16层螺旋CT三维容积重建在鼓室成形术中的应用  

Application of 16-SCT Volume Rending of the Auditory Ossicular Chain in the Tympanoplasty

作　　者：卢明[1] 张剑[1] 

机构地区：[1]南昌大学第一附属医院耳鼻咽喉-头颈外科,南昌330006

出　　处：《南昌大学学报（医学版）》2010年第5期35-38,共4页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫生厅课题(030101)

摘　　要：目的探讨16层螺旋CT三维容积重建(16-SCT VR)在鼓室成形术中的应用。方法对40例慢性化脓性中耳炎患者(40耳,病变组)患耳和35例病变组患者对侧正常耳(35耳,正常组)的听骨链VR进行研究。①采用薄层(层厚1.0 mm),小视野(FOV=5 cm),密集重建(间隔0.1 mm)技术行16-SCT扫描,获得常规断层图像及VR成像。②由2名影像科医师用盲法阅片,对断层图像和VR图像上听骨链各结构显示质量进行评价,并由此确定鼓室成形术分型。③完成鼓室成形术,将两种图像分型结果与手术结果进行对比。结果 16-SCT VR能直观立体地显示听骨链的形态及相互关系,除镫骨底板外,能清晰显示正常听骨链及其细小结构。病变组中VR图像显示:锤骨头破坏13例,锤骨柄破坏13例,砧骨体破坏15例,砧骨长脚破坏20例,砧骨短脚破坏12例,镫骨上结构破坏13例。38例VR图像术前鼓室成形术分型与手术结果一致(Ⅰ型4例,Ⅱ型19例,Ⅲ型10例,Ⅳ型5例)。结论通过选择两种阈值和两个视角,16-SCT VR具有快速、无创、准确地显示正常及异常听骨链的立体影像等优点,为慢性化脓性中耳炎的诊断及治疗提供更多的信息。Objective To evaluate 16-SCT volume rending（VR） of the auditory ossicular chain in the tympanoplasty.Methods Forty cases of patients with chronic suppurative otitis media（CSOM）（40 cases,Lesions group）and 35 cases of patients in the normal lesions（35 cases,normal group） auditory ossicular chain of 16-SCT VR were studied.①16-SCT scan of the auditory ossicular chain was performed with 1.0 mm slice thickness,5.0 cm filed of view,and 0.1 mm reconstraction interval in 35 normal subjects and 40 patients with CSOM with conventional CT and VR before surgery.②Two radiologist evaluated conventional CT and VR,the results were studied in a blind way.Qualitative assessment of the auditory ossicular structures was perforomed.The stages of the tympanoplasty weredetermined by the conventiona CT and VR.③The CT data obtained were compared with the operative（Ⅰtapy 4 cases,Ⅱtapy 19 cases,Ⅲ tapy 10 cases,Ⅳ tapy 5 cases）.Results 16-SCT VR could directly display shapes and correlate of the auditory ossicular chain and clearly demostrate the normal ossicular and its anatomic details.But the stapes footplate couldn＇t be exhibit.The other structure.VR could acurately show the destroy in CSOM.In abnormal ears,VR displayed of the head of malleus damage 13,manubrium malleus damage 13 cases,body of incus damage and destruction in 15 cases,long process limb of incus 20 cases of destruction and short limb of incus 12 cases,stapes footplate damage on 13 cases of structural damage.38 cases of VR image of preoperative tympanum angioplasty with surgical results.Conclusion With choosing two thresholds and by performing two views,16-SCT VR can quickly,non-invasively accurately display the three-dimensional images of the auditory ossicular chain.VR facilitates understanding of the complex anatomy of the middle ear.It is helpful for diagnosis and surgical planning in the tympanoplasty in CSOM before surgery.Presently VR is considered to be only complementary to conventional CT.

关 键 词：体层摄影术 X线计算机 听骨链 鼓室成形术 CT三维容积重建 

分 类 号：R814.42[医药卫生—影像医学与核医学] R764.9[医药卫生—放射医学]