外淋巴间隙钆成像MR评分及其对梅尼埃病的诊断价值  

MR score system on spatium perilymphaticum gadolinium opacification and its application for diagnosis of Meniere＇s disease

作　　者：方哲明[1] 刘颖[1] 曹代荣[1] 陈曦[2] 

机构地区：[1]福建医科大学附属第一医院放射科,福州350005 [2]福建医科大学附属第一医院耳鼻咽喉头颈外科,福州350005

出　　处：《中华放射学杂志》2012年第8期719-723,共5页Chinese Journal of Radiology

基　　金：福建省教育厅B类科技资助项目（JB10064）;福建省自然科学基金资助项目（2011J01161）

摘　　要：目的设计一种外淋巴间隙钆成像MRI评分方法，探讨其诊断梅尼埃病的价值。方法选择65例（65耳）梅尼埃病和51只无症状对照耳（对照组），行外淋巴间隙钆成像，根据MRI上迷路各部显影情况提出如下评分方法：（1）半规管不显影0分；部分显影1分；完整显影2分。（2）前庭内有高、低信号区，低信号区局限于水平半规管下缘平面以上为6分；低信号区向下超过该平面为3分；前庭内无高信号区为0分。（3）耳蜗底转整圈显影3分，部分显影且前庭阶面积不小于鼓阶2分，前庭阶面积小于鼓阶1分，底转不显影0分；中转完整显影2分，部分显影1分，不显影0分；顶转显影1分，不显影0分。由1名熟悉内耳解剖的放射科医师评分。运用统计软件SPSS17．0比较梅尼埃病与无症状组得分，建立基于总分的ROC曲线和Logistic回归联合ROC曲线评估评分体系，分析外淋巴间隙钆成像MRI评分对于梅尼埃病的诊断效能。结果（1）梅尼埃病组总分在0～12分之间，中位数9分（1～17分）；无症状组总分为15～18，中位数17分（15～18分），2组差异有统计学意义（Wilcoxon秩和检验，U=一9．118，P=0．00）。（2）基于总分诊断梅尼埃病界值为14．5，Youden指数0．969，特异度100．0％，敏感度96．9％。（3）以耳蜗、前庭、半规管评分为协变量，得Logistic回归模型：LogitP=61．216—7．381×前庭-3．056×半规管，基于预测值P值的ROC曲线，诊断界值0．651（前庭≤3分或半规管≤4分），Youden指数0．969，特异度为100．0％，敏感度为96．9％。结论外淋巴间隙钆成像MR评分对诊断梅尼埃病有实用价值。符合以下一点即可诊断：（1）外淋巴间隙钆成像MR总分〈14．5分；（2）前庭内低信号区向下超过水平半规管下缘平面，即前庭≤3分；（3）半规管得分≤4分。Objective To propose a MR scoring methods for spatium perilymphaticum gadolinium opaeifieation and explore the value of their diagnosis of Meniere＇ s disease. Methods Fifty-one asymptomatie and 65 symptomatic patients with Meniere＇s disease were enrolled in this study. MR imaging of spatium perilymphaticum after intratypanic gadolinium injection were analyzed with following scoring method. （ 1 ） Semicircular canal not visualized equal to score 0 ; some visualized equal score 1 ; full visualized equal score 2. （2）There were high-signal and low-signal in the vestibule, low-signal areas above the lateral semicircular canal plane equal score 6 ; low signal areas down to lateral semicircular canal plane equal score 3 ; no higher signal in the vestibule area equal score 0. （ 3 ） Basal turn of cochlea ： full visualized equal score 3; part visualized equal score 2; scala vestibule of basal turn smaller than scala tympani equal score 1 regardless of full or visualized in basal turn; no visualized equal score 0. Medial turn of cochlea： full visualized equal score 2 ; part visualized equal score 1 ; no visualized equal score 0. Apical turn of cochlea ： visualized equal score 1 ; no visualized equal score 0. One radiologist scored all cases with double blind. SPSS 17.0 software was used to conduct muhiple independent-samples nonparametric tests, multivariate Logistic regression, and ROC curve analysis. Evaluate the sensitivity and specificity for diagnosis of Meniere＇s disease with the scoring system. Results （1） Meniere＇s disease summation score 0 to 12,median 9 （quarter spacing 4. 5 ） ; no symptoms group summation score 15 to 18 ,median 17 （quarter spacing 3 ）, two group differences has statistics significance （ Wilcoxon rank and inspection U = - 9. 118, P = 0. 00）. （2）Based on summation score for the diagnosis of Meniere＇s disease, tangent point was 14. 5, Youden index 0. 969, specificity 100. 0% , sensitivity 96.9% . （ 3 ） Let cochlear, vestibular, semicircular canal sc

关 键 词：磁共振成像 内耳 外淋巴 钆DTPA 

分 类 号：R764[医药卫生—耳鼻咽喉科]