经鼓室注射内耳钆造影显影不良原因初探

doi:10.6040/j.issn.1673-3770.1.2020.070

摘要/Abstract

摘要： 目的总结分析经鼓室注射内耳钆造影显影不良的可能原因,探讨可行的解决方案。方法分析经鼓室注射内耳钆造影的356例患者(共706耳)病历资料,发现存在显影不良55例(共70耳),分析显影不良可能存在的原因。结果 55例(共70耳)中表现为显影浅淡16耳,表现为充盈欠佳14耳,不显影/未见造影剂充盈40耳。影像学提示单纯合并同侧中耳炎者39耳,考虑慢性中耳炎或隐匿性中耳炎,其中出现显影不良11耳(约28.2%,11/39);单纯合并鼻窦炎者32耳,出现显影不良4耳(约12.5%,4/32);同时合并中耳炎和鼻窦炎者3耳,出现显影不良者1耳(约33.3%,1/3);影像学未提示合并中耳炎/鼻窦炎者632耳,其中出现显影不良54耳(约8.5%,54/632)。合并中耳炎与未合并相比差异有统计学意义,合并鼻窦炎、同时合并中耳炎鼻窦炎与未合并比较差异无统计学意义。结论经鼓室注射内耳钆造影时,排除近期中耳炎病史后,慢性中耳炎或隐匿性中耳炎仍可能是显影不良的影响因素。通过对造影各个环节中其他可能存在的影响因素进行进一步探讨,建议根据可能存在的原因尽量规避,以提高内耳钆造影的成功率。

关键词: 经鼓室注射, 内耳钆造影, 显影不良, 中耳炎, 鼻窦炎

Abstract: Objective To analyze the possible causes of poor development of imaging in patients undergoing three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging(3D-FLAIR MRI)after intratympanic gadolinium injection in our hospital in recent years and propose possible solutions. Methods This study enrolled a total of 356 patients and 706 ears between January 2017 and June 2020. All patients underwent 3D-FLAIR MRI through intratympanic gadolinium injection. The imaging was poorly developed for a total of 55 patients(70 ears). The possible causes of poor development were analyzed. Results Poor images was obtained in 70 ears, including 16 instances in which the signal was not as strong as normal, 14 that were not filled contiguously, and 40 that showed no contrast agent in the inner ear on imaging. A total of 39 ears had simple ipsilateral otitis media as revealed by imaging; among those with chronic otitis media or occult otitis media, 11 showed poor visualization(28.2%). Imaging was poor for four(12.5%)out of 32 ears with sinusitis. Among the three ears with both otitis media and sinusitis, imaging was poor for one ear(33.3%). Among the 632 ears without otitis media/sinusitis, imaging was poor for only 54 ears(8.5%). A statistically significant difference was observed between combined and non-combined otitis media, but not between those non-combined,combined rhinosinusitis, as sell as those conbined with otitis media and nasosinusitis. Conclusion When gadolinium is injected into the inner ear through the tympanum, though excluding a recent history of otitis media, chronic or occult otitis media may still be influencing factors for poor imaging development. The present article further discusses other possible influencing factors in each link of angiography and suggests avoiding them to improve the success rate of inner ear gadolinium angiography.

Key words: Intratympanic gadolinium, Magnetic resonance imaging, Poor development, Otitis media, Nasasinusitis

中图分类号:

R764.3

王海霞,张彩霞,李银银,郑金秀,陈曦. 经鼓室注射内耳钆造影显影不良原因初探[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 61-66.

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