Inner ear perilymphaticum gadolinium based MR imaging in large vestibular aqueduct: a pilot study

Pub Date : 2020-04-10 DOI:10.3760/CMA.J.CN112149-20190523-00443

Lihong Zhang, Linsheng Wang, Xiaoyan Li, Xian Li, Xi-bin Hu, Yueqin Chen

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Abstract

回顾性分析2013年7月至2018年9月济宁医学院附属医院经临床诊断的13例（21耳）大前庭导水管综合征（LVAS）患者（LVAS组）和23例（23耳）听力正常者（正常组）外淋巴间隙钆成像资料。先行三维稳态构成干扰（3D-CISS）和三维液体衰减反转恢复（3D-FLAIR）序列MRI扫描，经鼓膜向鼓室内注入稀释的钆对比剂，1、2、3、6 d后分别行3D-FLAIR扫描。对两组耳蜗、前庭及半规管外淋巴间隙显示情况进行评分，评分结果比较采用Wilcoxon秩和检验。测量LVAS组内淋巴管（ED）和内淋巴囊（ES）区注射对比剂前后信号强度，计算与同层脑干的信号强度比（SIR），采用单因素方差分析比较注射前后的差异。结果显示注射对比剂前LVAS组和正常组耳蜗、前庭及半规管在3D-FLAIR上呈低信号；注射对比剂后，对比剂分布于内耳耳蜗、前庭、半规管外淋巴间隙，两组间显示情况评分差异无统计学意义（Z=-0.95，P=0.34）。正常组ED和ES均未显示，注射对比剂后亦无信号强度改变；LVAS组ED和ES区在3D-FLAIR上呈完全低信号2耳，呈分界清晰低、高信号19耳。注射对比剂后患侧ED和ES区低信号区信号强度增强，注射对比剂前后SIR值间比较差异有统计学意义（F=111.93，P <0.01）。本研究结果提示：LVAS患耳内耳（耳蜗、前庭和半规管）内淋巴积水不显著；患耳ED和ES可能与前庭外淋巴间隙相通；部分患耳的ED和ES内可能存在间隔。

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基于大前庭导水管内耳淋巴周围钆的磁共振成像:一项初步研究

Retrospective analysis of gadolinium imaging data of 13 patients (21 ears) with large vestibular aqueduct syndrome (LVAS group) and 23 patients (23 ears) with normal hearing (normal group) diagnosed clinically at the Affiliated Hospital of Jining Medical College from July 2013 to September 2018. First, 3D steady state interference (3D-CISS) and 3D liquid attenuation inversion recovery (3D-FLAIR) sequence MRI scans were performed. Diluted gadolinium contrast agent was injected into the tympanic cavity through the tympanic membrane, and 3D-FLAIR scans were performed after 1, 2, 3, and 6 days, respectively. Score the display of cochlear, vestibular, and semicircular lymphatic spaces between two groups, and compare the scoring results using Wilcoxon rank sum test. Measure the signal intensity of the lymphatic vessel (ED) and lymphatic sac (ES) in the LVAS group before and after injection of contrast agent, calculate the signal intensity ratio (SIR) with the same layer of brainstem, and compare the differences before and after injection using one-way analysis of variance. The results showed that the cochlea, vestibule, and semicircular canals of the LVAS group and the normal group showed low signal intensity on 3D-FLAIR before injection of contrast agent; After injection of contrast agent, the contrast agent was distributed in the cochlea of the inner ear, vestibule, and perilymphatic space of the semicircular canal. There was no statistically significant difference in display scores between the two groups (Z=-0.95, P=0.34). Both ED and ES were not displayed in the normal group, and there was no change in signal intensity after injection of contrast agent; The ED and ES regions of the LVAS group showed complete low signal in 2 ears on 3D-FLAIR, with clear boundaries between low and high signal in 19 ears. After injection of contrast agent, the signal intensity of the low signal area in the ED and ES areas on the affected side increased, and there was a statistically significant difference in SIR values before and after injection of contrast agent (F=111.93, P<0.01). The results of this study suggest that there is no significant lymphatic hydrops in the inner ear (cochlea, vestibule, and semicircular canal) of LVAS patients; The ED and ES of the affected ear may be connected to the anterior extramural lymphatic space; There may be gaps between ED and ES in some affected ears.

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