CT三维容积重建评价慢性化脓性中耳炎听骨链破坏的价值  

Value of CT Three-dimensional Volume Rendering in Assessment of the Oossicular Chain in Chronic Suppurative Otitis Media

作　　者：郭勇[1] 逯巧慧[1] 刘阳[2] 王庆军[1] 任爱军[1] 

机构地区：[1]海军总医院医学影像科,北京100048 [2]海军总医院耳鼻喉科,北京100048

出　　处：《中国医学影像学杂志》2013年第7期508-511,共4页Chinese Journal of Medical Imaging

摘　　要：目的探讨高分辨率CT三维容积重建(3DVR)评估慢性化脓性中耳炎听骨链破坏的能力。资料与方法 48例慢性化脓性中耳炎患者行1024高分辨率CT扫描,并行2D(轴位、冠状位)及3DVR重建,采用三分分级法对2D、3DVR所见听骨链12个解剖结构破坏情况进行评分,并与术中观察结果进行对照。结果 12个解剖部位中,砧骨长突、豆状突、砧镫关节破坏发生率较高,分别为66.7%、54.2%、54.2%;2D图像评价听骨破坏的准确度均在83%以上,其对砧骨长突、豆状突、砧镫关节破坏发生率较高部位的诊断准确度(83.3%、83.3%、87.5%)低于其他破坏发生率较低的部位(89.9%～97.9%)。3DVR评价听骨破坏的准确度均在93%以上,对各部位评价准确度均高于2D图像(P<0.001)。2D、3DVR评价听骨链破坏的分级结果与手术所见分级结果呈显著正相关(r=0.841、0.970,P<0.001),2D与3DVR评价听骨链破坏的分级结果也呈显著正相关(r=0.849,P<0.001)。结论听骨链CT3DVR对慢性化脓性中耳炎听骨链破坏的诊断准确度高于高分辨2D图像,可以作为颞骨2D图像的有效补充。Purpose To explore the value of three-dimensional volume rendering （3DVR） in assessment of the ossicular chain in chronic suppurative otitis media （CSOM）. Materials and Methods Forty-eight patients with CSOM undertook CT scan with 1024 matrix. 2D reformation （standard axial and coronal orthogonal planes） and 3DVR reconstruction were also carried out independently by two radiologists. The imaging findings of the 12 segments of the ossicular chain were scored by using a three-point scoring system, which were compared with surgical findings. Results The incidence of bone erosion was higher in incus long process, bean-shaped protrusion, and incudostapedial joint, which was 66.7%, 54.2%, and 54.2%, respectively. Accuracy of 2D in assessment of bone destruction was over 83%. Diagnostic accuracy of high erosion incidence in incus long process, bean- shaped protrusion, and incudostapedial joint （83.3%, 83.3%, and 87.5%, respectively） was lower than those with low erosion incidence （89.9%-97.9%）. Diagnostic accuracy of 3DVR for the assessment of bone erosion was over 93%, which was superior to 2D in evaluation of all 12 segments （P〈0.001）. Positive correlation was found between imaging findings and surgical findings （r=0,841 and 0.970, P〈0.001） and also between 2D and 3DVR findings （r=0.849, P〈0.001）. Conclusion 3DVR reconstruction of middle ear is more accurate and reliable than 2D for the assessment of the ossicular chain in cases of CSOM, which can be good complementation of 2D.

关 键 词：中耳炎 化脓性 听小骨 体层摄影术 螺旋计算机 图像处理 计算机辅助 

分 类 号：R764.21[医药卫生—耳鼻咽喉科] R445.3[医药卫生—临床医学]