義為丙組。本實驗選取下丘、內(nèi)側(cè)膝狀體為感興趣區(qū)(ROI),測量下丘及內(nèi)側(cè)膝狀體部位的部分各向異性(fractional anisotropy,FA)。結(jié)果1、甲組與對照組各感興趣區(qū)之間的FA值的差異無統(tǒng)計學(xué)意義(P0.05);2、乙組、丙組與對照組在下丘、內(nèi)側(cè)膝狀體間的FA值的差異存在統(tǒng)計學(xué)意義(P0.05),且均小于對照組;3、正常對照組的FA值在2個ROIs都隨年齡的增長而增大。結(jié)論1、中度、重度BSNHL患兒下丘、內(nèi)側(cè)膝狀體的FA值下降,說明髓鞘化有所破壞;2、FA值在正常兒及輕度BSNHL的診斷中價值有限。3、正常兒童下丘及內(nèi)側(cè)膝狀體部位的FA值隨年齡的增長而增加,說明髓鞘化過程隨年齡增長而不斷進(jìn)行。第二部分 MRI在感音神經(jīng)性耳聾患兒耳蝸植入術(shù)中的價值目的對于重度、極重度由內(nèi)耳畸形引起的感音神經(jīng)性耳聾患兒最有效的治療方法是人工耳蝸植入,但是Michel畸形、Mondini畸形、耳蝸未發(fā)育是耳蝸植入術(shù)禁忌癥,且不同的內(nèi)耳畸形對于手術(shù)開窗位置有著不同的影響,如果提前對患兒內(nèi)耳結(jié)構(gòu)不了解極易造成失誤,從而給手術(shù)增加難度。本研究通過回顧性分析的方法探討MRI在人工耳蝸植入術(shù)前的診斷價值,并通過與CT的檢查結(jié)果相比探究MRI的優(yōu)勢所在。材料與方法收集我院2014年3月至2016年12月間在我院進(jìn)行人工耳蝸術(shù)前篩查并擬行人工耳蝸植入術(shù)的150例(共300耳)患者的影像學(xué)資料,均被診斷為感音神經(jīng)性耳聾。所有被檢者均行顳骨CT掃描及后期重建、MRI顱腦平掃及內(nèi)耳水成像及內(nèi)耳三維重建,被檢者年齡在8月齡至5歲之間,平均年齡為2.1±0.8歲,其中男98例,女52例。結(jié)果1、在150例共300耳患者中,Mondini畸形、Michel畸形、共同腔畸形及IP-I型、半規(guī)管畸形CT與MRI的檢出率差異無統(tǒng)計學(xué)意義,而內(nèi)聽道狹窄、LAVS、蝸神經(jīng)異常MRI的檢查率高于CT,差異有統(tǒng)計學(xué)意義。2、MRI檢出14例腦白質(zhì)異常病例,檢出率為9.3%。結(jié)論1、MR在內(nèi)聽道狹窄、LAVS、蝸神經(jīng)異常的檢出率方面優(yōu)于CT。2、MRI有助于發(fā)現(xiàn)腦白質(zhì)病變。
[Abstract]:Objective to evaluate the value of DTI in the first part of bilateral sensorineural hearing loss in children with auditory pathway using diffusion tensor magnetic resonance imaging (diffusion tensor, imaging, DTI) technology for bilateral sensorineural hearing loss (bilateral sensorineural hearing loss, BSNHL) of auditory pathway were studied and compared between different degrees of BSNHL children and normal hearing children whether there are differences in pathway BSNHL were observed; and the auditory pathway of normal children with age changes. Materials and methods this experiment adopts SIEMENS 3.0T skyra magnetic resonance (Magnetic Resonance Imaging, MRI) in 21 cases of 42 ears were diagnosed by audiological examination for BSNHL patients and 24 cases of 48 ears of normal infants DTI data at the same time acquisition, magnetic resonance imaging scans to exclude water inner ear malformations of inner ear cases. The experimental group included in the same degree of binaural hearing impaired children , male 10 cases, female 11 cases, aged 2-12 months old, the average age was 6.3 + 3.2 months; the control group in our hospital underwent brain MRI examine and conventional MRI examination showed no abnormal infants, these were born in 3 days and 42 days have passed the hearing screening, male in 14 cases, female 10 cases, aged 2-14 months old, the average age was 8.5 + 3.6 months. According to the grouping audiometery thresholds of BSNHL were divided into three groups, respectively, mild, moderate, severe (in the study include severe sensorineural hearing loss), specific classification standard according to the World Health Organization (WHO-1997) definition, we will define the binaural hearing threshold in mild sensorineural hearing loss in children with 26-40d B in group A; binaural hearing threshold in children with moderate sensorineural hearing loss in children with 41-60d B for the definition of group B; g61d B "binaural hearing threshold will be severe and very severe sensorineural Deaf children is defined as C group. In this experiment, inferior colliculus, medial geniculate body for the region of interest (ROI), part of the anisotropy of the position measurement of inferior colliculus and medial geniculate body (fractional, anisotropy, FA). The results of the 1, there was no significant difference between the observation group and control group in each region of interest FA value (P0.05); 2, group B, group C and control group in the inferior colliculus, statistically significant differences between the FA value of the medial geniculate body (P0.05), and there were smaller than the control group; 3 normal control group, the FA value in 2 ROIs increase with age. Conclusion: 1, moderate and severe BSNHL children the inferior colliculus, medial geniculate body of FA decreased, indicating the damage of myelin sheath; 2, FA value in the diagnosis of normal and mild BSNHL value in.3 Co., part of the normal children inferior colliculus and medial geniculate body FA value increases with the increase of age, illustrate the process of myelination with age increasing. The second part MRI in the sense of value of nerve deafness in children with cochlear implantation in severe and extremely severe caused by a sense of inner ear malformation treatment of sensorineural deafness in children with cochlear implantation is the most effective, but Michel malformation, Mondini malformation, cochlear aplasia is cochlear implantation surgery contraindications, and for different inner ear malformation the operation position of the window has a different effect, if the children do not know in advance of the inner ear structure is easy to cause errors, so as to increase the difficulty of operation. Through the review of the value of MRI in diagnosis before cochlear implantation method of this study, and with the CT test results of MRI materials and advantages are compared. Methods 150 patients in our hospital from March 2014 to December 2016 in our hospital were cochlear preoperative screening and undergoing cochlear implantation (300 ears) with imaging, were A diagnosis of sensorineural hearing loss. All subjects underwent temporal bone CT scan and post reconstruction, brain MRI scan and three-dimensional reconstruction imaging of inner ear and inner ear water, subjects aged 8 month old to 5 years old, the average age was 2.1 + 0.8 years old, male 98 cases, female 52 cases. Results 1 in 150 cases, a total of 300 ears in patients with Mondini malformation, Michel malformation, common cavity malformation and type IP-I, CT and MRI were of semicircular canal malformations were not statistically significant, while the internal auditory canal stenosis, LAVS, cochlear abnormal MRI examination was higher than CT, there was a significant difference between the.2 and MRI were detected in 14 cases of brain white matter abnormalities, the detection rate was 9.3%. conclusion 1, MR, LAVS, stenotic, the detection rate is better than that of CT.2 cochlear nerve abnormalities, MRI helps to detect cerebral white matter lesions.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R764.43;R445.2

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