中耳疾病的CT诊断及与传统X线的比较

CT Diagnosis of Middle Ear Diseases: A Comparison with Conventional Radiology

目的 探讨CT在中耳疾病诊断中的应用及其价值。材料与方法 搜集本院经手术病理证实的中耳疾病 43例 46耳 :慢性化脓性中耳炎 3 6耳 ,其中单纯型 5耳 ,骨疡型 (肉芽肿型 ) 10耳 ,胆脂瘤型 2 1耳 (其中 1耳为乳突根治术后复发 )。中耳癌 4耳 ,中耳先天畸形 6耳。所有病例术前均行双侧乳突Mayer’s位和Schuller’s位摄片及螺旋CT轴位、冠状靶放大扫描。CT、平片所见与手术、病理对照。结果 3 6耳慢性化脓性中耳炎中 ,单纯型 5耳和骨疡型 10耳乳突平片均见乳突密度增高 ,2 1耳胆脂瘤型中乳突平片 10耳见明确的骨质破坏 ,诊断为胆脂瘤型 ,5耳见鼓窦入口略大可疑胆脂瘤形成 ,6耳胆脂瘤漏诊。 4耳中耳癌中平片仅 2耳见明确的骨质破坏。 6耳先天畸形平片仅反映乳突气化情况。而CT不但清楚地显示了耳内外解剖结构 ,而且显示的病变及其范围和浸润的程度均与手术所见一致。此外 ,还发现 3耳胆脂瘤型慢性化脓性中耳炎合并脑脓肿 ,1耳中耳癌浸润颞叶。结论 乳突平片已不能适应现代耳科显微手术的发展 ,不能满足临床的需要 ,螺旋CT明显优于平片 。

Objective To evaluate CT in diagnosing and clinical application of middle ear diseases.Materials and Methods Findings on plain films and spiral CT of 46 ears (in 43 cases) with chronic otitis media (n=36), cancer of middle ear (n=4) or congenital malformation of middle ear (n=6) were analyzed, and a comparison with surgical findings was made.Results Six cholesteatomas and 2 middle ear cancers missed diagnosis on plain films. No definite signs were seen on plain films in 6 ears with congenital malformation. Spiral CT well displayed the middle ear anatomy in all cases, and demonstrated the soft tissue and bone erosion both in 36 ears with chronic otitis media and in 4 ears with middle ear cancer, and also showed the brain abscess concurrent with cholesteatoma in 3 cases.Conclusion Spiral CT is superior to conventional X ray in displaying the anatomy of middle ear in detail and in diagnosing of middle ear diseases, providing the operator with useful information.