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.

参考文献

[1] Fang ZM, Chen X, Gu X, et al. A new magnetic resonance imaging scoring system for perilymphatic space appearance after intratympanic gadolinium injection, and its clinical application[J]. J Laryngol Otol, 2012, 126(5): 454-459. doi:10.1017/s0022215112000060.
[2] 刘旭晖, 黄魏宁, 孟曦曦, 等. 梅尼埃病患者内耳内淋巴间隙的比值与正常受试者的比较[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 39-42, 48. doi:10.6040/j.issn.1673-3770.0.2017.005. LIU Xuhui, HUANG Weining, MENG Xixi, et al. Comparison of endolymphatic spaces between patients suffering from Menieres disease and normal volunteers[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(2): 39-42, 48. doi:10.6040/j.issn.1673-3770.0.2017.005.
[3] Imai T, Uno A, Kitahara T, et al. Evaluation of endolymphatic Hydrops using 3-T MRI after intravenous gadolinium injection[J]. Eur Arch Otorhinolaryngol, 2017, 274(12): 4103-4111. doi:10.1007/s00405-017-4739-9.
[4] Nakashima T, Naganawa S, Sugiura M, et al. Visualization of endolymphatic Hydrops in patients with Menieres disease[J]. Laryngoscope, 2007, 117(3): 415-420. doi:10.1097/MLG.0b013e31802c300c.
[5] Nonoyama H, Tanigawa T, Tamaki T, et al. Evidence for bilateral endolymphatic Hydrops in ipsilateral delayed endolymphatic hydrops: preliminary results from examination of five cases[J]. Acta Otolaryngol, 2014, 134(3): 221-226. doi:10.3109/00016489.2013.850741.
[6] Iwasa YI, Tsukada K, Kobayashi M, et al. Bilateral delayed endolymphatic Hydrops evaluated by bilateral intratympanic injection of gadodiamide with 3T-MRI[J]. PLoS One, 2018, 13(12): e0206891. doi:10.1371/journal.pone.0206891.
[7] Attyé A, Dumas G, Troprès I, et al. Recurrent peripheral vestibulopathy: Is MRI useful for the diagnosis of endolymphatic Hydrops in clinical practice?[J]. Eur Radiol, 2015, 25(10): 3043-3049. doi:10.1007/s00330-015-3712-5.
[8] Naganawa S, Kawai H, Sone M, et al. Ratio of vestibular endolymph in patients with isolated lateral semicircular canal dysplasia[J]. Magn Reson Med Sci, 2015, 14(3): 203-210. doi:10.2463/mrms.2014-0112.
[9] Sone M, Yoshida T, Morimoto K, et al. Endolymphatic Hydrops in superior canal dehiscence and large vestibular aqueduct syndromes[J]. Laryngoscope, 2016, 126(6): 1446-1450. doi:10.1002/lary.25747.
[10] Williams MT, Ayache D, Alberti C, et al. Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings[J]. Eur Radiol, 2003, 13(1): 169-174. doi:10.1007/s00330-002-1423-1.
[11] Wesseler A, Óvári A, Javorkova A, et al. Diagnostic value of the magnetic resonance imaging with intratympanic gadolinium administration(IT-Gd MRI)versus audio-vestibular tests in menières disease[J]. Otol Neurotol, 2019, 40(3): e225-e232. doi:10.1097/mao.0000000000002082.
[12] Gürkov R, Hornibrook J. On the classification of hydropic ear disease(Menières disease)[J]. HNO, 2018, 66(6): 455-463. doi:10.1007/s00106-018-0488-3.
[13] Yoshioka M, Naganawa S, Sone M, el al. Individual differences in the permeability of the round window:evaluating the movement of intratympanic gadoIinium into the inner ear[J]. 0tol Neurotol, 2009,30(5):645-648. doi:10.1097/MAO.0b013e31819bda66.
[14] 孙建和, 杨仕明. 耳组织学[M]. 北京: 人民军医出版社, 2015.
[15] Franke K. Freeze-fracture aspects of the junctional complexes in the round window membrane[J]. Arch Otorhinolaryngol, 1977, 217(3): 331-337. doi:10.1007/bf00465550.
[16] Goycoolea MV. Clinical aspects of round window membrane permeability under normal and pathological conditions[J]. Acta Otolaryngol, 2001, 121(4): 437-447. doi:10.1080/000164801300366552.
[17] MacArthur CJ, Hausman F, Kempton JB, et al. Inner ear tissue remodeling and Ion homeostasis gene alteration in murine chronic otitis media[J]. Otol Neurotol, 2013, 34(2): 338-346. doi:10.1097/mao.0b013e31827b4d0a.
[18] King EB, Salt AN, Kel GE, et al. Gentamicin administration on the stapes footplate causes greater hearing loss and vestibulotoxicity than round window administration in Guinea pigs[J]. Hear Res, 2013, 304: 159-166. doi:10.1016/j.heares.2013.07.013.
[19] King EB, Salt AN, Eastwood HT, et al. Direct entry of gadolinium into the vestibule following intratympanic applications in Guinea pigs and the influence of cochlear implantation[J]. J Assoc Res Otolaryngol, 2011, 12(6): 741-751. doi:10.1007/s10162-011-0280-5.
[20] Salt AN, Plontke SK. Pharmacokinetic principles in the inner ear: Influence of drug properties on intratympanic applications[J]. Hear Res, 2018, 368: 28-40. doi:10.1016/j.heares.2018.03.002.
[21] Salt AN, Hirose K. Communication pathways to and from the inner ear and their contributions to drug delivery[J]. Hear Res, 2018, 362: 25-37. doi:10.1016/j.heares.2017.12.010.
[22] Tuñón Gómez M, Lobo Duro DR, Brea Álvarez B, et al. Diagnosis of endolymphatic Hydrops by means of 3T magnetic resonance imaging after intratympanic administration of gadolinium[J]. Radiologia, 2017, 59(2): 159-165. doi:10.1016/j.rx.2016.10.006.
[23] Shi HB, Li YH, Yin SK, et al. The predominant vestibular uptake of gadolinium through the oval window pathway is compromised by endolymphatic Hydrops in ménières disease[J]. Otol Neurotol, 2014, 35(2): 315-322. doi:10.1097/mao.0000000000000196.
[24] Pyykkö I, Zou J, Poe D, et al. Magnetic resonance imaging of the inner ear in Menieres disease[J]. Otolaryngol Clin N Am, 2010, 43(5): 1059-1080. doi:10.1016/j.otc.2010.06.001.
[25] Shi H, Li Y, Yin S, et al. The predominant vestibular uptake of gadolinium through the oval window pathway is compromised by endolymphatic Hydrops in Ménières disease[J]. Otol Neurotol, 2014, 35(2): 315-322. doi:10.1097/mao.0000000000000196.

