特发性突发性耳聋内耳3D-FLAIR信号异常与临床

Idiopathic Sudden Deafness: Abnormal Inner Ear High Signal on 3D-FLAIR Imaging and Its Clinical Features

目的探讨特发性突发性耳聋内耳3D-FLAIR上信号异常的原因及其临床意义。方法 150例特发性突发性耳聋行内耳3D-FLAIR检查,其中17例(18耳)内耳出现信号异常。详细分析其信号特点,总结其临床症状、听力学检测结果和治疗效果特点,探讨其信号异常的可能原因及临床意义。结果 17例(18耳)中3D-FLAIR及T1WI上均显示内耳不同程度的信号异常。其中4耳(4/18,22.2%)耳蜗及前庭-半规管信号稍增高,同时T1WI上为稍高信号。4耳(4/18,22.2%)耳蜗、前庭-半规管不均匀高信号,其中伴有斑点状高信号影。6耳(6/18,33.3%)耳蜗为稍高信号,而前庭、半规管见斑点状高信号影,2耳(2/18,11.1%)仅在前庭见小点状高信号,2耳(2/18,11.1%)半规管高信号影。3D-SPACE上仅2耳(2/18,11.1%)表现为稍低信号。临床上17例均起病突然,进程快,数小时听力完全丧失,并伴有明显眩晕,治疗后听力恢复差。结论特发性突发性耳聋MRI上FLAIR信号异常者具有相同的临床特点,同时提示预后不良。

Objective To investigate the cause of abnormal MRI signal displayed on 3D-FLAIR imaging in idiopathic sudden deafness and to discuss its clinical significance. Methods 3D-FLAIR imaging was performed in 150 cases with idiopathic sudden deafness, of whom abnormal inner ear signal was demonstrated in 17 （ 18 ears in total）. The characteristics of the abnormal signals were analyzed in detail. The clinical symptoms, the audiology study results and the therapeutic effect were summarized. The possible cause of abnormal MRI signal and its clinical significance were discussed. Results Different degrees of abnormal MRI signals were demonstrated on 3D-FLAIR and T1WI images in all 18 ears of the 17 patients. The signals of cochlear and vestibular semicircular canal were slightly increased in 4 ears （4/18, 22.2% ） , and slight higher signal was displayed on T1WI. In 4 ears （4/18, 22.2% ） the cochlear and vestibular semicircular canal showed heterogeneous high signal with mottled highlighting signals. In 6 ears （6/18, 33.3% ） the cochlea showed slightly higher signal, while the vestibule semicircular canal assumed mottled high signals. In 2 ears （2/18, 11.1% ） only small spots high signals could be seen in vestibular, and in other 2 ears （2/18, ll. 1% ） the semicircular canal was manifested as high signal. On 3D-SPACE images, only two ears （2/18, 11.1% ） showed slightly lower signal. Clinically, 17 cases began with a very acute onset, the condition progressed quickly, and the complete hearing loss could occur within several hours, and together with heavy dizziness. The recover of hearing was usually poor. Conclusion In idiopathic sudden deafness patients the presence of abnormal signals on MR FLAIR images usually indicates that these patients have some similar clinical features and their prognoses are poor.