本文選題：彌散張量成像 + 先天性感音神經(jīng)性耳聾��； 參考：《天津醫(yī)科大學》2011年碩士論文

【摘要】：目的：探討先天性感音神經(jīng)性耳聾(CSNHL)患兒的蝸神經(jīng)(CN)及內(nèi)耳道(IAC)是否存在發(fā)育異常,并探討CN發(fā)育與年齡及IAC大小的關(guān)系。應(yīng)用磁共振擴散張量成像(DTI)技術(shù)評價CSNHL患兒中樞聽覺傳導通路的完整性及損傷情況,探討聽覺傳導通路腦白質(zhì)微觀結(jié)構(gòu)改變。 方法：應(yīng)用德國Siemens公司Magnetom Trio Tim MR 3.0T掃描儀對43例CSNHL患兒及15例聽力正常對照(NC)者進行全腦的常規(guī)T1WI、T2WI掃描,、T2-SPACE及DTI掃描。T2-SPACE序列參數(shù)為：[TR/TE 1000/132ms,矩陣200×200]。DTI序列參數(shù)[TR/TE 10500/103ms,空間分辨率1.8×1.8×1.8LP/mm,b值分別取0、1000 s/mm2,方向20個]。測量所有研究對象雙側(cè)CN的水平徑、橫截面積、橫截面周長及雙側(cè)內(nèi)耳道的水平徑、垂直徑徑線；并測量聽覺傳導通路上的斜方體(TB)、上橄欖核(SON)、下丘(IC)、內(nèi)側(cè)膝狀體(MGB)、顳橫回下白質(zhì)(WTG)的部分各向異性(FA)、表面擴散系數(shù)(ADC)、橫向擴散系數(shù)(λ(?))及縱向擴散系數(shù)(λ⊥)。用r檢驗,比較左右側(cè)各徑線有無統(tǒng)計學差別。將患兒按兩個標準分組,①內(nèi)耳結(jié)構(gòu)是否異常②是否能感知聲音。用LSD檢驗對組間CN徑線進行比較。采用Pearson積差相關(guān)法對CN和IAC大小進行相關(guān)性分析。用t檢驗,比較左右側(cè)兩組間5個興趣區(qū)(ROI)4個DTI參數(shù)值有無差異。將患兒按是否能感知聲音分組。用LSD檢驗對組間5個興趣區(qū)(ROI)4個DTI參數(shù)值進行比較。采用Pearson積差相關(guān)法對最敏感參數(shù)和年齡進行相關(guān)性分析。 結(jié)果：1.43例患兒中,16例內(nèi)耳畸形,其中大前庭9例,大前庭導水管8例。耳蝸螺旋畸形12例。2.CSNHL組、NC組CN左右側(cè)橫徑、橫截面積、橫截面周長及IAC水平徑、垂直徑分別比較,均無統(tǒng)計學差異(P0.05)。3.CN橫徑、橫截面積及橫截面周長在內(nèi)耳結(jié)構(gòu)正常組患兒(Ⅰ組)、內(nèi)耳結(jié)構(gòu)異常組患兒(Ⅱ組)與正常對照組(Ⅲ組)間進行方差分析,存在統(tǒng)計學差異(P0.05)。Ⅰ組、Ⅱ組CSNHL患兒的CN橫徑、橫截面積及橫截面周長小于Ⅲ組對照組；Ⅰ組左側(cè)CN面積大于Ⅱ組,均有統(tǒng)計學差異(P0.05)。4CN橫徑、橫截面積及橫截面周長在帶助聽器患兒組(甲組)、不帶助聽器患兒組(乙組)及正常對照組(丙組)間進行方差分析,存在統(tǒng)計學差異(P0.05)。甲組、乙組CSNHL患兒的CN橫徑、橫截面積及橫截面周長小于丙組對照組,差別有統(tǒng)計學意義(P0.05)。5. CSNHL患兒的CN橫截面積和周長相對于NC組和年齡無明顯的線性關(guān)系。6.CSNHL左側(cè)IAC水平徑與CN橫截面積有線性關(guān)系。7.CSNHL組下丘及顳橫回下白質(zhì)的FA、ADC、λ∥、λ⊥左右側(cè)比較差異有統(tǒng)計學意義(P0.05)。NC組下丘左右FA、ADC、λ∥、λ⊥有統(tǒng)計學差異(P0.05)。8.除斜方體外其他4個ROIs,甲組、乙組CSNHL患兒的FA與丙組之間均存在統(tǒng)計學差異(P0.05),且均小于丙組對照組；除顳橫回下白質(zhì)其他4個ROIs,甲組、乙組CSNHL患兒的λ⊥與丙組之間均存統(tǒng)計學差異(P0.05),且均大于丙組對照組。兩組CSNHL患兒之間各參數(shù)均無統(tǒng)計學差異(P0.05)。9.正常對照組的FA值在5個ROIs都隨著年齡的增長而增大,CSNHL組患兒5個ROIs的FA值與年齡并未存在相關(guān)。 結(jié)論：本研究發(fā)現(xiàn)CSNHL患兒的CN大小比正常組略小。內(nèi)耳結(jié)構(gòu)可能會影響聽神經(jīng)的發(fā)育。CN橫截面積為測量CN大小最敏感指標。幼兒左、右腦FA值不對稱是先天形成的。CSNHL組4個ROIs的FA值下降,λ⊥升高,而ADC值和λ″沒有改變,說明聽神經(jīng)纖維束有所破壞,但纖維束依然完整。下丘是對聲音刺激影響最敏感部位。微弱的聲音刺激對腦內(nèi)聽覺傳導通路發(fā)育沒有顯著的影響。
[Abstract]:Objective: To investigate the developmental abnormalities of the cochlear nerve (CN) and the inner auditory canal (IAC) in children with congenital sensorineural deafness (CSNHL), and to explore the relationship between the development of the CN and the size of IAC. The integrity and damage of the central auditory pathway in children with CSNHL were evaluated by magnetic resonance diffusion tensor imaging (DTI), and the auditory conduction was discussed. The microstructural changes of the white matter in the brain of the road.
Methods: 43 children with CSNHL and 15 cases of normal hearing control (NC) were used to perform routine T1WI, T2WI scanning, T2-SPACE and DTI scanning sequence parameters of 43 children with CSNHL and 15 cases of normal hearing control (NC), using the Magnetom Trio Tim MR 3.0T scanner in Germany. .8LP/mm, b values were 01000 s/mm2, 20 directions, respectively. The horizontal diameter, cross section area, cross section circumference, horizontal diameter and vertical diameter line of the bilateral inner ear were measured in all the subjects, and the trapezoid (TB), the upper olivary nucleus (SON), the inferior colliculus (IC), the medial geniculate body (MGB), and the white matter (WTG) part of the temporal gyrus were measured. Anisotropy (FA), surface diffusion coefficient (ADC), transverse diffusion coefficient ([lambda] (?)) and longitudinal diffusion coefficient ([lambda]). By R test, there is no statistical difference between the left and right sides. The children are divided into two criteria, (1) whether the structure of the inner ear is abnormal and whether the sound can be perceived. The CN diameter between the groups is compared with the LSD test. The Pearson product difference phase is used. Correlation analysis of the size of CN and IAC. Using t test, comparing the 4 DTI parameters of 5 interest areas (ROI) between the left and right sides of the two groups. The children were grouped according to whether they could perceive sound. The 4 DTI parameters of the 5 interest areas (ROI) between the groups were compared with LSD test. The most sensitive parameters and age were compared by the Pearson product difference correlation method. The analysis of customs.