相关文章 15

[1]	张国民,王茂华,高松,吴文斌,虞幼军. 持续灌流模式耳内镜下粘连性中耳炎手术疗效分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 16-19.
[2]	冯思聪,于晓岚,娄丹. 基于囊泡组织Ki67、GM-CSF表达评估Messerklinger中鼻甲成形术对慢性鼻-鼻窦炎合并鼻息肉的效果[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 31-39.
[3]	翟雪纯,边欣,陈敬彩,邓家钰,叶子,杨萍丽. 慢性额窦炎患者焦虑抑郁特点及横断面研究[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 35-43.
[4]	李阳松,袁发洋,杨艳,张田,喻国冻. 基于Web of Science进行生物制剂治疗慢性鼻窦炎文献计量学分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 54-64.
[5]	杜康丽,郑振宇,徐战将,张宇,陈露,卢梦垚. 鼻中隔偏曲并发慢性鼻窦炎风险预测模型的构建与验证[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 78-86.
[6]	熊琴, 张砚, 乌日娜, 李锋, 唐力行. 鼻用糖皮质激素在儿童中的应用[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 160-167.
[7]	黄焕,华红利,邓玉琴,江承洋,王雨薇,杨星海. 儿童过敏性鼻炎、扁桃体腺样体肥大和鼻窦炎之间相关性及其对临床指导价值[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 34-41.
[8]	张家齐,袁野,洪陈,顾敏,程雷,陆美萍. 基于孟德尔随机化的肠道菌群与慢性鼻窦炎鼻息肉的因果关系及代谢物中介研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 49-60.
[9]	张广玲,陈兴雪,武天义,孙占伟,王卫卫,李世超,王广科. Tespa1在慢性鼻窦炎伴鼻息肉中的表达及作用研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 35-42.
[10]	曹正勇,李小波. 慢性鼻-鼻窦炎合并哮喘术后短程局部使用糖皮质激素辅助治疗的安全性和有效性[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 43-50.
[11]	王文晴,张丹,朱梦迪,王路阳,杨培培,孙思思,张秋敏,周慧. 慢性鼻窦炎伴鼻息肉复发手术时临床及组织病理学特征变化[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 46-53.
[12]	王奥维,时文杰. CRSwNP中医证型与TFH细胞相关因子的相关性研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 54-60.
[13]	张婕,尼玛吉宗,徐小东,周菁,刘建敏,罗依蕤,杜进涛,巴罗. 藏红花素在嗜酸性慢性鼻窦炎伴鼻息肉中调控2型炎症反应的研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 61-67.
[14]	宋瑾,尹慧,高娴,李永团. 坏死梭杆菌致成人中耳炎并发脑膜炎1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 96-100.
[15]	张韵秋,任秀敏,徐鸥,董金辉,王建星. 奥马珠单抗靶向治疗慢性鼻窦炎伴鼻息肉的研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 136-140.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed