本文選題：骨性蝸神經(jīng)管 + 體層攝影術(shù)��； 參考：《山東大學(xué)》2012年博士論文

【摘要】：第一部分CT仿真內(nèi)窺鏡在診斷骨性蝸神經(jīng)管發(fā)育不良中的初步應(yīng)用 研究目的：回顧性評(píng)價(jià)螺旋狀結(jié)構(gòu)消失做為CT仿真內(nèi)窺鏡診斷骨性蝸神經(jīng)管發(fā)育不良的可行性。 研究方法：病例組包括14例骨性蝸神經(jīng)管發(fā)育不良患者(平均年齡5.5歲,1-15歲,6男,8女),共20耳。對(duì)照組由沒有內(nèi)耳及內(nèi)聽道疾患的50例(平均年齡6.6歲,1-15歲,29男,21女)受試者組成,共100耳。3例病人和9例對(duì)照組受試者采用4排多層螺旋CT(MX8000)掃描；11例病人和41例對(duì)照組受試者應(yīng)用16排多層螺旋CT (Somatom Sensation16)或64排多層螺旋CT (Somatom Sensation Cardiac64)掃描。每個(gè)受試者仰臥位,頭放在中立位置,下頦無旋轉(zhuǎn),掃描基線為瑞德基線。掃描方向：從上到下；雙側(cè)顳骨均掃描。掃描參數(shù)如下：MX8000多層螺旋CT：電壓120kV；電流150mAs；層厚0.6mm；準(zhǔn)直0.5mm；螺距0.875；重建間隔50%；骨算法重建；視野250mm。Sensation16和Sensation64多層螺旋CT：電壓120kV；電流150mAs；層厚0.6mm；準(zhǔn)直0.6mm；螺距0.5；重建間隔50%；卷積核B70；視野250mm。 仿真內(nèi)窺鏡觀察骨性蝸神經(jīng)管采用Fly through技術(shù)(Fly Through,3D)。視軸垂直于檢查平面,仿真內(nèi)窺鏡視點(diǎn)放在內(nèi)聽道底的前下象限處,指向蝸軸,調(diào)整視點(diǎn)位置、視軸方向,如果仿真內(nèi)窺鏡閡值設(shè)置如下：下限閾值850-1150,上限閾值3071,在蝸區(qū)會(huì)出現(xiàn)與螺旋孔列相對(duì)應(yīng)的螺旋狀結(jié)構(gòu)。中央管指的是位于橫嵴前下方的孔；螺旋狀結(jié)構(gòu)指的是位于蝸區(qū)的,中央管周圍的螺旋狀裂隙。陽性結(jié)果指螺旋狀結(jié)構(gòu)或者中央管的消失；陰性結(jié)果指螺旋狀結(jié)構(gòu)或者中央管的存在。 兩個(gè)放射科醫(yī)師獨(dú)立評(píng)價(jià)螺旋狀結(jié)構(gòu)是否存在。以臨床及常規(guī)影像診斷結(jié)果作為骨性蝸神經(jīng)管發(fā)育不良的診斷金標(biāo)準(zhǔn)。計(jì)量資料用Mann-Whitney U檢驗(yàn),計(jì)數(shù)資料用卡方檢驗(yàn)或Fisher確切檢驗(yàn)。計(jì)算觀察者間一致性及CT仿真內(nèi)窺鏡診斷骨性蝸神經(jīng)管發(fā)育不良的敏感性、特異性、準(zhǔn)確率、Youden指數(shù)。 結(jié)果：病例組及對(duì)照組在年齡(P=0.335)、性別(P=0.314)、左右側(cè)(P=0.683)上無統(tǒng)計(jì)學(xué)差異。診斷為骨性蝸神經(jīng)管發(fā)育不良的20耳(右11,左9)中,17例未顯示螺旋狀結(jié)構(gòu),3例顯示螺旋狀結(jié)構(gòu),對(duì)照組中均顯示螺旋狀結(jié)構(gòu)。觀察者間有大量一致性(K=0.773)。以螺旋狀結(jié)構(gòu)消失做為征象診斷骨性蝸神經(jīng)管發(fā)育不良的敏感性、特異性、準(zhǔn)確率、Youden指數(shù)分別為85%,100%,98%,0.85。螺旋狀結(jié)構(gòu)消失在病例組及對(duì)照組之間有明顯的統(tǒng)計(jì)學(xué)差異(P0.001)。 診斷為骨性蝸神經(jīng)管發(fā)育不良的20耳中,5例未顯示中央管,對(duì)照組中均顯示中央管。以中央管消失做為征象診斷骨性蝸神經(jīng)管發(fā)育不良的敏感性、特異性、準(zhǔn)確率、Youden指數(shù)分別為25%,100%,88%,0.25。中央管消失在病例組及對(duì)照組之間有明顯的統(tǒng)計(jì)學(xué)差異。雖然螺旋狀結(jié)構(gòu)消失和中央管消失在診斷骨性蝸神經(jīng)管發(fā)育不良有相似的特異度,但是前者有更好的敏感性和準(zhǔn)確率。 結(jié)論：以螺旋狀結(jié)構(gòu)消失做為征象診斷骨性蝸神經(jīng)管發(fā)育不良有高的敏感性、特異性、準(zhǔn)確率和觀察者間一致性,螺旋狀結(jié)構(gòu)消失可以作為診斷骨性蝸神經(jīng)管發(fā)育不良的有用征象。 第二部分聽骨鏈連接關(guān)系層面診斷錘砧復(fù)合體中斷的臨床價(jià)值 研究目的：評(píng)價(jià)聽骨鏈連接關(guān)系層面診斷錘砧復(fù)合體中斷的價(jià)值。 