单侧突发性聋伴眩晕及耳鸣患者迷路磁共振成像T1加权像高信号比值定量分析

Quantitative study of T1 weighted imaging labyrinthine high signal ratio based on magnetic resonance imaging in patients with unilateral sudden deafness accompanied by vertigo and tinnitus

目的:探讨单侧突发性聋伴眩晕及耳鸣患者迷路磁共振成像(MRI)T1加权像(T1WI)高信号比值的病因推测价值及其与听力预后的关系。方法:收集2016年1月至2019年7月就诊于首都医科大学附属北京同仁医院单侧突发性聋伴眩晕及耳鸣患者52例(男27例,女25例),年龄(47.7±15.1)岁,分析其内耳MRI资料(17例平扫,35例平扫+增强)。由两名医师独立测量T1WI、增强T1WI患侧与正常侧迷路的信号强度并计算(患侧-正常侧)/正常侧的信号比值。增强组根据T1WI迷路信号有无强化(不强化提示出血,强化提示炎症)及增强三维液体衰减反转恢复(3D-FLAIR)序列显示迷路累及部位(外淋巴间隙受累提示炎症,内、外淋巴间隙受累提示出血)两种方法对病因进行推测;平扫组参考3D-FLAIR迷路高信号累及部位进行病因推断。结果:增强组推测8例(22.9%,8/35)出血,27例(77.1%,27/35)炎症,两种方法对病因推测结果一致;平扫组推测7例(7/17)出血,10例(10/17)炎症。两名医师组内及组间测量结果呈高度一致性[组内相关系数(ICC)值均>0.800]。增强组T1WI高信号比值对病因推测的受试者工作特征(ROC)曲线下面积(AUC)为0.949( P<0.01),诊断界值为0.467时,灵敏度96.3%,特异度87.5%,高于此界值提示出血,反之提示炎症。出血组较炎症组的T1WI高信号比值更高,且听力预后情况更差(均 P<0.05);听力未恢复组较听力恢复组的T1WI高信号比值更高( P=0.034)。 结论:信号定量数值结合累及部位能够推测迷路MRI高信号形成病因;迷路出现高信号提示听力预后不良,信号强度越高,提示出血可能性越大,听力预后越差。

Objective To explore the value of speculating etiology of the magnetic resonance imaging(MRI)T1 weighted imaging(T1WI)labyrinthine high signal ratio in patients with unilateral sudden deafness accompanied by vertigo and tinnitus and its relationship with hearing prognosis.Methods Fifty-two patients with unilateral sudden deafness accompanied by vertigo and tinnitus who were admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from January 2016 to July 2019 were collected,including 27 males and 25 females,aged(47.7±15.1)years.The inner ear MRI data of 52 patients(17 plain scan,35 enhanced scan)with unilateral sudden deafness were retrospectively analyzed.Two radiologists independently measured the labyrinthine high signal intensity of the affected side and the contralateral normal side on T1WI and enhanced T1WI and calculated the signal ratio(the normal labyrinth signal was subtracted from the affected signal and then divided by the normal signal).The etiology of the enhanced group was judged based on two methods,including whether the abnormal high signal was enhanced or not(unenhancement indicated hemorrhage and enhancement indicated inflammation),and the locations of labyrinthine involvement on enhanced three-dimensional fluid attenuated inversion recovery(3D-FLAIR)(inflammation usually involved the perilymph spaces,while hemorrhage involved the perilymph and endolymph spaces).In the plain group,the locations of labyrinthine involvement on 3D-FLAIR was applied to infer the potential etiology.Results The two methods presumed that 8 cases might be hemorrhage(22.9%,8/35)and 27 be inflammation(77.1%,27/35)in the enhanced group,which had a high consistency,while it was speculated that 7 patients might be hemorrhage(7/17)and 10 patients be inflammation(10/17)in the plain group.The measurement results of the two radiologists were highly consistent within and between the groups[the intraclass correlation coefficient(ICC)values were greater than 0.800].The area under the receiver operating characteristic(ROC)curve(AUC)of the T1WI high signal ratio in the enhanced group for speculating etiology was 0.949(P<0.01),when the predictive threshold value was 0.467,with a sensitivity of 96.3%and a specificity of 87.5%.It might be hemorrhage when the ratio was higher than the threshold value,otherwise it was inflammation.The T1WI labyrinthine high signal ratio was higher in the hemorrhage group than that of the inflammation group,and the hearing prognosis was worse(all P<0.05).The T1WI labyrinthine high signal ratio of the unrecovered group was higher than that of the recovered group(P=0.034).Conclusions The etiology of labyrinthine high signal formation can be inferred by quantitative values combined with the involved sites.The high signal in the labyrinth indicates poor hearing prognosis,the higher the signal intensity,the greater the possibility of hemorrhage and the worse the hearing prognosis.