本文選題：MPR + VR��； 參考：《蚌埠醫(yī)學院》2017年碩士論文

【摘要】：研究目的通過MSCT常用的三種后處理技術:多平面重組(MPR)、容積再現(xiàn)(VR)及最大密度投影(MIP)觀察正常中耳聽骨鏈的形態(tài)結(jié)構;并基于此三種重建技術觀察慢性中耳炎患者病耳聽骨鏈的骨質(zhì)破壞情況,將影像學診斷結(jié)果與術中所見進行對比,觀察兩者的一致性,從而探討MSCT三維重建技術對中耳炎患者聽骨鏈完整性顯示的價值;同時評價聽骨鏈破壞程度與聽力水平的相關性。資料與方法選取蚌埠醫(yī)學院第一附屬醫(yī)院耳鼻喉科收治的中耳炎、突聾、耳后瘺管及梅尼耳埃病患者(所選病例均剔除雙側(cè)耳病變患者),詳細記錄其臨床癥狀、術前聽力情況,應用64層螺旋CT,進行顳骨薄層螺旋掃描,按照納入標準從受檢者中選出正常組及疾病組共計63例將其數(shù)據(jù)傳至ADW4.4工作站(Advanced Workstation 4.4),應用相關軟件進行聽骨鏈的三維重建。正常對照耳觀察聽骨鏈的形態(tài)結(jié)構;病變耳觀察聽骨鏈的改變及骨質(zhì)破壞情況并和手術結(jié)果所見進行對比。選用SPSS21.0統(tǒng)計軟件完成所需的統(tǒng)計學分析。結(jié)果(1)正常組錘骨頭、錘骨頸、錘骨柄、錘砧關節(jié)、砧骨體、砧骨長腳、砧骨短腳這七個結(jié)構均能在MPR、VR及MIP上很好地顯示,它們的顯示率無明顯差異,當把豆狀突、砧鐙關節(jié)和鐙骨頭看成一個整體時,這三種顯示方式亦無明顯差異。對鐙骨前、后弓的顯示,MPR與MIP之間無明顯差異,都優(yōu)于VR,且MPR在顯示鐙骨前弓上更好。VR和MIP都不能很好顯示鐙骨足板,MPR在顯示鐙骨足板上有較大優(yōu)勢。(2)病變組錘骨頭、錘骨柄、砧骨長腳、砧骨短腳及錘砧關節(jié)骨質(zhì)破壞MSCT診斷與手術結(jié)果比較,Kappa值均0.75,表明兩者的一致性較好,砧鐙關節(jié)及鐙骨骨質(zhì)破壞的比較,Kappa值分別為0.529, 0.538,表明兩者的一致性一般。(3)中耳炎聽小骨的破壞中,砧骨的破壞率最高;聽力損失程度與聽骨鏈的破壞呈正相關關系(rs'=0.824 , P0.01),聽骨鏈破壞的程度越重,聽力下降越嚴重,當聽小骨破壞程度達到Ⅲ期時,氣導聽力損失一般在62dB以上。結(jié)論1. .MSCT后處理技術對正常聽小骨大部分細微結(jié)構能夠很好的顯示,尤其是MPR技術對鐙骨底板的顯示;VR技術則不適用于鐙骨的顯示;MIP技術能夠呈現(xiàn)出三維立體效果,操作起來省時,簡單同時又能達到較高的顯示效能,值得影像醫(yī)生在實際工作中常規(guī)使用。2.對于鼓室內(nèi)伴有軟組織病灶的中耳炎患者,綜合MSCT后處理技術可以準確的評估聽小骨的破壞,為臨床醫(yī)生提供有價值信息。3.砧骨更容易受到破壞,聽骨鏈的破壞程度與聽力損失密切相關。
[Abstract]:Objective to observe the morphologic structure of the auditory chain of the normal middle ear by using three kinds of post-processing techniques commonly used in MSCT: multiplanar recombination, volumetric reconstruction and maximum density projection. The bone destruction of ossicular chain in patients with chronic otitis media was observed on the basis of these three reconstruction techniques. The imaging diagnosis results were compared with those during operation, and the consistency between the two methods was observed. To explore the value of MSCT three-dimensional reconstruction in displaying the ossicular chain integrity in patients with otitis media, and to evaluate the correlation between the degree of ossicular chain destruction and hearing level. Materials and methods patients with otitis media, sudden deafness, retroauricular fistula and Meniere's disease were selected from the Otolaryngology Department of the first affiliated Hospital of Bengbu Medical College. A total of 63 cases of normal group and disease group were selected according to the inclusion criteria to transmit their data to ADW4.4 workstation and Advanced Workstation 4.4 to reconstruct the auditory ossicular chain by using the relevant software. The morphological structure of ossicular chain was observed in normal control ears and the changes of ossicular chain and bone destruction in diseased ears were observed and compared with the results of operation. Use SPSS21.0 software to complete the required statistical analysis. Results 1) the seven structures of the mallet bone, the neck of the malleus, the stalk of the malleus, the anvil joint, the incus, the long foot of the incus and the short foot of the incus could be well displayed on MPR-VR and MIP. There was no significant difference in the display rate of these seven structures. When the stirrup joint and head of stapes were regarded as a whole, there were no significant differences among the three display modes. For the anterior stapes, there was no significant difference between MPR and MIP in the posterior arch, and MPR was better than MIP in displaying the stapes anterior arch. VR and MIP could not well display the malleus bone and pedicle of the stapes pedis in the lesion group. The results of MSCT diagnosis and operation of long foot, short foot of incus and malus anvil joint were 0.75, which indicated that the consistency of the two methods was good. The comparison of the destruction of the incudrup joint and the stapes bone showed that the Kappa value was 0.529 and 0.538 respectively, which indicated that the destruction rate of the incus was the highest in the small auditory bone of otitis media. There was a positive correlation between the degree of hearing loss and the destruction of ossicular chain. The more severe the damage of auditory chain was, the more serious the hearing loss was. When the damage degree of small auditory bone reached stage 鈪，

本文編號：1843518