研究方法：收集經(jīng)手術(shù)證實(shí)錘砧復(fù)合體中斷的患者74例(共85耳),男45例,女29例,年齡3-75歲,平均年齡35.7歲,其中11例雙耳患病。所有患者均應(yīng)用16排多層螺旋CT (Somatom Sensation16)掃描。受試者仰臥位,頭放在中立位置,下頦無旋轉(zhuǎn),掃描基線為瑞德基線。橫軸位掃描參數(shù)：電壓120kV；電流350mAs；層厚0.6mm；螺距0.8；重建間隔0.3mm；視野12cm；卷積核B70。 聽骨鏈連接關(guān)系層面由兩個(gè)放射科醫(yī)師獨(dú)立制作,選擇MIP重建,層厚3mm,各解剖結(jié)構(gòu)的定位在軸位及冠狀位上確認(rèn)。聽骨鏈連接關(guān)系層面的制作：在軸位圖像上參考線平行于錘骨頸和砧磴關(guān)節(jié)的連線,在冠狀位圖像上參考線平行于砧骨長腳。放射科醫(yī)師閱讀這些層面,判斷下列各段(錘骨頭、錘骨頸、錘骨柄、錘砧關(guān)節(jié)、砧骨短腳、砧骨體、砧骨長腳)是否連續(xù)(陰性)或中斷(陽性)。同時(shí)判斷錘砧復(fù)合體各組成部分及其中斷部位能否在同一個(gè)聽骨鏈連接關(guān)系層面顯示。兩個(gè)放射科醫(yī)師獨(dú)立評(píng)價(jià),不一致的協(xié)商解決達(dá)成一致做為最后的結(jié)果。以手術(shù)證實(shí)的上述各段的連續(xù)或中斷做為評(píng)價(jià)的金標(biāo)準(zhǔn)。分類資料用McNemar檢驗(yàn)。計(jì)算敏感性、特異性、準(zhǔn)確率、Youden指數(shù)、觀察者間一致性。 結(jié)果：直接軸位圖像診斷錘砧復(fù)合體中斷結(jié)果如下：錘骨頭(n=21)、錘骨頸(n=20)、錘骨柄(n=23)、錘砧關(guān)節(jié)(n=7)、砧骨短腳(n=25)、砧骨體(n=35)、砧骨長腳(n=63)。聽骨鏈連接關(guān)系層面診斷錘砧復(fù)合體中斷結(jié)果如下：錘骨頭(n=20)、錘骨頸(n=19)、錘骨柄(n=26)、錘砧關(guān)節(jié)(n=10)、砧骨短腳(n=28)、砧骨體(n=34)、砧骨長腳(n=66)。手術(shù)證實(shí)錘砧復(fù)合體中斷結(jié)果如下：錘骨頭(n=22)、錘骨頸(n=21)、錘骨柄(n=27)、錘砧關(guān)節(jié)(n=11)、砧骨短腳(n=26)、砧骨體(n=35)、砧骨長腳(n=68)。85耳的錘骨頭、錘骨頸、錘骨柄、錘砧關(guān)節(jié)、砧骨體及砧骨長腳及其中斷部位均可在同一個(gè)聽骨鏈連接關(guān)系層面顯示。85耳的砧骨短腳及其中斷部位需要在多個(gè)聽骨鏈連接關(guān)系層面上顯示。在診斷錘砧復(fù)合體中斷中聽骨鏈連接關(guān)系層面和軸位圖像沒有統(tǒng)計(jì)學(xué)差別。 聽骨鏈連接關(guān)系層面診斷錘砧復(fù)合體中斷的敏感性：錘骨頭90.9%、錘骨頸90.5%,、錘骨柄96.3%、錘砧關(guān)節(jié)90.9%、砧骨短腳71.4%、砧骨體94.3%、砧骨長腳97.1%；特異度：錘骨頭100.0%、錘骨頸100.0%,、錘骨柄100.0%、錘砧關(guān)節(jié)100.0%、砧骨短腳89.5%、砧骨體98.0%、砧骨長腳100.0%；陰性預(yù)測值：錘骨頭96.9%、錘骨頸97.0%,、錘骨柄98.3%、錘砧關(guān)節(jié)98.7%、砧骨短腳86.4%、砧骨體96.1%、砧骨長腳89.5%；Youden指數(shù)：錘骨頭0.909、錘骨頸0.905、錘骨柄0.963、錘砧關(guān)節(jié)0.909、砧骨短腳0.609、砧骨體0.923、砧骨長腳0.971。 在評(píng)價(jià)錘骨、錘砧關(guān)節(jié)、砧骨體、砧骨長腳時(shí)Youden指數(shù)較高；在評(píng)價(jià)砧骨短腳時(shí)Youden指數(shù)較低。評(píng)價(jià)錘骨時(shí),Youden指數(shù)最高的是錘骨柄,次之的是錘骨頭,最低的是錘骨頸。評(píng)價(jià)錘砧關(guān)節(jié)、砧骨體、砧骨長腳的Youden指數(shù)也較高。 兩個(gè)放射醫(yī)師用聽骨鏈連接關(guān)系層面診斷錘砧復(fù)合體中斷的觀察者間一致性如下：錘骨頭0.90、錘骨頸0.94、錘骨柄0.95、錘砧關(guān)節(jié)0.89、砧骨短腳0.75、砧骨體0.85、砧骨長腳0.93。 結(jié)論：聽骨鏈連接關(guān)系層面可以代替直接軸位圖像診斷錘砧復(fù)合體中斷；聽骨鏈連接關(guān)系層面可在同一個(gè)層面上顯示錘砧復(fù)合體的大部分結(jié)構(gòu)和病變,有較高的臨床價(jià)值。
[Abstract]:Preliminary application of first part CT virtual endoscopy in the diagnosis of dysplasia of the cochlear nerve canal

