本文關(guān)鍵詞： 耳聾 感音神經(jīng)性 兒童 磁共振成像　出處：《山東大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 探討MRI在兒童感音神經(jīng)性耳聾(sensorinueral hearing loss,SNHL)中的成像特點(diǎn)及診斷價(jià)值。 材料與方法： 1.一般材料：應(yīng)用Philips Achieva1.5T超導(dǎo)型磁共振掃描儀、頭部正交線圈,對(duì)經(jīng)臨床初診為雙耳感音神經(jīng)性耳聾的52例兒童患者及24例無(wú)聽(tīng)力損失兒童(對(duì)照組)分別進(jìn)行顱腦常規(guī)磁共振成像和T2W-3D-DRIVE序列軸位水成像。所有患兒檢查前家長(zhǎng)均簽署知情同意書。檢查前對(duì)不能保持平靜呼吸的患兒口服5%水合氯醛鎮(zhèn)靜。 2.方法： 掃描序列：軸位T1WI序列(TE/15ms,TR/550ms,層厚/4mmm,層間距/0.4mm,層數(shù)/20層)；T2WI序列(TE/150ms,TRshortest,層厚/4mm,層間距/0.4mm,層數(shù)/20層)；T2-FLAIR序列(TE/120ms, TR/6000ms, TI/2000ms,層厚/4mm,層間距/0.4mm,層數(shù)/20層)；彌散加權(quán)成像(DWI:TE/50ms,TRshortest,b值/1000,層厚/4mm,層間距/0.4mm,層數(shù)/20層)。T2W-3D-DRIVE序列(TE/200ms, TR/2000ms, Flip/90°,層厚0.5mm,無(wú)間距連續(xù)掃描,FOV130～180mm,矩陣/256×256；NSA/2次)。MRI水成像掃描方法：為了獲得精確的內(nèi)耳解剖結(jié)構(gòu)及其位置關(guān)系,使進(jìn)床的定位線盡量能通過(guò)雙側(cè)耳廓的相同位置(眥耳線),以T2WI顯示的內(nèi)耳為定位中心進(jìn)行高分辨三維快速自旋回波(3D/DRIVE)的軸位掃描,掃描范圍準(zhǔn)確包括全部的內(nèi)耳結(jié)構(gòu)。后期在工作站進(jìn)行各方位MIP和MPR重組,部分進(jìn)行VRT重組,獲得各個(gè)方位(包括冠狀位、斜矢狀位)的迷路圖像,利用MIP重組方法多角度多方位旋轉(zhuǎn)分別測(cè)前庭最大徑、前庭垂直徑、3個(gè)半規(guī)管最大徑和管徑、蝸高。 3.統(tǒng)計(jì)學(xué)處理：采用SPSS17.0統(tǒng)計(jì)軟件對(duì)測(cè)量結(jié)果進(jìn)行兩樣本均數(shù)比較t檢驗(yàn)或t’檢驗(yàn)或u檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。同時(shí)計(jì)算對(duì)照組兒童上述內(nèi)耳各觀察結(jié)構(gòu)MRI測(cè)量值的95%雙側(cè)醫(yī)學(xué)參考值范圍。 結(jié)果： 1.常規(guī)顱腦MRI可以清晰顯示腦內(nèi)病變。T2-DRIVE-HR SENSE圖像及多平面重組(MPR)可清晰顯示內(nèi)耳膜迷路、內(nèi)聽(tīng)道內(nèi)的精細(xì)解剖結(jié)構(gòu)及微小病變,52例SNHL兒童及對(duì)照組兒童耳蝸前庭神經(jīng)顯示率達(dá)到100%,內(nèi)耳道內(nèi)血管(迷路動(dòng)脈或小腦下動(dòng)脈)顯示率為38.5%。最大信號(hào)強(qiáng)度投影(MIP)重組可獲得明了可觀的膜迷路三維立體圖像。 2.52例SNHL患兒中發(fā)現(xiàn)19例異常(陽(yáng)性率36.5%),其中雙側(cè)腦白質(zhì)病8例,雙側(cè)腦白質(zhì)病并右側(cè)大腦半球發(fā)育不良1例；雙耳前庭導(dǎo)水管擴(kuò)大綜合征(large vestibular aqueduct syndrome, LVAS)6例(圖5)；雙耳半規(guī)管發(fā)育不良2例(1例伴有前庭及前庭導(dǎo)水管擴(kuò)大,圖6)；Mondini畸形2例(耳蝸發(fā)育不全僅有1.5圈,伴有前庭小、半規(guī)管發(fā)育不全,圖7)；依據(jù)以上測(cè)量前MRI檢查結(jié)果,將52例SNHL患兒分為四組：腦白質(zhì)病變組(9例18耳)、LVAS組(6例12耳)、內(nèi)耳復(fù)雜畸形組(4例8耳),MRI陰性組(33例66耳)。 3.MIP重組圖像上：參照對(duì)照組各內(nèi)耳結(jié)構(gòu)測(cè)量值界定的95%雙側(cè)醫(yī)學(xué)參考值范圍,腦白質(zhì)病變組、LVAS組所有內(nèi)耳結(jié)構(gòu)測(cè)量值均超過(guò)半數(shù)以上屬95%雙側(cè)范圍；MRI陰性組除前庭垂直徑外,其他內(nèi)耳結(jié)構(gòu)測(cè)量值均超過(guò)半數(shù)以上屬95%雙側(cè)范圍；而內(nèi)耳復(fù)雜畸形組大部分測(cè)量值在95%雙側(cè)范圍外。SNHL組和對(duì)照組的前庭最大徑垂直徑、后半規(guī)管最大徑和管徑、水平半規(guī)管最大徑和管徑、蝸高的測(cè)量值有統(tǒng)計(jì)學(xué)差異；腦白質(zhì)病變組和對(duì)照組的前庭最大徑和垂直徑、后半規(guī)管最大徑和管徑、水平半規(guī)管管徑及蝸高的測(cè)量值有統(tǒng)計(jì)學(xué)差異；LVAS組和對(duì)照組的前庭最大徑、后半規(guī)管管徑、水平半規(guī)管最大徑及蝸高的測(cè)量值有統(tǒng)計(jì)學(xué)差異；內(nèi)耳復(fù)雜畸形組例數(shù)較少,各內(nèi)耳結(jié)構(gòu)測(cè)量均值如表2,未做統(tǒng)計(jì)比較；MRI陰性組和對(duì)照組的前庭最大徑和垂直徑、上半規(guī)管的最大徑和管徑、后半規(guī)管和水平半規(guī)管最大徑、蝸高的測(cè)量值有統(tǒng)計(jì)學(xué)差異。 結(jié)論： 1.3D-DRIVE內(nèi)耳水成像序列能夠清晰顯示內(nèi)耳膜迷路、內(nèi)聽(tīng)道神經(jīng)及部分微小血管,彌補(bǔ)了CT只能顯示骨迷路的不足,對(duì)LVAS及內(nèi)耳復(fù)雜畸形的檢出有重要意義。 2.常規(guī)顱腦MRI對(duì)顯示腦白質(zhì)病等腦內(nèi)病變有重要意義,聯(lián)合內(nèi)耳水成像對(duì)診斷兒童感音神經(jīng)性耳聾有著重要的臨床價(jià)值,是SNHL患兒進(jìn)行人工耳蝸術(shù)前的必要檢查。 3.與對(duì)照組比較,MRI陰性組存在內(nèi)耳不同結(jié)構(gòu)MRI測(cè)量值均值的差異,其與SNHL是否存在病因?qū)W相關(guān)性,有待進(jìn)一步研究。