Results: of the 1.43 children, there were 16 cases of inner ear malformation, including 9 large vestibule, 8 cases of large vestibular aqueduct, 12 cases of cochlear spiral malformation,.2.CSNHL group, NC group CN lateral transverse diameter, cross section area, cross section circumference and IAC horizontal diameter, and there were no statistical differences (P0.05).3.CN transverse diameter, transverse area and cross section circumference were in the inner ear structure. Children (group I), children with abnormal structure of inner ear (Group II) and normal control group (Group III) carried out variance analysis, there was statistical difference (P0.05). Group I, group II, CSNHL children's CN transverse diameter, cross section area and cross section circumference less than group III control group, the left CN area in group I was larger than group II, there were statistical differences (P0.05).4CN transverse diameter, transverse The sectional area and the circumference of cross section in children with hearing aids (Jia Zu), without hearing aids children group (group B) and normal control group (Bing Zu) analysis of variance analysis, there were statistical differences (P0.05). Jia Zu, group B CSNHL children's CN transverse diameter, cross section area and cross section circumference is less than the control group, the difference is statistically significant (P0.05).5. CSNHL There was no significant linear relationship between the CN cross section area and the perimeter of the children compared with the NC group and the age..6.CSNHL left IAC horizontal diameter and the CN cross sectional area had a linear relationship with the FA, ADC, lambda and the left and right side of the white matter in the inferior colliculus and the temporal transverse gyrus of the.7.CSNHL group (P0.05), and there was a statistically significant difference between the left and right sides of the.NC group (P0.05), ADC, [lambda], and there were statistical differences. .05).8. except the other 4 ROIs in the orthopulse, there were statistical differences between group A and group B CSNHL (P0.05) between group B and group C (P0.05), and all were smaller than those in group C. The statistical difference between group A and group B CSNHL children except the other 4 ROIs, group a and group B CSNHL children was larger than that of group C (P0.05), and the two groups of CSNHL were in the two group. There was no statistical difference between the parameters of the children (P0.05) the FA value of the.9. normal control group increased with the age of 5 ROIs, and the FA value of 5 ROIs in the children of CSNHL group was not associated with age.
Conclusion: This study found that the size of CN in children with CSNHL was slightly smaller than that in the normal group. The inner ear structure may affect the.CN transverse area of the auditory nerve development as the most sensitive indicator of the measurement of the size of the CN. The FA value of the left and right FA in the left and right brain of young children is a decrease in the FA value of the 4 ROIs in the congenital.CSNHL group, and the ADC value and the lambda "are not changed, indicating the auditory nerve fiber. The vascular bundle is damaged, but the fiber bundle remains intact. The hypothalamus is the most sensitive part of the sound stimulation. Weak sound stimulation has no significant effect on the development of the auditory pathway in the brain.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R764

