经静脉内耳钆造影对疑似梅尼埃病的临床诊断价值
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新疆维吾尔自治区人民医院

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新疆维吾尔自治区人民医院 院内自助课题(20180312)第一


The clinical fvalue of Meniere"s disease verified by intravenous gadolinium contrast-enhanced magnetic resonance imaging
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1.ENT Clinic,People'2.'3.sHospital of Xinjiang Uygur Autonomous Region,Urumqi,China;4.新疆维吾尔自治区人民医院

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    目的 分析经静脉内耳钆造影(Intravenous Gadolinium,IV-Gd),3D-FLAIR MRI技术对拟诊断为梅尼埃病(Meniere's disease,MD)患者中内淋巴积水(Endolymphatic hydrops , EH)比例,探讨其对MD的临床诊断价值。方法 选取我院2016年3月-2021年10月期间,根据临床症状疑似MD患者86例,经静脉注射钆造影(Intravenous Gadolinium,IV-Gd),进行内耳3D-FLAIR MRI扫描,对病例资料及EH结果进行分析。结果 86例疑似MD患者中,男性32例,女性54例,年龄28岁~72岁,平均年龄51.7±11.2岁,病史1月~18年,平均2.9±2.6年。61例疑似MD患者内耳IV-Gd显示出EH(称为:EH阳性),其中56例确诊MD,其余25例疑似MD患者内耳IV-Gd未见明显EH(称为:EH阴性),其中7例确诊为MD。61例EH阳性者中,23例(37.7%)患者双耳EH阳性,EH阳性的84耳中29耳(34.5%)前庭EH,15耳(17.9%)耳蜗EH,其中33例(75%)同时前庭和耳蜗EH。IV-Gd诊断MD的灵敏度、特异度、准确度、阳性和阴性预测值分别为88.9%、78.3%、86.1%、91.8%、78.3%, ROC曲线下面积为:0.836;IV-Gd与临床确诊结果的一致性较好(Kappa=0.653 P<0.001 )。EH阳性和EH阴性两组MD患者对比:年龄、性别、合并偏头痛、MD分期均无显著差异(P>0.05)。MD病程、平均PTA均有显著相关性(P<0.05)。结论 借助于IV-Gd检测的EH结果,可以有效提高MD的确诊率,MD病程及听力损失可能与EH相关。若条件允许,对疑似MD患者进行IV-Gd进一步佐证。

    Abstract:

    Objective The aim of this study is to analyze the proportion of endolymphatic hydrops (EH) in patients with Meniere's disease (MD) verified by 3D-FLAIR MRI through intravenous gadolinium (IV-Gd) and to explore its clinical diagnostic value for MD. Methods Selected from March 2016 to October 2021 in our hospital, 86 patients with suspected MD according to clinical symptoms, all of them underwent inner ear 3D -FLAIR MRI scan through IV-Gd, the clinical characteristics and EH results were compared and analyzed. Results Among the 86 patients with suspected MD, There are 32 males and 54 females, aged 28 to 72 years ald, with an average age of 51.7±11.2 years, and a medical history of 1month to 18 years, with an average of 2.9 ± 2.6 years. 61 suspected MD patients showed EH in inner ear IV-Gd (set as EH-positive), 56 of them were confirmed MD, and the remaining 25 suspected MD patients showed no obvious EH in inner ear IV-Gd (set as EH negative), of which 7 A patient was diagnosed with MD.. Among the 61 cases of EH positive, 23 cases (37.7%) had both ears EH Positive,and among the 84 EH positive ears, 29 ears (34.5%) had vestibular EH, 15 ears (17.9%) had cochlear EH, and 33ears (75%) had both vestibular and cochlear EH. IV-Gd diagnosis of MD The sensitivity, specificity, accuracy, the positive and negative predictive values were 88.9%, 78.3%, 86.1%, 91.8%, and 78.3%, respectively, and the area under the ROC curve was 0.836; the IV-Gd had a good consistency with the clinical diagnosis result (Kappa=0.653 P <0.001). Comparison of EH-positive and EH-negative groups of MD patients, There was no statistical significance in age, gender, migraine complicated and MD stage between the EH-positive and EH-negative groups of MD patients (P>0.05). The clinical course of MD and average PTA were statistical significance (P<0.05). Conclusion With the help of the EH results detected by IV-Gd can effectively improve, the confirm diagnosis rate of MD. The course of MD and hearing loss may be related to EH. If possible, IV-Gd may be used for further corroboration in patients with suspected MD.

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  • 收稿日期:2021-12-09
  • 最后修改日期:2022-01-13
  • 录用日期:2022-01-28
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