基于10μm级耳科专用CT的前庭导水管峡部形态与梅尼埃病关系评估

Study on the relationship between the morphology of the isthmus of the vestibular aqueduct and Meniere′s disease based on 10μm otology CT

目的探讨基于10μm级耳科专用CT评估前庭导水管(VA)峡部形态与梅尼埃病(MD)的发生、病程及听力障碍程度的关系。方法前瞻性纳入2020年10月至2021年7月在首都医科大学附属北京友谊医院放射科13例梅尼埃病患者的资料,其中男4例,女9例,年龄16~77(56±16)岁。所有患者均使用10μm级耳科专用CT检查。纳入病变侧耳为患侧组(14侧),非病变侧耳为健侧组(12侧),按1∶2侧纳入性别、侧别匹配的无外、中耳病变者为对照组16例(28侧),其中男4例,女12例,年龄16~77(56±14)岁。以水平半规管显示最大层面为标准横断面,在此图像上连续观察,根据VA峡部显示情况分为Ⅰ~Ⅳ级。采用Kruskal-Wallis检验比较患侧组、健侧组、对照组间VA峡部形态的差异,以纯音测听(PTA)结果评估听力障碍程度,分为正常/轻度/中度/中重度/重度/极重度听力障碍。采用Spearman相关性分析比较患侧VA峡部形态评级与年龄、病程、听力障碍程度间的相关性。结果患侧组中VA峡部形态Ⅰ、Ⅱ、Ⅲ、Ⅳ级占比分别为28.6%(4/14)、42.9%(6/14)、21.4%(3/14)、7.1%(1/14),健侧组中占比分别为0(0/12)、33.3%(4/12)、33.3%(4/12)、33.3%(4/12),对照组中占比分别为0(0/28)、7.1%(2/28)、64.2%(18/28)、28.6%(8/28)。MD患侧组VA峡部评分[M(Q1,Q3)]低于MD健侧组[2(1,3)比3(2,4)]及对照组[2(1,3)比3(3,4)](均P<0.05)。MD患侧VA峡部形态与年龄呈负相关(r=-0.81,P=0.002),与病程、听力障碍程度间均无相关性(r=-0.40、-0.26;均P>0.05)。结论MD的VA峡部狭窄,可能是引发MD的解剖因素。

Objective To evaluate the morphology of isthmus of the vestibular aqueduct(VA)and its relationship with the occurrence,course of Meniere′s disease(MD)and the degree of hearing loss based on 10μm otology CT.Methods A total of 13 patients with MD in Beijing Friendship Hospital,Capital Medical University from October 2020 to July 2021,including 4 males and 9 females,age from 16 to 77(56±16)years,were prospectively enrolled.All patients underwent 10μm otology CT examination.The included lesion side was the MD affected group(14 sides),and the non-lesion side was the MD healthy group(12 sides).According to the 1∶2 side,16 sex-and side matched cases(28 sides)without external and middle ear disease were included in the control group,including 4 males and 12 females,age from 16 to 77(56±14)years.The horizontal semicircular canal showed on the largest plane was considered as the standard cross-section,and continuous observation was made on this image.According to the display type of isthmus of the VA,it was divided intoⅠtoⅣgrades.Kruskal Wallis test was used to compare the morphological differences of VA isthmus among the affected group,the healthy group and the control group.The degree of hearing impairment was assessed by pure tone audiometry(PTA)results,which were divided into normal/mild/moderate/moderately severe/severe/extremely severe hearing impairment.Spearman correlation analysis was used to compare the correlation between the morphological rating of VA isthmus on the affected side and age,course of disease and the results of pure tone audiometry(PTA).Results The proportions of VA isthmic morphology GRADEⅠ,Ⅱ,Ⅲ,Ⅳin the MD affected group were 28.6%(4/14),42.9%(6/14),21.4%(3/14),7.1%(1/14),those in the MD healthy group were 0(0/12),33.3%(4/12),33.3%(4/12),33.3%(4/12),and those in the control group were 0(0/28),7.1%(2/28),64.2%(18/28),28.6%(8/28).The VA isthmus scores[M(Q1,Q3)]of MD affected group was lower than that of MD healthy group[2(1,3)vs 3(2,4)]and control group[2(1,3)vs 3(3,4)](all P<0.05,respectively).The morphology of the VA isthmus on the affected side of MD was negatively correlated with age(r=-0.81,P=0.002),and there was no correlation with the course of disease and degree of hearing impairment(r=-0.40,r=-0.26;all P>0.05,respectively).Conclusion The stenosis of the VA isthmus in MD was a possible anatomical factor for the occurrence of MD.