高分辨率CT对慢性化脓性中耳炎听骨链破坏的评估价值

The Diagnostic Value of HRCT in the Destruction of Ossicular Chain in Chronic Otomastoiditis

目的探讨高分辨率CT(high resolution computerized tomography,HRCT)2D、3D重建技术对慢性化脓性中耳炎听骨链破坏的评估价值。方法慢性化脓性中耳炎患者48例(53耳),术前均行HRCT检查,并行多平面重组(multi-planer reformation,MPR)及容积重建(CT volume rendering,CTVR),获得2D、3D图像,比较两种重建方法对听骨链各部位的评估结果,并分别将术中所见与MPR及CTVR评估结果比较。结果 MPR及CTVR显示锤砧关节完全破坏、部分破坏及完整分别为7、10、36耳及6、2、45耳,显示砧镫关节完全破坏、部分破坏及完整分别为9、2、42耳及1、1、51耳,显示镫骨完全破坏、部分破坏及完整分别为9、11、33耳及6、3、44耳,差异均有统计学意义(P<0.05),MPR及CTVR对锤骨头、锤骨柄、砧骨体、砧骨长脚、砧骨短脚状态的评估差异无统计学意义(P>0.05)。MPR对锤骨头、锤骨柄、锤砧关节、砧骨体、砧骨长脚、砧骨短脚、砧镫关节及镫骨状态评估结果与手术所见一致性(Kappa=0.82、0.81、0.75、0.79、0.92、0.84、0.75、0.76)均高于CTVR评估结果与手术所见一致性(Kappa=0.63、0.79、0.65、0.62、0.84、0.78、0.55、0.61)。结论 HRCT能够准确评估慢性化脓性中耳炎听骨链状态,2D及3D重建技术对锤砧关节、砧镫关节及镫骨状态的评估存在差异;2D重建技术对听骨链各部位状态评估较3D重建技术更为精准,但不及3D重建技术直观。

Objective To study the value of image post-processing technology of high resolution CT(HRCT) in the diagnosis of ossicular bone destruction in chronic otomastoidtis. Methods Forty-eight patients (fifty-three ears) with otomastoiditis underwent HRCT and transparent multiple plane reconstruction (MPR) and volume reconstruction to study the morphology of ossicles destruction. The results from the two methods were compared. Results The multi-planer reformation(MPR) and CT volume rendering(CTVR) showed incudomalleolar joint complete destruction, partial destruction and integrity in 7,10,16 and 6,2,45 ears, respectively, and incus stapes joint complete destruction, partial destruction and integrity in 9,2,42 and 1,1,51 ears, respectively, and stapes complete destruction, partial destruction and integrity in 9,11,33 and 6,3,44 ears, respectively, and the differences were significant ( P < 0.05 ). There was no significant difference in the head and manubrium of malleus ,corpus incudis and its short and long limbs between the MPR and CTVR ( P > 0.05 ). When compare to the findings during operation, the MPR technology was superior to volume rending technology in showing destruction of ossicular chain. Conclusion HRCT provides a clear view of the morphology of ossicular bones in patients with chronic otomastoiditis. There are differences in the evaluation of incudomalleolar joint, incus stapes joint and stapes between 2D and 3D technology. The 2D technology is more accurate, but 3D image provides better views.