64排128层螺旋CT图像重建技术对胆脂瘤型中耳炎的术前评估价值

The Value of Preoperative Assessment about Otitis Media with Cholesteatoma by Image Reconstruction of 64-Multidetector 128-Slice Computer Tomography

目的探讨MSCT后处理技术对胆脂瘤型中耳炎骨质破坏情况显示的优劣势。材料与方法采用64排128层螺旋CT对42耳胆脂瘤型中耳炎中耳及内耳结构进行多种方式重建,结果与术中所见对照,Kappa检验二者的一致性,采用SPSS11.0软件包处理,规定Kappa值大于或等于0.75为两者有很高的一致程度,其值在0.4-0.75说明一致程度尚可。小于0.4则说明一致程度不够理想。结果锤骨头、砧骨长脚、砧骨短脚、砧骨体、脑膜板骨壁骨质破坏、鼓窦入口扩大、面神经管水平段骨管结构缺损Kappa值均大于0.75;锤骨柄、锤砧关节、面神经管水平段、迷路段、半规管、盾板、乙状窦骨壁、迷路结构骨质破坏情况Kappa值在0.4-0.75之间;而砧镫关节、镫骨前脚、镫骨后脚、镫骨底板骨质破坏情况Kappa值小于0.4。结论 MSCT后处理技术对胆脂瘤型中耳炎中耳、内耳结构骨质破坏情况的成像对手术有重要参考价值。

Obiective To explore the advantages and disadvantages of post-processing techniques of MSCT to the manifestation of bone destruction in ears with otitis media with cholesteatoma.Materials and Methods Image reconstruction of 64-multidetector 128-slice CT were performed to middle and internal ears of 42 ears with otitis media with cholesteatoma in different ways.The images were compared to intraoperative findings,and the concordance of the two underwent Kappa test.SPSS was used to deal with the results.High concordance was defined as Kappa 0.75.Acceptable concordance was defined as 0.4≤Kappa≤0.75.Low concordance was defined as Kappa≤0.4.Results Kappa values of head of malleus,long crus of incus,short crus of incus,body of incus body,bone destruction of meningeal board,aditus ad antrum expanding and structure defects of horizontal segment of facial nerve canal were greater than 0.75;Kappa values of handle of malleus,incudomelleolar joints,horizontal and labyrinthin segment of facial nerve canal,semicircular canal,scutum,bone wall of sigmoid sinus and bone destruction of labyrinth were between 0.4 and 0.75,but Kappa values of incudostapedial joint,anterior crus of stapes,posterior crus of stapes and bone destruction of footplate of stapes were less than 0.4.Conclusions Images of bone destruction in middle and internal ears with otitis media with cholesteatoma have important reference value for the operation.