本文選題：MPR + VR�。� 參考：《蚌埠醫(yī)學(xué)院》2017年碩士論文

【摘要】：研究目的通過(guò)MSCT常用的三種后處理技術(shù):多平面重組(MPR)、容積再現(xiàn)(VR)及最大密度投影(MIP)觀察正常中耳聽(tīng)骨鏈的形態(tài)結(jié)構(gòu);并基于此三種重建技術(shù)觀察慢性中耳炎患者病耳聽(tīng)骨鏈的骨質(zhì)破壞情況,將影像學(xué)診斷結(jié)果與術(shù)中所見(jiàn)進(jìn)行對(duì)比,觀察兩者的一致性,從而探討MSCT三維重建技術(shù)對(duì)中耳炎患者聽(tīng)骨鏈完整性顯示的價(jià)值;同時(shí)評(píng)價(jià)聽(tīng)骨鏈破壞程度與聽(tīng)力水平的相關(guān)性。資料與方法選取蚌埠醫(yī)學(xué)院第一附屬醫(yī)院耳鼻喉科收治的中耳炎、突聾、耳后瘺管及梅尼耳埃病患者(所選病例均剔除雙側(cè)耳病變患者),詳細(xì)記錄其臨床癥狀、術(shù)前聽(tīng)力情況,應(yīng)用64層螺旋CT,進(jìn)行顳骨薄層螺旋掃描,按照納入標(biāo)準(zhǔn)從受檢者中選出正常組及疾病組共計(jì)63例將其數(shù)據(jù)傳至ADW4.4工作站(Advanced Workstation 4.4),應(yīng)用相關(guān)軟件進(jìn)行聽(tīng)骨鏈的三維重建。正常對(duì)照耳觀察聽(tīng)骨鏈的形態(tài)結(jié)構(gòu);病變耳觀察聽(tīng)骨鏈的改變及骨質(zhì)破壞情況并和手術(shù)結(jié)果所見(jiàn)進(jìn)行對(duì)比。選用SPSS21.0統(tǒng)計(jì)軟件完成所需的統(tǒng)計(jì)學(xué)分析。結(jié)果(1)正常組錘骨頭、錘骨頸、錘骨柄、錘砧關(guān)節(jié)、砧骨體、砧骨長(zhǎng)腳、砧骨短腳這七個(gè)結(jié)構(gòu)均能在MPR、VR及MIP上很好地顯示,它們的顯示率無(wú)明顯差異,當(dāng)把豆?fàn)钔�、砧鐙關(guān)節(jié)和鐙骨頭看成一個(gè)整體時(shí),這三種顯示方式亦無(wú)明顯差異。對(duì)鐙骨前、后弓的顯示,MPR與MIP之間無(wú)明顯差異,都優(yōu)于VR,且MPR在顯示鐙骨前弓上更好。VR和MIP都不能很好顯示鐙骨足板,MPR在顯示鐙骨足板上有較大優(yōu)勢(shì)。(2)病變組錘骨頭、錘骨柄、砧骨長(zhǎng)腳、砧骨短腳及錘砧關(guān)節(jié)骨質(zhì)破壞MSCT診斷與手術(shù)結(jié)果比較,Kappa值均0.75,表明兩者的一致性較好,砧鐙關(guān)節(jié)及鐙骨骨質(zhì)破壞的比較,Kappa值分別為0.529, 0.538,表明兩者的一致性一般。(3)中耳炎聽(tīng)小骨的破壞中,砧骨的破壞率最高;聽(tīng)力損失程度與聽(tīng)骨鏈的破壞呈正相關(guān)關(guān)系(rs'=0.824 , P0.01),聽(tīng)骨鏈破壞的程度越重,聽(tīng)力下降越嚴(yán)重,當(dāng)聽(tīng)小骨破壞程度達(dá)到Ⅲ期時(shí),氣導(dǎo)聽(tīng)力損失一般在62dB以上。結(jié)論1. .MSCT后處理技術(shù)對(duì)正常聽(tīng)小骨大部分細(xì)微結(jié)構(gòu)能夠很好的顯示,尤其是MPR技術(shù)對(duì)鐙骨底板的顯示;VR技術(shù)則不適用于鐙骨的顯示;MIP技術(shù)能夠呈現(xiàn)出三維立體效果,操作起來(lái)省時(shí),簡(jiǎn)單同時(shí)又能達(dá)到較高的顯示效能,值得影像醫(yī)生在實(shí)際工作中常規(guī)使用。2.對(duì)于鼓室內(nèi)伴有軟組織病灶的中耳炎患者,綜合MSCT后處理技術(shù)可以準(zhǔn)確的評(píng)估聽(tīng)小骨的破壞,為臨床醫(yī)生提供有價(jià)值信息。3.砧骨更容易受到破壞,聽(tīng)骨鏈的破壞程度與聽(tīng)力損失密切相關(guān)。
[Abstract]:Objective to observe the morphologic structure of the auditory chain of the normal middle ear by using three kinds of post-processing techniques commonly used in MSCT: multiplanar recombination, volumetric reconstruction and maximum density projection. The bone destruction of ossicular chain in patients with chronic otitis media was observed on the basis of these three reconstruction techniques. The imaging diagnosis results were compared with those during operation, and the consistency between the two methods was observed. To explore the value of MSCT three-dimensional reconstruction in displaying the ossicular chain integrity in patients with otitis media, and to evaluate the correlation between the degree of ossicular chain destruction and hearing level. Materials and methods patients with otitis media, sudden deafness, retroauricular fistula and Meniere's disease were selected from the Otolaryngology Department of the first affiliated Hospital of Bengbu Medical College. A total of 63 cases of normal group and disease group were selected according to the inclusion criteria to transmit their data to ADW4.4 workstation and Advanced Workstation 4.4 to reconstruct the auditory ossicular chain by using the relevant software. The morphological structure of ossicular chain was observed in normal control ears and the changes of ossicular chain and bone destruction in diseased ears were observed and compared with the results of operation. Use SPSS21.0 software to complete the required statistical analysis. Results 1) the seven structures of the mallet bone, the neck of the malleus, the stalk of the malleus, the anvil joint, the incus, the long foot of the incus and the short foot of the incus could be well displayed on MPR-VR and MIP. There was no significant difference in the display rate of these seven structures. When the stirrup joint and head of stapes were regarded as a whole, there were no significant differences among the three display modes. For the anterior stapes, there was no significant difference between MPR and MIP in the posterior arch, and MPR was better than MIP in displaying the stapes anterior arch. VR and MIP could not well display the malleus bone and pedicle of the stapes pedis in the lesion group. The results of MSCT diagnosis and operation of long foot, short foot of incus and malus anvil joint were 0.75, which indicated that the consistency of the two methods was good. The comparison of the destruction of the incudrup joint and the stapes bone showed that the Kappa value was 0.529 and 0.538 respectively, which indicated that the destruction rate of the incus was the highest in the small auditory bone of otitis media. There was a positive correlation between the degree of hearing loss and the destruction of ossicular chain. The more severe the damage of auditory chain was, the more serious the hearing loss was. When the damage degree of small auditory bone reached stage 鈪，

本文編號(hào)：1843518