搏动性耳鸣的CT和DSA

CT and DSA evaluation of pulsatile tinnitus

目的:采用CT和DSA探讨疗效显著的搏动性耳鸣的病因,总结针对搏动性耳鸣患者的最佳影像学检查方法。方法:回顾性分析102例经手术或介入治疗后搏动性耳鸣消失或明显减轻患者的CT和DSA资料,患者均行颅面部双期增强CT扫描和DSA检查。结果:102例引起搏动性耳鸣的病变包括颈内动脉海绵窦瘘(CCF)41例,海绵窦区及横窦、乙状窦区硬脑膜动静脉瘘25例,乙状窦憩室15例,颈静脉球体瘤12例,鼓室球瘤5例,颅外动静脉畸形3例,面颊部动静脉瘘1例。CT显示CCF39例,显示率为95.1%;硬脑膜动静脉瘘18例,显示率为72%;颅外动静脉畸形2例,显示率为66.7%;对乙状窦憩室、颈静脉球体瘤及鼓室球瘤的显示率为100%。DSA对所有病变均能显示,DSA显示血管畸形的能力明显优于CT(P=0.004),CT对CCF的显示率明显高于对血管畸形的显示率(P=0.006)。结论:疗效显著的搏动性耳鸣常见病因是CCF和硬脑膜动静脉瘘,双期CT增强扫描和DSA是寻找病原因的重要方法,CT可取代DSA作为筛选方法。

Objective：To study the causes of pulsatile tinnitus（PT） with CT and DSA and evaluate the optimal imaging means for detecting underlying causes of PT.Methods：We retrospectively studied 102 cases of PT proven by surgery or interventional therapy.All patients underwent cerebral digital subtraction angiography（DSA） and dual phase contrast enhanced CT.Results：Among the 102 cases,there were 41 cases with carotid cavernous fistula（CCF）,25 cases with cerebral dural arteriovenous fistula（dAVF）,15 cases with sigmoid sinus diverticula,12 cases with glomus jugulare tumor,5 cases with glomus tympanicum tumor,3 cases with extracranial arteriovenous malformation（AVM） and one case with arteriovenous fistula in the cheek.The accuracy of CT in diagnosing CCF,dAVF and extracranial AVM was 95.1%（39/41）,72%（18/25） and 66.7（2/3） respectively.The accuracy of CT in diagnosing sigmoid sinus diverticulum,glomus jugulare tumor and glomus tympanicum tumor reached 100%.The accuracy of DSA in the diagnosis of above diseases were 100%.DSA was significantly better than CT for demonstrating vascular malformation and the detection rate of CT was significantly higher in CCF than in vascular malformations.Conclusion：The most common treatable causes of PT are CCF and dAVF.DSA is the most definitive method for detecting underlying causes of PT and CT can replace DSA as a screening method.