【參考文獻】

相關(guān)期刊論文 前8條

1 夏爽,祁吉;感音神經(jīng)性耳聾的影像學及病因?qū)W研究[J];國外醫(yī)學(臨床放射學分冊);2005年06期

2 夏爽;祁吉;;感音神經(jīng)性耳聾的聽皮質(zhì)形態(tài)學及功能學研究[J];國外醫(yī)學(臨床放射學分冊);2006年01期

3 李子孝;戴建平;李少武;;BOLD-fMRI和DTI:腦功能-結(jié)構(gòu)結(jié)合的研究進展[J];國外醫(yī)學(臨床放射學分冊);2006年05期

4 李巖,李建軍,趙應(yīng)滿,符征;MRI內(nèi)耳水成像在感音性耳聾的臨床應(yīng)用[J];海南醫(yī)學;2004年11期

5 孫喜斌;于麗玫;張曉東;張彩萍;曲成毅;;中國0～17歲聽力殘疾兒童抽樣調(diào)查分析[J];中國聽力語言康復科學雜志;2008年05期

6 祁吉,夏爽;感音神經(jīng)性耳聾的影像學及病因?qū)W研究[J];中國醫(yī)學影像技術(shù);2005年09期

7 夏爽,祁吉,尹建忠,薛永剛;單側(cè)感音神經(jīng)性耳聾病人聽覺中樞的fMRI研究[J];中國醫(yī)學影像技術(shù);2005年09期

8 王勝;李永輝;周媛;于春水;許存祿;秦文;劉勇;蔣田仔;;擴散張量成像觀察先天性耳聾患者腦白質(zhì)結(jié)構(gòu)[J];中國醫(yī)學影像技術(shù);2009年04期

，

本文編號：1986057