三维真实重建反转恢复磁共振成像在梅尼埃病内耳淋巴造影中的诊断价值
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摘要
目的对比分析钆喷酸葡胺(Gadolinium-diethylene triamine pentaacetic acids,Gd-DTPA)增强的三维液体衰减反转恢复(three-dimensionalfluid-attenuatedinversion recovery,3DFLAIR)与三维真实重建反转恢复(three-dimensionalrealinversion recovery,3DrealIR)磁共振成像(magneticresonanceimaging,MRI)在梅尼埃病内耳内淋巴积水中的诊断价值。材料与方法回顾性分析29例梅尼埃病患者,男10例,女19例,年龄22～71岁,12例为双侧耳发病,17例为单侧耳发病,共患侧耳41只。29例患者均经咽鼓管向中耳鼓室内注入Gd-DTPA稀释液,24 h后行3D FLAIR序列及3D real IR序列MRI内耳造影,在两种序列图像上分别定量测量前庭最大切面及穿过窝轴的耳蜗底旋短轴切面的内淋巴间隙与总淋巴间隙面积比值R(前庭为RV,耳蜗为RC)及定性评估相应内淋巴积水分级G (前庭为GV,耳蜗为GC),比较两组扫描序列图像所测得的RV、RC、GV及GC的差异。结果 29例梅尼埃病患者41只患侧耳中,3D FLAIR与3D real IR两种序列所测得的RV、RC、GC及GV均具有统计学差异性(P_(RV)=0.000,P_(RC)=0.000,P_(GV)=0.000,P_(GC)=0.001),3DrealIR序列测得的RV及RC值大于3DFLAIR序列测得值,GV及GC达1～2级(即发现内淋巴积水)患耳数量大于3D FLAIR序列。结论相比于3D FLAIR序列,3D real IR序列内耳造影对于梅尼埃病患者内耳内淋巴积水的检测更敏感,检出率更高。
Objective: To compare the diagnostic value of three-dimensional fluid-attenuated inversion recovery(3D FLAIR) and 3D real inversion recovery(3D real IR) sequence after intratympanic injection of Gadolinium-diethylene triamine pentaacetic acids(Gd-DTPA) in the visualization of endolymphatic hydrops(EH) in patients with meniere's disease(MD). Materials and Methods: Twenty-nine patients with MD were included in this study. There were 10 men and 19 women, aged from 22 to 71. Twelve patients had MD in bilateral ears and 17 patients had MD in unilateral ear. A total of 41 ears were involved. The EH in the vestibule and cochlea of 41 sick ears of 29 MD patients was retrospectively quantitatively and qualitatively analyzed.The bilateral ears of all the patient were intratympanic injected with diluted Gd-DTPA. After 24 hours, both 3D FLAIR and 3D real IR sequence were performed. The ratio(R) of the area of the endolymphatic space to the sum of the endolymphatic and perilymphatic space was measured in these two sequences(RV in the vestibule and RC in the cochlea). And the grading(G) of EH was assessed(GV in the vestibule, GC in the cochlea). Corresponding statistical methods were used to compare the RV, RC, GV and GC acquired from the two sets of sequence images.Results: Among 41 ears in 29 patients, the RV, RC, GC and GV from the two sequences were statistically different(P_(RV)=0.000, P_(RC)=0.000, P_(GV)=0.000, P_(GC)=0.001). The RV and RC of the 3D real IR sequence were larger than those of the 3D FLAIR sequence, and the number of sick ears which's GV and GC ranged 1—2(ie, found EH) was greater than that of the 3D FLAIR sequence. Conclusions: Compared with the 3D FLAIR sequence, the 3D real IR sequence is more sensitive for the detection of EH in MD patients and has a higher detection rate.