[Abstract]:Objective:
To explore the imaging features and diagnostic value of MRI in sensorinueral hearing loss (SNHL).
Materials and methods:
1. general materials: Philips Achieva1.5T superconducting magnetic resonance scanner head orthogonal coil of clinically diagnosed as 52 cases of children with bilateral sensorineural hearing loss and 24 cases without hearing loss in children (control group) were conventional brain magnetic resonance imaging and T2W-3D-DRIVE weighted axial water imaging with parents before checking. Signed informed consent. Unable to keep quiet breathing check before oral 5% chloral hydrate sedation.
The 2. method:
Scanning sequence: axial T1WI sequence (TE/15ms, TR/550ms, thickness /4mmm, spacing /0.4mm, layer /20 layer); T2WI sequence (TE/150ms, TRshortest, thickness /4mm, spacing /0.4mm, layer /20 layer); T2-FLAIR sequence (TE/120ms, TR/6000ms, TI/2000ms, thickness /4mm, spacing /0.4mm, number /20 layer); diffusion weighted imaging (DWI:TE/50ms, TRshortest, b value /1000, thickness /4mm, spacing /0.4mm, layers of /20 layer).T2W-3D-DRIVE sequence (TE/200ms, TR/2000ms, Flip/90, 0.5mm thickness, gapless continuous scanning, FOV130 ~ 180mm, matrix /256 * 256; NSA/2).MRI water imaging scanning method in order to obtain accurate anatomic structure and position of the inner ear, the positioning line into the bed as much as possible through the same location of the bilateral auricular (canthomeatal line), with T2WI display of the inner ear as location center for high resolution 3D fast spin echo (3D/DRIVE) axial scan, scan range In the inner ear structures. Accurate including later each range MIP and MPR recombination in the workstation, part of VRT recombination and obtain all directions (including coronal, oblique sagittal) of the lost image, using MIP recombination method of multi angle rotation were measured in vestibular maximum diameter, vertical diameter 3 vestibule, semicircular canal maximum the diameter and diameter of worm.
3. statistical analysis: the results were two samples were compared with t test or t test or u test using SPSS17.0 statistical software P0.05, the difference was statistically significant. At the same time calculation of the 95% bilateral medical reference group of children above the inner ear structure observation MRI measurement range of the control.
Result錛，

本文編號(hào)：1485919