Objective : To retrospectively evaluate the feasibility of spiral structure disappearance as CT virtual endoscopy for diagnosing the dysplasia of the cochlear nerve canal .

Methods : A total of 50 cases ( mean age of 5.5 years , 1 - 15 years old , 6 male , 8 female ) were included in the case group . The control group consisted of 50 cases ( mean age of 6.6 years , 1 - 15 years old , 29 male , 21 female ) who had no inner ear and internal auditory canal disease , and the control group consisted of 100 ears . 3 patients and 9 control subjects were scanned with 4 rows of multi - slice spiral CT ( MX8000 ) ;
11 patients and 41 control subjects were scanned with 16 - row multi - slice spiral CT ( Somatom Sensation16 ) or 64 - row multi - slice spiral CT ( Somatom sensationcardioac64 ) . Each subject was supine , the head was placed in a neutral position , the chin did not rotate , and the scan baseline was from the baseline . The scan direction : from top to bottom ;
The scanning parameters are as follows : MX8000 multi - slice spiral CT : voltage 120kV ;
current 150mAs ;
the thickness of the layer is 0.6mm ;
collimation 0.5mm ;
Pitch 0.875 ;
the reconstruction interval is 50 % ;
Reconstruction of bone algorithm ;
Field of view 250mm . Sensation16 and Sensation64 multi - slice spiral CT : voltage 120kV ;
current 150mAs ;
the thickness of the layer is 0.6mm ;
collimation 0.6mm ;
Pitch 0.5 ;
the reconstruction interval is 50 % ;
convolution kernel B70 ;
The field of view is 250mm .