Objective: To compare the diagnostic value of three-dimensional fluid-attenuated inversion recovery(3D FLAIR) and 3D real inversion recovery(3D real IR) sequence after intratympanic injection of Gadolinium-diethylene triamine pentaacetic acids(Gd-DTPA) in the visualization of endolymphatic hydrops(EH) in patients with meniere's disease(MD). Materials and Methods: Twenty-nine patients with MD were included in this study. There were 10 men and 19 women, aged from 22 to 71. Twelve patients had MD in bilateral ears and 17 patients had MD in unilateral ear. A total of 41 ears were involved. The EH in the vestibule and cochlea of 41 sick ears of 29 MD patients was retrospectively quantitatively and qualitatively analyzed.The bilateral ears of all the patient were intratympanic injected with diluted Gd-DTPA. After 24 hours, both 3D FLAIR and 3D real IR sequence were performed. The ratio(R) of the area of the endolymphatic space to the sum of the endolymphatic and perilymphatic space was measured in these two sequences(RV in the vestibule and RC in the cochlea). And the grading(G) of EH was assessed(GV in the vestibule, GC in the cochlea). Corresponding statistical methods were used to compare the RV, RC, GV and GC acquired from the two sets of sequence images.Results: Among 41 ears in 29 patients, the RV, RC, GC and GV from the two sequences were statistically different(P_(RV)=0.000, P_(RC)=0.000, P_(GV)=0.000, P_(GC)=0.001). The RV and RC of the 3D real IR sequence were larger than those of the 3D FLAIR sequence, and the number of sick ears which's GV and GC ranged 1—2(ie, found EH) was greater than that of the 3D FLAIR sequence. Conclusions: Compared with the 3D FLAIR sequence, the 3D real IR sequence is more sensitive for the detection of EH in MD patients and has a higher detection rate.
引文
[1]Nakashima T,Pyykk?I,Arroll MA,et al.Meniere's disease.Nat Rev Dis Primers,2016,12(2):16028.
[2]Semaan MT,Megerian CA.Contemporary perspectives on the pathophysiology of Meniere's disease:implications for treatment.Curr Opin Otolaryngol Head Neck Surg,2010,18(5):392-398.
[3]Hoa M,Friedman RA,Fisher LM,et al.Prognostic implications of and audiometric evidence for hearing fluctuation in Meniere's disease.Laryngoscope,2015,125(12):S1-12.
[4]Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery.Guideline of diagnosis and treatment of Meniere disease(2017).Chin J Otorhinolaryngology Head and Neck Surg,2017,52(3):167-172.中华耳鼻咽喉头颈外科杂志编辑委员会.梅尼埃病诊断和治疗指南(2017).中华耳鼻咽喉头颈外科杂志,2017,52(3):167-172.
[5]Nakashima T,Naganawa S,Sugiura M,et al.Visualization of endolymphatic hydrops in patients with Meniere's disease.Laryngoscope,2007,117(3):415-420.
[6]Zhao ML,Liu Z,Sha Y,et al.Visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPA:a comparison of high resolution three dimensional-real inversion recovery and three dimensional fluid-attenuated inversion recovery with a variable flip angle sequence.Chin J Radiol,2016,50(8):581-585.赵梦龙,刘壮,沙炎,等.高分辨率三维真实重建反转恢复序列和三维液体衰减反转恢复序列评估内淋巴积水的对比研究.中华放射学杂志,2016,50(8):581-585.
[7]Naganawa S,Sone M,Yamazaki M,et al.Visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPAcomparison of 2D and 3D real inversion recovery imaging.Magn Reson Med Sci,2011,10(2):101-106.
[8]Liu XH,Huang WN,Meng XX,et al.Comparison of endolymphatic spaces between patients suffering from meniere's disease and normal volunteers.J Otolaryngol Ophthalmol Shandong University,2017,31(2):39-42,48.刘旭晖,黄魏宁,孟曦曦,等.梅尼埃病患者内耳内淋巴间隙的比值与正常受试者的比较.山东大学耳鼻喉眼科学报,2017,31(2):39-42,48.
[9]Liu F,Huang W,Chen Q,et al.Comparison of noninvasive evaluation of endolymphatic space in healthy volunteers in different age groups using magnetic resonance imaging.Acta Otolaryngol,2015,135(5):416-421.
[10]Nakashima T,Naganawa S,Pyykko I,et al.Grading of endolymphatic hydrops using magnetic resonance imaging.Acta Otolaryngol Suppl,2009,(560):5-8.
[11]Fu J,Ou YK,Gao ZJ,et al.Application of three-dimensional fluidattenuated inversion recovery magnetic resonance imaging for the diagnosis of inner ear diseases.Chin J Otorhinolaryngol-skull Base Surg,2018,24(4):381-385.付佳,区永康,高志娟,等.三维液体衰减反转恢复序列磁共振成像在内耳疾病中的应用研究.中国耳鼻咽喉颅底外科杂志,2018,24(4):381-385.
[12]AttyéA,Dumas G,Troprès I,et al.Recurrent peripheral vestibulopathy:Is MRI useful for the diagnosis of endolymphatic hydrops in clinical practice?Eur Radiol,2015,25(10):3043-3049.
[13]Schuknecht HF.Endolymphatic hydrops:can it be controlled?Ann Otol Rhinol Laryngol,1986,95(1 Pt 1):36-39.
[14]Salt AN,Ma Y.Quantification of solute entry into cochlear perilymph through the round window membrane.Hear Res,2001,154(1-2):88-97.
