3D-FIESTA与高分辨率CT对儿童内耳不全分隔Ⅰ型畸形并自发性脑脊液耳漏的诊断价值

Utility of 3D-FIESTA and HRCT in Detection of Cerebrospinal Fluid Otorrhea Associated with Incomplete Partition Type Ⅰ Deformity in Children

目的探讨MRI三维稳态进动快速成像(3D-FIESTA)序列及高分辨率CT(HRCT)对儿童先天性内耳不全分隔Ⅰ型畸形并自发性脑脊液耳漏的诊断价值。方法回顾性分析本院6例内耳不全分隔Ⅰ型畸形并自发性脑脊液耳漏患儿3D-FIESTA、HRCT表现及临床资料,总结其影像及临床特点。结果6例患儿中4例为单侧畸形,2例为双侧畸形;6例脑脊液耳漏为单侧发病;6例耳蜗均为不全分隔Ⅰ型;6例均伴前庭扩大;6例HRCT多平面重组(MPR)均可见内耳道底骨质缺损及前庭窗扩大,5例FIESTA可显示位于内耳道底与前庭间的瘘道;6例中耳乳突蜂房、鼓室、咽鼓管均可见积液。5例有反复化脓性脑膜炎病史,1例有脑外伤史。结论内耳不全分隔Ⅰ型畸形并自发性脑脊液耳漏儿童多有化脓性脑膜炎病史,HRCT MPR可见内耳道底骨质缺损及前庭窗扩大,3D-FIESTA可显示瘘道,HRCT及3D-FIESTA对于该病的诊断有重要价值。

Objective To discuss the value of three-dimensional(3 D)fast-imaging employing steadystate acquisition(FIESTA)and high resolution computed tomography(HRCT)in detection of cerebrospinal fluid(CSF)otorrhea associated with incomplete partition typeⅠdeformity in children.Methods A total of 6 children were included.The imaging data including 3 D-FIESTA and HRCT,the characteristics of the clinical presentations were retrospectively analyzed.Results There were 6 cases with incomplete partition typeⅠdeformity,including unilateral in 4 cases and bilateral in 2 cases.All 6 cases had unilateral incidence of cerebrospinal fluid otorrhea.The defect of the floor of the internal auditory canal and dilated oval window were observed in all 6 cases by MPR images of HRCT.The CSF fistulae were found located between the oval window and the floor of the internal auditory canal in 5 cases by FIESTA images.Effusion in the middle ear and eustachian tube were seen in all 6 cases.5 cases had a history of recurrent purulent meningitis,1 case had a history of brain trauma.Conclusion Children with incomplete partition typeⅠdeformity combined with cerebrospinal fluid otorrhea commonly have a history of recurrent purulent meningitis.HRCT and 3 D-FIESTA has significant value in diagnosis of this disease.