基于超高分辨率CT的砧镫关节影像解剖初步研究

Radiological Anatomy of Incudostapedial Joint Based on Ultra-High Resolution CT:A Pilot Study

目的基于超高分辨率CT(U-HRCT)分析正常砧镫关节(ISJ)影像解剖。方法回顾性分析2020年9月至2021年8月行U-HRCT检查的耳鼻喉科患者258例,正常耳共计304侧。于U-HRCT图像设置ISJ标准观察层面,描述其解剖特征,并比较不同年龄及性别的ISJ解剖形态差异。结果88.2%(268/304)ISJ清晰可见,11.8%(36/304)模糊可见;47.7%(145/304)ISJ表现为低密度,40.8%(124/304)为部分骨性密度,11.5%(35/304)为骨性密度。≤30岁及>30岁中ISJ解剖特征未见显著差异(P均>0.05)。男性镫骨头-豆状突外侧距离、豆状突长径数值均大于女性,分别为[0.93 mm(0.81 mm,1.02 mm)vs.0.87 mm(0.74 mm,0.96 mm)(Z=-2.870,P=0.004)]、[0.66 mm(0.55 mm,0.77 mm)vs.0.59 mm(0.51 mm,0.69 mm),(Z=-2.825,P=0.005)],关节间隙宽度(即二者差值)则未见显著差异。砧骨豆状突-镫骨头夹角在男性[137.9°(126.3°,155.6°)]显著大于女性[129.8°(119.8°,148.9°)](Z=-2.942,P=0.003)。结论U-HRCT可清晰显示正常ISJ,可为ISJ病变的影像诊断及术前评估提供基础。

Objective To analyze the anatomy of normal incudostapedial joint(ISJ)using ultra-high-resolution CT(U-HRCT).Methods A total of 258 patients from Otorhinolaryngology Department who underwent U-HRCT from September 2020 to August 2021 were retrospectively analyzed,with a total of 304 normal sides.After setting the standard observation plane for ISJ on U-HRCT images,its anatomical characteristics were described,and the differences of ISJ anatomical morphology between age groups or sexes were compared.Results There were 88.2%(268/304)of ISJ being clearly visible,and 11.8%(36/304)were vaguely visible.While 47.7%(145/304)of ISJ showed low attenuation,40.8%(124/304)presented partial bony density,and 11.5%(35/304)had bony density.There was no significant difference in the anatomical features of ISJ between those≤30 years old and>30 years old(all P>0.05).The distance between stapes head to lateral border of the lenticular processand the length of the lenticular process were higher in males than in females[0.93 mm(0.81 mm,1.02 mm)]vs.[0.87 mm(0.74 mm,0.96 mm)],Z=-2.870,P=0.004,[0.66 mm(0.55 mm,0.77 mm)]vs.[0.59 mm(0.51 mm,0.69 mm)],Z=-2.825,P=0.005,respectively.No significant difference was found in the width of ISJ space(that is,the difference between the former two metrics).The angle between the incus lenticular process and the stapes head was significantly greater in males[137.9°(126.3°,155.6°)]than in female[129.8°(119.8°,148.9°)],Z=-2.942,P=0.003].Conclusion U-HRCT can clearly display normal ISJ,which provides the basis for imaging diagnosis and preoperative evaluation of ISJ lesions.