本文選題：膽脂瘤型中耳炎　切入點(diǎn)：磁共振成像　出處：《復(fù)旦大學(xué)》2011年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的探討常規(guī)MRI序列成像在膽脂瘤型中耳炎診斷中的應(yīng)用價(jià)值。 方法選取21位臨床上初步懷疑膽脂瘤型中耳炎的患者行常規(guī)MRI序列檢查(包括T,WI、T2WI、T1增強(qiáng)序列),后在患者知情同意條件下行患耳手術(shù)探查或鼓室成形術(shù),并將術(shù)中標(biāo)本送病理,最后將影像診斷與手術(shù)、病理結(jié)果進(jìn)行對(duì)比。 結(jié)果在21位患者中,患耳23,影像上病灶大小不等。在常規(guī)MRI序列上,23耳中有18耳符合膽脂瘤診斷標(biāo)準(zhǔn),即T,WI上病灶相對(duì)腦組織顯示低或等信號(hào),T2WI上高信號(hào),且T1增強(qiáng)無(wú)明顯強(qiáng)化或邊緣輕度強(qiáng)化；3耳影像上不典型,但術(shù)中及病理均證實(shí)有膽脂瘤；還有1耳假陰性。常規(guī)MRT序列診斷膽脂瘤型中耳炎的敏感性、特異性可分別達(dá)到86.4%、50.0%,閱片者間一致性極強(qiáng)。 結(jié)論常規(guī)MRI序列對(duì)于中耳膽脂瘤的診斷具有較高敏感性,并能夠清晰地顯示較大膽脂瘤與周?chē)M織間關(guān)系,閱片者間診斷一致性強(qiáng),并且影像上病灶大小更接近實(shí)際,為手術(shù)治療提供很有價(jià)值的影像信息,但其診斷特異性偏低,且對(duì)于3mm大小早期病灶難以辨別出。 目的探討彌散加權(quán)成像在膽脂瘤型中耳炎診斷中的應(yīng)用價(jià)值。 方法選取20位臨床上初步懷疑膽脂瘤型中耳炎的患者行彌散加權(quán)成像(b=1000s/mm2),后在患者知情同意條件下行患耳手術(shù)探查或鼓室成形術(shù),并將術(shù)中標(biāo)本送病理,最后將影像診斷與手術(shù)、病理結(jié)果進(jìn)行對(duì)比。 結(jié)果在20位患者中有22耳行彌散加權(quán)成像檢查,影像上病灶大小不等,其中20耳完全符合該序列診斷標(biāo)準(zhǔn),即病灶相對(duì)于腦組織呈高信號(hào)(b=1000 s/mm2),而在ADC圖上則為低或等信號(hào),均診斷為膽脂瘤；1耳彌散加權(quán)成像上信號(hào)無(wú)相對(duì)增高,診斷為中耳乳突炎,還有1耳偽影明顯難以診斷,兩位閱片者間觀點(diǎn)完全一致。彌散加權(quán)成像診斷膽脂瘤型中耳炎的敏感性、特異性可分別達(dá)到95.2%、100%。 結(jié)論彌散加權(quán)成像對(duì)于中耳膽脂瘤的診斷具有高度敏感性、特異性,且不同閱片者間診斷一致性強(qiáng),可以避免一些不必要的手術(shù)探查。但其空間分辨率低,對(duì)于中耳膽脂瘤的并發(fā)癥或膽脂瘤與周?chē)M織間關(guān)系的顯示上效果差,不宜單獨(dú)檢查。 目的分析在HRCT難以確診的早期或臨床不典型患者中,彌散加權(quán)成像組合CT在膽脂瘤型中耳炎診斷中的應(yīng)用價(jià)值。 方法選取慢性中耳炎患者9人,其術(shù)前均已行HRCT檢查,且CT上不能確定是否為膽脂瘤病變或臨床癥狀不符合膽脂瘤或需排除腫瘤病變者,隨后均加做彌散加權(quán)成像,將其術(shù)前影像診斷信息與手術(shù)、病理結(jié)果對(duì)比,并匯總分析其對(duì)中耳病變性質(zhì),即是否為膽脂瘤(彌散加權(quán)成像為主)、位置及并發(fā)癥(HRCT為主)診斷的準(zhǔn)確性。 結(jié)果9位患者中有9耳術(shù)前行彌散加權(quán)成像及HRCT組合檢查,后行手術(shù)探查或鼓室成形術(shù)。在病灶性質(zhì)的診斷上,即是否為膽脂瘤,DWI診斷結(jié)果與手術(shù)病理完全一致,敏感性、特異性均達(dá)到100%,而HRCT診斷結(jié)果中分別有2例假陰性、1例假陽(yáng)性；在中耳乳突的骨質(zhì)破壞的判斷方面,HRCT優(yōu)勢(shì)明顯,聽(tīng)骨鏈及周?chē)琴|(zhì)破壞情況與手術(shù)所見(jiàn)一致；在CT術(shù)前對(duì)病灶的位置診斷方面,影像上病變范圍較術(shù)中所見(jiàn)偏大,但膽脂瘤病變位置基本一致。 結(jié)論在HRCT難以確診的早期或不典型患者中,彌散加權(quán)成像診斷中耳膽脂瘤的敏感性、特異性高,而CT對(duì)病灶空間位置、骨質(zhì)破壞情況術(shù)前判斷準(zhǔn)確,兩者組合檢查在膽脂瘤型中耳炎臨床診療中有較高的應(yīng)用價(jià)值。
[Abstract]:Objective to evaluate the value of conventional MRI sequence imaging in the diagnosis of cholesteatoma otitis media.
