2D、3D影像重建对听骨链病变诊疗的评估价值  

The diagnostic value of 2D and 3D computed tomography(CT) in the evaluation of the pathologic conditions of ossicular chain

作　　者：孙建军[1] 刘阳[1] 郭勇[2] 逯巧慧[2] 

机构地区：[1]海军总医院全军耳鼻咽喉科中心,北京100048 [2]海军总医院医学影像科,北京100048

出　　处：《中华耳科学杂志》2011年第2期117-123,共7页Chinese Journal of Otology

摘　　要：目的分析CT2D、3D影像重建在听骨链病变诊疗中的价值,旨在提高放射科与耳科医师对该类病变的临床认知精度。方法选择胆脂瘤性中耳炎、慢性化脓性中耳炎;先天性耳畸形。鼓室硬化症、听骨链中断典型病例,采用高分辨率CT(High resolution,HRCT)轴位及冠状位成像、后期多平面重组(Multi-planer reformation,MPR)、虚拟耳镜(CT Virtual Endoscopy,CTVE)与容积重建(CT Volume Rendering,CTVR)等方法进行术前及听骨成型术后影像重建。结果 HRCT轴位与冠状位显示听骨与周围骨及软组织的界面关系良好,对于听骨本身显示不佳;MPR可实现听骨的同层全程显示,进而再现听骨链的真实形态,对于重建听骨亦有良好显示;CTVE可显示听骨链的表面空间构像,但有一定的几何失真,与周围软组织分辨略差;CTVR采用容积重建技术,可滤除听骨周围软组织及骨性遮挡,用于听骨链术前及重建术后评估时的空间构像更近真实。结论对于听骨链病变的影像诊断在常规轴位、冠状位HRCT的基础,综合MPR、CTVR和CTVE等技术,可更好地对听骨链病变做出准确评价。Objective TO discuss and analysis the diagnostic method, scope and value to the ossicular chain in the CT imagine in order to help otologists and radiologists get mastery and understanding. Materials and Methods The five typical cases, including eholesteatoma otitis media, c, hronic suppurative otitis media, congential auval defo^ynity tympanosclerosis and ossicular chain discontinuity, were assessed by axial and coronal high resolution CT （HRCT）, multi-planer reformation （MPR）, CT virtual endoscopy （CTVE） and CT volume rendering （CTVR） before surgery and after reconstruction of ossicular chain. Results HRCT （axis and coronal position） can better demonstrate tympanic cavity and soft tissue lesion in it, but poorly demonstrate ossicles, implanted prosthesis in the operation, and has difficuhy in showing the whole ossicular chain. MPR could demonstrate each ossicle and the ossicular chain on the same plane. The CTVE showed the 3-D imagine of the ossicular chain hut wasn＇t quite true to the original. Because of the shaded surface display in the virtual technology of computer. The CTVR, adopting the volume rendering technology, showed the true shape of the ossicular chain when the unwanted soft tissue and bone were cut down especially to the reconstructed ossicular chain. Conclusion The diagnosis of ossicular chain of the modern CT technology should combine the HRCT with MPR, CTVR and CTVE. The CTVR 3-D reconstruction may be better than CTVE.

关 键 词：三维重建 听骨链 多平面重组 

分 类 号：R764.2[医药卫生—耳鼻咽喉科] R814.42[医药卫生—临床医学]