640层螺旋CT显示胆脂瘤型中耳炎听小骨的价值

640-slice CT Imaging for Ossicles in Cholesteatomatous Otitis Media

目的探讨胆脂瘤型中耳炎听小骨的640层螺旋CT轴位扫描及多平面重组(MPR)、容积再现(VR)表现,分析CT重建图像的应用价值。资料与方法经手术及病理证实的胆脂瘤型中耳炎患者29例(30耳),均采用轴位扫描、MPR及VR重建,并与手术结果对照。结果 29例患者(30耳)听小骨破坏部位共86个,砧镫关节脱位1耳。锤骨柄和砧骨短脚CT轴位扫描、MPR及VR的敏感度、特异度、阳性预测值、阴性预测值、符合率均为100.00%;锤骨头和砧骨体CT轴位扫描、MPR及VR的特异度及阳性预测值均为100.00%,锤骨头MPR的敏感度、阴性预测值及符合率分别为94.74%、91.67%及96.67%,砧骨体MPR的敏感度、阴性预测值及符合率分别为93.75%、93.33%及96.67%,均高于VR及轴位扫描。砧骨长脚的VR及镫骨的轴位扫描显示效果最佳,敏感度、特异度、阳性预测值、阴性预测值及符合率均为100.00%。结论 640层螺旋CT能准确地显示胆脂瘤型中耳炎听小骨的结构及破坏情况。VR在显示听小骨关节脱位方面有其独特优势。

Purpose To explore the axial scanning, multiplanar reconstruction （MPR） and volume rendering （VR） manifestations of the ossicles in cholesteatomatous otitis media in 640-slice CT, and to analyze the clinical application value of CT reconstruction images. Materials and Methods Twenty-nine cases （30 ears） of cholesteatomatous otitis media confirmed by surgery and pathology were enrolled; all patients underwent axial scanning and MPR, VR reconstruction and the results were compared with surgical findings. Results Eighty-six parts of ossicular destruction were found in 29 patients （30 ears）, with incudostapedial dislocation detected in one ear. Sensitivity, specificity, positive predictive value, negative predictive value and compliance rate of malleus and incus short legs CT axial scan, MPR and VR were all 100.00%; specificity and positive predictive value of malleus head and incus body axial CT scan, MPR and VR were all 100.00%, sensitivity, negative predictive value and compliance rate of malleus head MPR was 94.74%, 91.67% and 96.67%, respectively; sensitivity, negative predictive value and compliance rate of incus body was 93.75%, 93.33% and 96.67%, which were all higher than the VR and axial scans. The best results were showed by incus long foot VR and stapes foot axial scan; the sensitivity, specificity, positive predictive value, negative predictive value and the compliance rate were all 100.00%. Conclusion 640-slice spiral CT is able to accurately display the structure and destruction of ossicles in cholesteatomatous otitis media. VR possesses its unique advantages in the display of ossicles dislocation.