[15]Fu J,Ou YK,Gao ZJ,et al.Preliminary study on development effect and imaging time window of 3D fluid-attenuated inversion-recovery sequence of magnetic resonance imaging in Meniere's disease.Int Med Health Guidance News,2018,24(13):1910-1913.付佳,区永康,高志娟,等.三维液体衰减反转恢复序列磁共振成像在梅尼埃病中的显影效果及成像时间窗的初步探讨.国际医药卫生导报,2018,24(13):1910-1913.
[2]Semaan MT,Megerian CA.Contemporary perspectives on the pathophysiology of Meniere's disease:implications for treatment.Curr Opin Otolaryngol Head Neck Surg,2010,18(5):392-398.
[3]Hoa M,Friedman RA,Fisher LM,et al.Prognostic implications of and audiometric evidence for hearing fluctuation in Meniere's disease.Laryngoscope,2015,125(12):S1-12.
[4]Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery.Guideline of diagnosis and treatment of Meniere disease(2017).Chin J Otorhinolaryngology Head and Neck Surg,2017,52(3):167-172.中华耳鼻咽喉头颈外科杂志编辑委员会.梅尼埃病诊断和治疗指南(2017).中华耳鼻咽喉头颈外科杂志,2017,52(3):167-172.
[5]Nakashima T,Naganawa S,Sugiura M,et al.Visualization of endolymphatic hydrops in patients with Meniere's disease.Laryngoscope,2007,117(3):415-420.
[6]Zhao ML,Liu Z,Sha Y,et al.Visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPA:a comparison of high resolution three dimensional-real inversion recovery and three dimensional fluid-attenuated inversion recovery with a variable flip angle sequence.Chin J Radiol,2016,50(8):581-585.赵梦龙,刘壮,沙炎,等.高分辨率三维真实重建反转恢复序列和三维液体衰减反转恢复序列评估内淋巴积水的对比研究.中华放射学杂志,2016,50(8):581-585.
[7]Naganawa S,Sone M,Yamazaki M,et al.Visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPAcomparison of 2D and 3D real inversion recovery imaging.Magn Reson Med Sci,2011,10(2):101-106.
[8]Liu XH,Huang WN,Meng XX,et al.Comparison of endolymphatic spaces between patients suffering from meniere's disease and normal volunteers.J Otolaryngol Ophthalmol Shandong University,2017,31(2):39-42,48.刘旭晖,黄魏宁,孟曦曦,等.梅尼埃病患者内耳内淋巴间隙的比值与正常受试者的比较.山东大学耳鼻喉眼科学报,2017,31(2):39-42,48.
[9]Liu F,Huang W,Chen Q,et al.Comparison of noninvasive evaluation of endolymphatic space in healthy volunteers in different age groups using magnetic resonance imaging.Acta Otolaryngol,2015,135(5):416-421.
[10]Nakashima T,Naganawa S,Pyykko I,et al.Grading of endolymphatic hydrops using magnetic resonance imaging.Acta Otolaryngol Suppl,2009,(560):5-8.
[11]Fu J,Ou YK,Gao ZJ,et al.Application of three-dimensional fluidattenuated inversion recovery magnetic resonance imaging for the diagnosis of inner ear diseases.Chin J Otorhinolaryngol-skull Base Surg,2018,24(4):381-385.付佳,区永康,高志娟,等.三维液体衰减反转恢复序列磁共振成像在内耳疾病中的应用研究.中国耳鼻咽喉颅底外科杂志,2018,24(4):381-385.
[12]AttyéA,Dumas G,Troprès I,et al.Recurrent peripheral vestibulopathy:Is MRI useful for the diagnosis of endolymphatic hydrops in clinical practice?Eur Radiol,2015,25(10):3043-3049.
[13]Schuknecht HF.Endolymphatic hydrops:can it be controlled?Ann Otol Rhinol Laryngol,1986,95(1 Pt 1):36-39.
[14]Salt AN,Ma Y.Quantification of solute entry into cochlear perilymph through the round window membrane.Hear Res,2001,154(1-2):88-97.
[15]Fu J,Ou YK,Gao ZJ,et al.Preliminary study on development effect and imaging time window of 3D fluid-attenuated inversion-recovery sequence of magnetic resonance imaging in Meniere's disease.Int Med Health Guidance News,2018,24(13):1910-1913.付佳,区永康,高志娟,等.三维液体衰减反转恢复序列磁共振成像在梅尼埃病中的显影效果及成像时间窗的初步探讨.国际医药卫生导报,2018,24(13):1910-1913.
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