Dissertation > Medicine, health > Otorhinolaryngology > Otology,ear disease

The Value of Preoperative Assessment About Cholesteatoma by Image Reconstruction Technique of 64-ranked 128-slice Computer Tomography

Author XiangLi
Tutor ZhengSuiSheng
School Anhui Medical University,
Course Medical Imaging and Nuclear Medicine
Keywords Cholesteatoma Otitis media Facial nerve canal Tomography X-ray computed
CLC R764
Type Master's thesis
Year 2010
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Fine background Anatomy of the Ear, complex, deep in the temporal bone radiology in the past including the information provided by the conventional X-ray, conventional CT and magnetic resonance imaging (MRI) can not meet the clinical needs. High-resolution CT (highresolution CT, HRCT) has the characteristics of high spatial resolution, excellent display the details of the bone, its prominent role in the diagnosis of diseases of the ear has been recognized, it appears ear development of imaging to before moving a big step, but single-slice spiral CT HRCT usually only get a set of temporal bone parallel to a plane axial or coronal images, sagittal, as due to the limitations of the scanning gantry angle and patients often need to adopt the special position of the unbearable and difficult to obtain. Chronic otitis media, cholesteatoma is the most common clinical ear disease, the clinical classification of chronic otitis media treatment programs play a decisive role, relying solely on clinical data diagnosis is difficult. Multi-slice spiral CT can effectively find tiny bone destruction, help for clinical classification and treatment. Simple otitis media line tympanoplasty tympanic lesions exploration is very important, multi-slice spiral CT three-dimensional reconstruction can be clearly found lesions, especially after tympanic recess lesions are more valuable to improve the success rate of surgery. Cholesteatoma lesions can also provide more information as cholesteatoma often can be observed the scutum damage, combined with clinical provide reliable information for the design of the surgical options, to create the conditions for tympanoplasty. Multi-slice spiral CT 3D post-processing techniques on the value of the middle ear and inner ear structure, has been the unanimous approval of the majority of scholars. In this study, based on past experience, divided into two groups, the normal group and cholesteatoma group, the normal group, discussed in more depth MSCT various post-processing techniques to the middle ear, inner ear structure imaging value and the complementary relationship between them; the cholesteatoma group chose the cholesteatoma group, is due to benign lesions of the middle ear cholesteatoma most likely to cause bone destruction, middle and inner ear structure imaging research provides an important basis of the lesion imaging, and cholesteatoma higher incidence of cholesteatoma has important clinical significance, cholesteatoma group of MSCT post-processing techniques, targeted the destruction of bone imaging and value. The first part of MSCT various post-processing techniques to 64 rows of 128-slice CT image reconstruction techniques in normal middle and inner ear structures display normal middle and inner ear structure imaging research purposes. Materials and Methods This study using 64 rows of 128-slice spiral CT 50 ears normal group for MSCT is, the reconstruction of a variety of ways, focus on the ossicles, MPR and volume of the the cochlear structure applications multi-plane restructuring and reproduction technology VR, facial nerve, half regulations tube The application surface reconstruction CPR, come to different display rate, all data with SPSS11.0 software package processing, use the x2 test, the display of the middle and inner ear fine structure analysis of a variety of 3D post-processing method, the provisions of p LT ; 0.05 considered statistically significant. Results the hammer anvil joints, kicking anvil joint, pedal bone front foot pedal bone back foot kicking bone bottom five structures in VR, MIP, MPR display rate difference, p values ??were lt; 0.05, the difference was statistically significant . The malleus, incus long-legged, hammer and anvil joint, kicking anvils joint, kicking bone forefoot, rear foot of the pedal bone, pedal bone bottom seven structures were in the axial MSCT processing imaging display rate difference p-value lt ; 0.05, the difference was statistically significant. Facial nerve canal, superior semicircular canal and posterior semicircular canal, the outer semi regulations tube, tympanum, drum sinus entrance, the six structures of the cochlea structure on different post-treatment imaging with axial display there are differences, p values ??were lt; 0.01, the difference was statistically significance. Conclusion MSCT post-processing techniques to normal middle ear, inner ear structure imaging than the axial imaging advantages; MSCT post-processing technology the stapes and incudostapedial joint display capabilities somewhat less than the other structures; MPR display the stapes is superior to other imaging method; VR than MIP middle ear, inner ear fine structure (in addition to the display of, stapes and incudostapedial joints) more intuitive and accurate; CPR is ideal for the full development of the facial nerve canal. The second part of the MSCT various processing technology of cholesteatoma in the middle ear and the inner ear structure of bone destruction Objective To investigate MSCT various post-processing techniques cholesteatoma bone destruction of the advantages and disadvantages of the display. Materials and Methods In this study, the 64-128-slice CT reconstruction of the 42 ear cholesteatoma in the middle ear and the inner ear structure a variety of ways, control seen in their the MSCT findings to the surgical technique, blinded to the results, Kappa test the consistency of the two, all data with SPSS11.0 software package processing requirements Kappa values ??greater than or equal to 0.75 MSCT and intraoperative findings achieved quite satisfactory degree of consistency degree of consistency can still value in the 0.4 to 0.75. Less than 0.4 then the degree of consistency is not ideal, and the value of MSCT in cholesteatoma disease. Malleus, the incus long-legged, short legs incus incus body, the meningeal board bone wall bone destruction, drum sinus entrance to expand the horizontal segment of the facial nerve canal bony canal structure defect Kappa values ??were greater than 0.75, indicating that the MSCT its case and intraoperative findings consistent with a very high degree; malleus handle, hammer anvil joints, horizontal segment of the facial nerve canal, labyrinthine segment, the semicircular canals, shield plate, sigmoid sinus bone wall, labyrinthine structure bone destruction Kappa values ??between 0.4 to 0.75 MSCT display can still be seen in the degree of consistency in the bone destruction with surgery; while the joint of incudostapedial, the stapes forefoot and rear foot of the stapes, stapes bone destruction Kappa value less than 0.4 MSCT display its bone destruction poor degree of consistency with the intraoperative findings. Conclusion MSCT various post-processing technology cholesteatoma middle ear, inner ear structure of bone destruction imaging surgery has important reference value; the stapes and incudostapedial joint imaging of bone destruction is still a vulnerable; analog surgical approach can provide guidance on the preoperative evaluation.

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