CT对慢性化脓性中耳炎的诊断意义

Significance of CT in diagnosis of chronic suppurative otitis media

目的探讨中耳和乳突不同病变组织术前诊断和鉴别诊断方法。方法回顾分析106例慢性化脓性中耳炎(含胆脂瘤中耳炎)患者颞骨薄层 CT 显示的病变组织,并进行183次 CT 值测量,与术中发现、术后病理进行对比分析,得出不同病变组织的 CT 值范围。从中随机抽取60例,由同一组医师根据不同病变组织 CT 值及周围组织破坏的情况,重新分析做出诊断,将其诊断符合率与放射科常规诊断报告进行比较。根据临床表现和颞骨薄层 CT 扫描结果对9例慢性化脓性中耳炎患者行预测性诊断,以验证本研究结果对于中耳、乳突不同病变组织术前诊断与鉴别诊断的价值。结果胆脂瘤、肉芽组织、胆脂瘤并肉芽组织、炎性渗出、硬化或钙化组织、黏膜增厚并息肉样变组织的 CT值分别为:(46.6±10.3)Hu、(26.6±7.4)Hu、(42.1±11.4)Hu、(-24.6±9.2)Hu、(223.6±63.7)Hu、(23.8±8.5)Hu。根据不同病变组织 CT 值大小及周围组织的破坏情况对60例患者重新分析诊断,诊断符合率从68.3%提高至81.7%(x^2=3.96,P<0.05)。根据临床表现和颞骨薄层 CT 扫描所见进行预测性诊断,诊断符合率达90.0%。结论 CT 值虽不能作为诊断和鉴别诊断中耳、乳突不同病变组织惟一可靠的依据,但不失为一种很有意义的线索;根据临床表现、颞骨薄层 CT 扫描所见对中耳各种病变进行综合分析,可显著提高中耳、乳突病变诊断和鉴别诊断的准确率。

Objective To investigate the methods of preoperative diagnosis and differentiation of different pathological tissue in middle ear and mastoid. Methods The temporal bone lamellar CT findings in 106 patients with chronic suppurative otitis media （including cholesteatoma ） were retrospectively analized. The CT value of pathological tissue were measured for 183 times and were compared with the surgical findings and postoperative pathological findings to definitude the CT value range of different pathological tissue. Sixty patients taken from 106 patients at random were analyzed and made the diagnosis again by the same doctor team according to the CT value of the different pathological tissue and surrounding histoclasia resulted by pathological tissue. The diagnose accordance rate was compared with the routine diagnose report from radiology department. The predetective diagnosis was made in 10 patients with chronic suppurative otitis media according to clinical manifestation （ pathological changes of tympanic membrane, nature of otorrhea, character of hearing） , temporal bone lamellar CT finding （ CT value of pathological tissue, surrounding histoclasia ） to validate the value of this study for preoperative diagnosis and differentiation of different pathological tissue in middle ear and mastoid. Results The CT value of cholesteatoma,granulation tissue,cholesteatoma combined with granulation tissue, effusion, calcified tissue, thickened and polypoid membrane was respectively （46.6 ± 10. 3 ） Hu, （26.6 ± 7.4） Hu, （42.1 ± 11.4） Hu, （ - 24. 6 ± 9. 2 ） Hu, （223.6 ± 63.7 ） Hu, （23.8 ± 8.5 ） Hu. The diagnose accordance rate in 60 patients who were analyzed and made dignosis again according to the CT value of the different pathological tissue and surrunding histoclasia resulted by pathological tissue raised from 68.3% to 81.7% （P 〈 0. 05 ） . The predetective diagnose accordance rate reached at 90% according to clinical manifestation, temporal bone lamellar CT. Conclusions It was not reliable to diagnose and differentially diagnose different pathological tissue in middle ear and mastoid only by the CT value , however , the CT value could still be considered to be a very significant information. The accurate rates of diagnosis and differentiation of different pathological tissue in middle ear and mastoid obviously raised by synthetically analyzing various kinds of pathological tissues in middle ear and mastoid according to clinical manifestation, temporal bone lamellar CT finding.