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背景:中耳结构复杂、细微,位置深而隐匿。CT仿真内窥镜成像可利用螺旋CT容积扫描数据重建出空腔器官内表面的立体图像,类似纤维内镜所见。目的:验证64排螺旋CT中耳仿真内窥镜对中耳正常结构的显示能力以及在病变中耳中的临床应用价值。设计、时间及地点:验证性对比观察,于2005-10/2006-03在中山大学附属第一医院放射科完成。对象:选择33例(66耳)疑有中耳疾病行双耳螺旋CT检查患者,其中正常35耳;病变31耳包括慢性化脓性中耳炎24耳,慢性化脓性中耳炎乳突根治术后复发2耳、中耳癌2耳、外耳道异物肉芽肿1耳及颞骨骨折2耳。方法:行颞骨64排螺旋CT容积扫描,软组织算法密集重建后,利用Navigator软件行中耳CT仿真内窥镜成像。所有CT仿真内窥镜成像均与常规二维CT图像及手术对照。主要观察指标:观察的主要结构包括各听小骨及其间的关节、上中下鼓室、鼓窦及外耳道、鼓室各壁结构、面隐窝、鼓室天盖、锤骨前、上韧带、砧骨后韧带及后鼓室的结构。结果:100%的CT仿真内窥镜图像可清晰显示正常中耳大部分听小骨及鼓室各壁结构,68.6%(24/35)及74.3%(26/35)的CT仿真内窥镜图像可分别清晰显示镫骨前、后脚,而且CT仿真内窥镜图像可清晰显示后鼓室重要解剖结构。慢性化脓性中耳炎病例中,CT仿真内窥镜显示锤骨柄、砧骨长脚骨质破坏与手术所见的符合率为91.7%(22/24),锤骨头、砧骨短脚、镫骨脚骨质骨质破坏的符合率分别为95.8%(23/24),100%(24/24)及87.5%(21/24);1耳中耳癌中CT仿真内窥镜可清晰、立体显示鼓室盖、鼓岬及外半规管的骨质破坏;1耳颞骨骨折中CT仿真内窥镜可清晰显示锤砧关节脱位。中耳CT仿真内窥镜成像平均耗时约10min。结论:64排螺旋CT中耳CT仿真内窥镜可以清晰显示中耳的正常解剖细节,对病变中耳骨质破坏显示的符合率较高,且CT仿真内窥镜耗时不长,可以临床常规使用。
Background: Middle ear structure is complex, subtle, deep and hidden. CT virtual endoscopic imaging can be used spiral CT volume scan data to reconstruct the three-dimensional images of the inner surface of the hollow cavity, similar to the fiber endoscopy seen. Objective: To verify the ability of 64-slice spiral CT middle ear simulation endoscopy to display the normal structure of the middle ear and its clinical value in the middle ear. DESIGN, TIME AND SETTING: Confirmatory Comparative Observation was performed at the Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University from October 2005 to March 2006. PARTICIPANTS: Thirty-three patients (66 ears) suspected of middle ear disease were screened by double-ear spiral CT, of which 35 were normal; 31 ears of chronic otitis media included 24 ears of chronic suppurative otitis media and 2 ears of chronic suppurative otitis media , 2 ears of middle ear cancer, 1 ear of external ear foreign body granuloma and 2 ears of temporal bone fracture. Methods: The temporal bone 64-slice spiral CT volume scan, soft tissue algorithm intensive reconstruction, the use of Navigator software in the middle ear CT simulation endoscopic imaging. All CT simulation endoscopic imaging and conventional two-dimensional CT images and surgical control. MAIN OUTCOME MEASURES: The main structures observed included the ossicles and interphalangeal joints, the upper and lower tympanic space, the sinuses and external auditory meatus, the tympanic wall structures, facial crypts, tympanic skullcap, anterior malleolus, supraspinatus, posterior incus Ligaments and rear tympanic structure. Results: CT virtual endoscopy images of 100% CT images clearly showed most of the normal otolaryngogastric structures and tympanic wall structures, and 68.6% (24/35) and 74.3% (26/35) CT virtual endoscopic images were available Clearly show the tarsal anterior and posterior legs, respectively, and CT simulation endoscopic images clearly show the anatomical structure of the posterior tympanic cavity. In the case of chronic suppurative otitis media, the computed tomography endoscopy showed that the malleolus handle, the incision rate of the incus long bone fracture was 91.7% (22/24), the mallet head, the incus short foot and the stapes foot The coincidence rates of bone destruction were 95.8% (23/24), 100% (24/24) and 87.5% (21/24), respectively. CT virtual endoscopy in 1 otologically middle ear carcinoma could be clearly and stereoscopically displayed Tympanic cavern, drum promontory and external semicircular canal bone destruction; 1 ear temporal bone fracture CT simulation endoscopy can clearly show hammer anvil joint dislocation. Middle-ear CT simulation of endoscopic imaging took an average of about 10min. Conclusion: 64-slice spiral CT middle ear CT virtual endoscopy can clearly show the normal anatomy of the middle ear. The coincidence rate of middle ear osteoarthritis lesions shows high, and the CT simulation endoscope takes less time and can be clinically Routine use.