Fly Through ( 3D ) was used to observe the bone cochlear nerve canal . the visual axis is perpendicular to the inspection plane , the simulated endoscope viewpoint is positioned at the front lower quadrant of the inner auditory canal bottom , points to the scroll axis , adjusts the viewpoint position and the optic axis direction , and if the simulated endoscopic threshold value is set as follows : the lower limit threshold value is 850 - 1150 and the upper limit threshold value 3071 , the spiral structure corresponding to the spiral hole column appears in the scroll region .
The spiral structure refers to the spiral fracture around the central tube in the cochlear area . The positive result refers to the disappearance of the spiral structure or the central tube ;
The negative result refers to the presence of a helical structure or a central tube .

Two radiologists independently evaluated the existence of spiral structures . The diagnostic results of clinical and conventional imaging were used as the diagnostic criteria for dysplasia of the cochlear nerve . The statistical data was examined by Mann - Whitney U . The statistics were examined by Chi - square test or Fisher ' s exact test . The sensitivity , specificity , accuracy and Youden index were calculated by using the Mann - Whitney U test .

Results : There was no statistical difference between the case group and the control group at age ( P = 0.335 ) , sex ( P = 0.314 ) , left and right sides ( P = 0.683 ) .

The sensitivity , specificity , accuracy and Youden index were 25 % , 100 % , 88 % and 0.25 respectively .

Conclusion : The disappearance of spiral structure is a useful sign for the diagnosis of dysplasia of the cochlear nerve canal with high sensitivity , specificity , accuracy and inter - observer agreement .

The clinical value of diagnosis hammer anvil complex interruption in the second part of icular chain connection relation level

Objective : To evaluate the value of the disruption of the hammer anvil complex at the level of the connection relationship between the auditory and the icular chain .

Methods : 74 patients ( 85 ears ) , 45 male , 29 female , aged 3 - 75 years , with a mean age of 33.7 years , were collected . All patients were scanned with 16 - row multi - slice spiral CT ( Somatom Sensation16 ) .
Current 350mAs ;
the thickness of the layer is 0.6mm ;
Pitch 0.8 ;
the reconstruction interval is 0.3 mm ;
the field of view is 12 cm ;
Convolution kernel B70 .

The relationship level of the icular chain connection was made by two radiologists , MIP reconstruction was chosen , the thickness of the layer was 3mm , the location of each anatomical structure was confirmed at the axial position and coronal position .

Results : The results were as follows : hammer head ( n = 21 ) , malleolar neck ( n = 20 ) , malleus stem ( n = 23 ) , hammer anvil joint ( n = 7 ) , short foot ( n = 25 ) , anvil body ( n = 35 ) and foot ( n = 63 ) .

The sensitivity of the diagnosis hammer anvil complex was 90.9 % , 90.5 % , 95.3 % , 90.9 % , 71.4 % , 94.3 % and 97.1 % respectively .
specificity : 100.0 % of hammer head , 100.0 % of hammer neck , 100.0 % of malleus stem , 100.0 % of hammer anvil joint , 89.5 % of short foot of anvil , 91.0 % of incus body and 100.0 % of the long foot of the anvil ;
The negative predictive value was 96.9 % of the hammer bone , 97.0 % of the hammer ' s neck , 98 . 3 % of the malleus , 98 . 7 % of the anvil joint , 86.4 % of the short foot of the anvil , 96.1 % of the anvil body and 89.5 % of the long foot of the anvil ;
Youden index : hammer head 0.909 , hammer neck 0.905 , hammer stem 0.9963 , hammer anvil joint 0.909 , anvil short foot 0.609 , anvil body 0.923 , anvil long leg 0.9971 .

Youden index was higher when evaluating malleus , hammer anvil joint , incus body and anvil .
The Youden index was lower during the evaluation of the rootstocks . When the malleus was evaluated , the Youden index was the highest in the malleolus , the lowest was the hammer head , and the lowest was the malleolus . The Youden index of the anvil joint , the anvil and the anvil was also higher .

The inter - observer agreement between the two radiologists to diagnose the interruption of the hammer anvil complex was as follows : the weight of the hammer was 0.90 , the malleolus was 0.94 , the malleolus was 0.95 , the hammer anvil joint was 0.89 , the short leg of the anvil was 0.75 , the anvil body was 0.85 , and the length of the anvil was 0.93 .

Conclusion : It is possible to replace the direct axial position image diagnosis hammer anvil complex with the connection relation level of the icular chain link ;
At the same level , the structure and the lesion of the anvil complex can be displayed at the same level , which has higher clinical value .

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2012
【分類號(hào)】：R764

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