桥小脑角-内耳道小血管与搏动性耳鸣相关性的研究

Study of the correlation between the vascular loops of the cerebellopontine angle-internal auditory and pulsatile tinnitus

目的探讨桥小脑角区及内耳道内血管与搏动性耳鸣的关系,寻找引起搏动性耳鸣的相关因素。方法回顾性分析单侧搏动性耳鸣患者和无耳鸣对照组各44例的三维双激发平衡式自由进动序列(3D-FIESTA-C)MRI,对比分析耳鸣组患侧、健侧和对照组血管袢在桥小脑角区和(或)内耳道内出现的部位以及血管与前庭蜗神经的关系。结果对照组不同侧别和性别的血管袢出现部位类型和血管与神经关系类型均无显著性差异。耳鸣组患侧、健侧和对照组血管袢部位分型(Ⅰ~Ⅳ型)发生率有统计学差异(χ^(2)=38.501,P=0.000),其中患侧与健侧之间和患侧与对照组之间具有显著性差异,而患侧血管袢的显示率(Ⅱ~Ⅳ型)最高93.2%(41/44),其次是健侧56.8%(25/44),显示率最低的是对照组39.7%(35/88)。患侧、健侧和对照组血管袢与前庭蜗神经关系类型具有显著性差异(χ^(2)=49.357,P=0.000),其中患侧与对照组之间和健侧与对照组之间均有显著性差异,耳鸣组患侧C型的发生率最高,高达53.7%,而A型发生率仅12.2%;对照组A型的发生率最高,高达91.4%,而C型发生率仅5.7%;耳鸣组健侧三型的发生率相似。结论血管压迫神经(C型)是引起搏动性耳鸣的可能有关因素,而内耳MR 3D-FIESTA-C是显示该异常的重要方法。

OBJECTIVE To investigate the relationship between the blood vessels in the cerebellopontine angle and internal auditory canal and pulsatile tinnitus,and to find the underlying relevant factors of pulsatile tinnitus.METHODS We retrospectively analyzed MRI data of 44 cases of unilateral pulsatile tinnitus patients and 44 control subjects without tinnitus using 3D-FIESTA-C MRI.The location of blood vessels in the cerebellopontine angle and/or internal auditory canal on the affected and unaffected sides of the tinnitus group,as well as the relationship between the blood vessels and the vestibulocochlear nerve,were compared and analyzed.RESULTS There was no significant difference in the location and relationship between blood vessels and nerves in the control group based on gender and affected side.The incidence of blood vessel location(typesⅠ-Ⅳ)was statistically different between the affected side,unaffected side,and control group(χ~2=38.501,P=0.000).The affected side had a significantly higher incidence compared to the unaffected side and control group.The display rate of blood vessel location(typesⅡ-Ⅳ)on the affected side was the highest at 93.2%(41/44),followed by 56.8%(25/44)on the unaffected side and 39.7%(35/88)in the control group.The relationship between blood vessels and the vestibulocochlear nerve was also significantly different between the affected side,unaffected side,and control group(χ~2=49.357,P=0.000).The incidence of Type C in the affected side was the highest at 53.7%,while Type A had the lowest incidence at 12.2%.The incidence of Type A in the control group was the highest at 91.4%,while Type C had the lowest incidence at 5.7%.The incidence of TypeⅢwas similar in the unaffected side and control group of the tinnitus group.CONCLUSION Vascular compression of the nerve(Type C)is a possible relevant factors of pulsatile tinnitus,and 3D-FIESTA-C MRI is an important method for displaying this abnormality in the inner ear.