高分辨率MRI用于伴眩晕症状的迷路内微小病变诊断的价值  

Value of high resolution MRI in the evaluation of small intralabyrinthine lesions with the symptom of vertigo

作　　者：赵梦龙[1] 沙炎[1] 程玉书[1] 张放[1] 洪汝建[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院放射科,上海200031

出　　处：《中华放射学杂志》2015年第6期440-444,共5页Chinese Journal of Radiology

摘　　要：目的：探讨高分辨率MRI在伴有眩晕症状的迷路内微小病变中的应用价值。方法回顾性分析13例迷路出血或渗出，以及6例迷路内神经鞘瘤患者不同影像检查方法和影像特点。4例迷路内神经鞘瘤经手术病理证实，其余病例均为临床诊断。迷路出血或渗出的临床诊断根据临床表现和影像检查结果，并排除颞骨占位性病变侵犯内耳等。迷路内神经鞘瘤的临床诊断依据临床和影像表现。影像检查：2例迷路出血或渗出患者和3例迷路内神经鞘瘤患者接受了耳部高分辨率CT （HRCT）平扫。19例患者均接受了MRI检查，其中迷路出血或渗出患者除常规耳部MR平扫外，还接受了液体衰减反转恢复（FLAIR）序列T2WI扫描；迷路内神经鞘瘤患者接受了耳部MR平扫和增强扫描，其中3例患者接受了可变反转角的三维快速自旋回波（3D-SPACE）序列扫描。结果迷路出血或渗出：T1WI上7例患者可见患侧迷路内信号轻度升高区，6例无明显内耳信号改变；FLAIR序列T2WI上13例患者均可发现患侧迷路内信号异常升高区；HRCT和T2WI上内耳均未见明显异常。迷路内神经鞘瘤：T2WI上，3例患者显示患侧内耳轻度信号减低区，3例表现正常；3例接受3D-SPACE序列扫描的患者，均表现为患侧迷路内边缘清晰光整的充盈缺损灶，其中2例病灶在常规耳部T2WI上未见显示；增强扫描显示6例患者患侧迷路内结节状强化；HRCT和T2WI上内耳均未见明显异常。结论高分辨率MRI对迷路出血或渗出和迷路内神经鞘瘤的诊断有着很大的帮助，FLAIR序列T2WI能够更加灵敏地发现迷路出血或渗出，3D-SPACE序列能够更好地发现和诊断迷路内微小占位，从而减少漏诊。Objective To discuss the value of high resolution MRI in the evaluation of small intralabyrinthine lesions with the symptom of vertigo. Methods We retrospectively analyzed the imaging examination techniques and imaging finding of 13 cases of labyrinthine hemorrhage or exudate and 6 cases of intralabyrinthine schwannoma （ILS） with the symptom of vertigo. Two cases of labyrinthine hemorrhage or exudate and 3 cases of ILS underwent temporal bone high resolution CT（HRCT） scan and all the 19 patients received highresolution MR examination. Patients of labyrinthine hemorrhage or exudate received fluid-attenuated inversion recovery （FLAIR）T2WI in addition to routine pre-contrast temporal bone MR. Pre-and post-contrast MR of the temporal bone were performed on the ILS patients. In particular, 3 ILS cases received three-dimensional sampling perfection with application-optimized contrasts by using different flip angle evolutions （3D-SPACE） sequence. Results There was no abnormal finding on HRCT of the inner ear of the 2 labyrinthine hemorrhage cases. On T1WI, regions of mild increased signal intensity of the labyrinth of affected side could be spotted in 7 patients whereas no abnormal signal intensity was found in the other 6 patients. On T2WI, all the 13 labyrinthine hemorrhage or exudate cases had no abnormal finding in the inner ear. On FLAIR T2WI sequence, regions of increased signal intensity of the labyrinth of affected side could be found in all the 13 cases. Thress ILS patients that received HRCT scan showed no valuable finding.＆amp;nbsp;On T1WI, no abnormal signal intensity was found in the labyrinth of the 6 patients. On T2WI, regions of decreased signal intensity of the labyrinth could be found in only 3 patients. All the 3 cases that received 3D-SPACE sequence appeared as a filling defect in the high-signal labyrinth clearly while 2 of the 3 lesions could not be found on T2WI. After Gadolinium administration, all the 6 ILSs were obviously enhancing. Conclusions High resolution MRI is valuable

关 键 词：眩晕 磁共振成像 迷路病变 出血 神经鞘瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.61[医药卫生—诊断学]