梅尼埃病钆造影结果的研究

Study on Gadolinium-Enhanced Inner-Ear MRI in Meniere's Disease

目的分析梅尼埃病(MD)患者内淋巴积水评分与疾病分期、纯音听阈的相关性,疾病分期与听觉、前庭功能的相关性,分析钆造影结果与前庭诱发肌源性电位(VEMP)、耳蜗电图(ECochG)的关系,探讨三者在反映内淋巴积水部位上是否相符。方法回顾分析2018年10月至2022年5月在我院耳鼻喉科诊断为单侧MD,完成纯音测听、VEMP、ECochG后行内耳钆造影的34例患者,采用方哲明等评分标准行内淋巴积水评分,分析积水评分与疾病分期、纯音听阈等的相关性,疾病分期与听觉、前庭功能等的相关性,并将钆造影结果分别与VEMP、ECochG结果进行比较。结果内淋巴积水总分与纯音听阈、疾病分期均呈负相关(r=-0.407、-0.487,P<0.05),与MRI扫描距上次眩晕发作时间、病程、年龄、眩晕发作频率无明显相关(P>0.05);疾病分期与VEMP、ECochG、病程、眩晕发作频率、耳蜗积水评分、前庭积水评分均相关(P<0.05);耳蜗积水患者ECochG的敏感度62.1%,特异度66.7%,与钆造影结果符合率为62.5%,进行配对精确概率法,两者差异有统计学意义(P<0.05);前庭积水患者VEMP的敏感度68.0%,特异度80.0%,与钆造影结果符合率为70.0%,进行配对精确概率法,两者差异有统计学意义(P<0.05)。结论评估MD患者内淋巴积水、疾病分期可为临床诊断、病情评估提供可靠依据;VEMP、ECochG虽可反映前庭、耳蜗功能,但不能准确反映前庭、耳蜗是否积水,钆造影检查对与评估前庭、耳蜗功能有一定的意义。

Objective To analyze the correlation between endolymph score and disease stage and pure tone hearing threshold in patients with Meniere s disease(MD),and the correlation between disease stage and hearing and vestibular function,the relationship between gadolinium contrast results and vestibular evoked myogenic potential(VEMP)and electrocochlear imaging(ECochG),and explore whether the three are consistent in reflecting the location of endolymph.Methods 34 patients with unilateral Meniere s disease diagnosed in the department of otorhinolaryngology from October 2018 to May 2022,who underwent Gadolinium-enhanced inner-ear MRI after completing pure tone audiometry,VEMP and ECochG were retrospectively analyzed and evaluated with Fang Zheming scoring criteria for endolymphatic hydronephrosis.The correlation between hydrops score and disease stage,pure tone threshold,etc,and the correlation between disease stage and auditory,vestibular function were analyzed.The results of Gadolinium-enhanced inner-ear MRI were compared with those of VEMP and ECochG.Results The total score of endolymphatic hydrops was negatively correlated with pure tone hearing threshold and disease stage(r=-0.407、-0.487,P<0.05);The disease stage was correlated with VEMP,ECochG,course,frequency of vertigo,cochlear hydrocephalus score and vestibular hydrocephalus score(P<0.05);The sensitivity and specificity of ECochG in hydrocochlea patients were 62.1%,66.7%,and the coincidence rate with Gadolinium-enhanced inner-ear MRI was 62.5%.The difference between ECochG and Gadolinium-enhanced inner-ear MRI was statistically significant(P<0.05).The sensitivity and specificity of VEMP in patients with hydrovestibular effusion were 68.0%,80.0%,respectively,and the coincidence rate with Gadolinium-enhanced inner-ear MRI was 70.0%.The difference between the two was statistically significant(P<0.05).Conclusion Evaluation of endolymphatic hydrops and disease stages in patients with MD can provide reliable basis for clinical diagnosis and disease evaluation.Although VEMP and ECochG can reflect vestibular and cochlear functions,they cannot accurately reflect endolymphatic hydrops.Gadolinium-enhanced inner-ear MRI has certain significance in evaluating vestibular and cochlear functions.