Methods 21 patients clinically suspected cholesteatoma otitis media underwent conventional MRI scan (including T, WI, T2WI, T1 enhanced sequence), after informed consent of patients under the condition of the affected ear surgical exploration or tympanoplasty, and the intraoperative specimens were sent to pathology, the image diagnosis and surgery. Compared with pathological results.
The results of the 21 patients, 23 ear images, lesion size range. In conventional MRI sequences, 23 ears and 18 ears with cholesteatoma diagnosis standard, namely T, WI showed low signal lesions relative to brain tissue, T2WI high signal, and enhanced T1 showed no enhancement or slight strong edge 3; untypical, but in surgery and pathology confirmed cholesteatoma; and 1 false negative. The sensitivity of the conventional MRT sequence in the diagnosis of chronic otitis media with cholesteatoma, a specificity of 86.4% and 50% respectively, radiologists were extremely strong consistency.
Conclusion MRI sequence has high sensitivity in the diagnosis of middle ear cholesteatoma, and can clearly display the bold lipoma and surrounding tissues between readers, diagnostic consistency, and the image of lesion size is closer to the actual, to provide the image information is very valuable for surgical treatment, but its specificity is low, and for the 3mm size of early lesions difficult to identify.
Objective to evaluate the value of diffusion-weighted imaging in the diagnosis of cholesteatoma.
Methods 20 patients clinically suspected patients underwent diffusion-weighted imaging of cholesteatoma (b=1000s/mm2), after informed consent of patients under the condition of the affected ear surgical exploration or tympanoplasty, and the intraoperative specimens were sent to pathology, the imaging diagnosis and surgery, compared with pathological results.
Results 22 ears underwent diffusion-weighted imaging in 20 patients, imaging lesions of varying size, of which 20 ears completely accord with the sequence of diagnostic criteria, namely with respect to the brain lesions showed high signal (b=1000 s/mm2), and on the ADC chart is low or signal were diagnosed as cholesteatoma tumor; signal 1 the ear on diffusion-weighted imaging without the relative increase in diagnosis of otitis media, and 1 ear artifacts is difficult to diagnose, two radiologists were exactly the same point of view. The sensitivity of diffusion weighted imaging in diagnosis of chronic otitis media with cholesteatoma, specificity can reach 95.2% 100%. respectively.
Conclusion diffusion-weighted imaging has high sensitivity and specificity for diagnosis of cholesteatoma, and between different viewers diagnostic consistency, to avoid unnecessary surgical exploration. But its low spatial resolution, the effect of cholesteatoma of the middle ear cholesteatoma and surrounding tissue complications or the relationship between display, not a single check.
Objective to analyze the value of diffusion weighted imaging combined with CT in the diagnosis of cholesteatoma type otitis media in HRCT undiagnosed early or clinical atypical patients.
Methods 9 patients with chronic otitis media, the preoperative were examined by HRCT and CT can not determine whether the cholesteatoma lesions or clinical symptoms do not meet the need to exclude cholesteatoma or tumor, were subsequently combined with diffusion weighted imaging, the preoperative diagnosis and surgical pathology information, comparison and summary the analysis of middle ear lesions, whether for cholesteatoma (diffusion-weighted imaging mainly), location and complications (HRCT) diagnostic accuracy.
Results of 9 patients with 9 ears of DWI and HRCT examination underwent surgical exploration or tympanoplasty. In the diagnosis of tumors, whether for cholesteatoma, DWI diagnosis and pathological results completely consistent, sensitivity, specificity reached 100%, and the diagnostic results of HRCT in 2 cases respectively. Negative and 1 false positive; in the middle ear and mastoid bone damage judgment, HRCT obvious advantages, the ossicular chain and the surrounding bone destruction and surgical findings; location diagnosis of lesions in CT images before surgery, intraoperative findings, the lesion is relatively large, but in cholesteatoma position is consistent.
Conclusion in the early diagnosis of atypical or difficult to HRCT patients, the sensitivity of diffusion weighted imaging in diagnosis of cholesteatoma of the middle ear, high specificity, and CT on the spatial location of lesions, bone damage, preoperative accurate judgment, the application value of combined examination was high in clinical diagnosis and treatment of cholesteatoma otitis media.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R764

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本文編號(hào)：1619771