内耳三维真实重建反转恢复成像与突发性聋预后

Three-dimensional Real Inversion Recovery MRI Imaging in Sudden Deafness and Its Relationship with Prognosis

目的分析突发性聋(突聋)患者的内耳三维真实重建反转恢复(three dimensional real inversion recovery,3D Real IR)成像表现,探讨内耳不同信号强度与突聋预后的关系。方法选取2022年9月25日—2023年4月10日郑州大学第五附属医院耳鼻咽喉科住院治疗及门诊治疗的单侧突聋患者60例,按照听力曲线将患者分为低频下降型4例、高频下降型1例、平坦下降型34例和全聋型21例。由于平坦下降型和全聋型治疗方法一致,将平坦下降型和全聋型的55例患者按治疗有效与否分为无效组25例和有效组30例;按治疗前听力分级,分为轻度听力损失组11例、中度听力损失组7例、重度听力损失组16例和极重度听力损失组21例;根据听力下降与否分为患耳组55耳和健耳组55耳。比较患耳和健耳的耳蜗信号强度,并测量延髓信号强度,分别计算耳蜗/延髓(cochlea/medulla ratio,CM)比值,分析耳蜗信号强度与治疗结果之间关系。结果无效组CM比值明显高于治疗有效组,差异有统计学意义(P<0.001);患耳组与健耳组CM比值比较,差异有统计学意义(P<0.05)。轻度、中度、重度和极重度听力损失组患耳CM比值比较(2.57±3.02 vs 1.77±0.87 vs 2.04±1.98 vs 2.51±2.33),差异无统计学意义(F=0.304,P=0.823)。结论内耳3D Real IR可显示突聋患者血-迷路屏障通透性的改变,CM比值可以更精确了解突聋患者内耳受损的程度,CM比值大小与听力损失程度并不一致,可以单独作为一种判断突聋预后的因素。突聋患者CM比值高于1.58提示可能预后不良。

Objective To report inner ear three-dimensional real inversion recovery(3D Real IR)imaging in patients with sudden deafness and the relationship between signal intensity and prognosis.Methods A total of 60 patients with unilateral sudden hearing loss from September 25,2022 to April 10,2023 were included.Hearing pattern included low frequency loss(n=4),high frequency loss(n=1),all frequency loss(n=34)and total deafness(n=21).Patients with the latter two types of hearing loss(n=55)were further divided into a no effect group(n=25)and an improvement group(n=30)based on treatment outcomes.Hearing loss in these patients was graded as mild in 11 cases,moderate in 7 cases,severe in 16 cases and profound in 21 cases.Cochlear signal strength in the affected ears(n=55)was compared to that of the healthy ears(n=55).Signal strength of the medulla oblongata was measured and cochlea/medulla signal ratio(CM)was calculated to determine the relationship between cochlea signal intensity and treatment outcome.Results The CM ratio was significantly higher in non-responding patients than that in patients showing improvement(P<0.01),and showed significant differences between affected and healthy ears(P<0.05)but not for different degrees of hearing loss(F=0.304,P=0.823).Conclusion Increasing perilymph signal intensity on the 3D Real IR sequence is related to increased blood-labyrinth barrier permeability.The CM ratio can be used to evaluate the severity of inner ear damage in patients with sudden deafness,although it does not appear to correlate with the degree of audiometric thresholds.It however can serve as a prognostic indicator for treatment outcomes in sudden deafness,with 1.58 or greater indicating a poor prognosis.