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院内课题(20180312)。


Clinical value of intravenous gadolinium contrast-enhanced magnetic resonance imaging for the diagnosis of Meniere’s disease
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    目的 分析经静脉内耳钆造影(IV-Gd),3D-FLAIR MRI技术对拟诊断为梅尼埃病(MD)患者中内淋巴积水(EH)比例,探讨其对MD的临床诊断价值。方法 选取2016年3月—2021年10月根据临床症状疑似MD患者86例,经IV-Gd进行内耳三维快速液体衰减反转恢复磁共振(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32例,女54例;年龄28~72岁,平均年龄(51.7±11.2)岁;病史1个月至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 To analyze the proportion of endolymphatic hydrops (EH) in patients with Meniere’s disease (MD) verified by 3D-FLAIR magnetic resonance imaging (MRI) through intravenous gadolinium (IV-Gd) and to explore its clinical diagnostic value for MD.Methods A total of 86 patients with suspected MD according to clinical symptoms were selected from March 2016 to Oct 2021. All the patients underwent inner ear 3D -FLAIR MRI scan through IV-Gd, the clinical characteristics and EH results were analyzed.Results Among all the 86 patients, 32 were male and 54 female, aged from 28 to 72 years old with an average of 51.7±11.2 years, and medical history of one month to 18 years with an average of 2.9±2.6 years. Of the 61 patients with EH in inner ear (EH-positive), MD was confirmed in 56, and 7 of the remaining 25 patients without obvious EH in inner ear (EH-negative) were diagnosed with MD. Among the 61 EH-positive cases, 23 (37.7%) had both ears EH, and among the 84 EH-positive ears, 29 ears (34.5%) had vestibular EH, 15 (17.9%) had cochlear EH, and 33 (75%) had both vestibular and cochlear EH. The sensitivity, specificity, accuracy, the positive and negative predictive values of IV-Gd MRI for the diagnosis of MD 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 MRI had a good consistency with the clinical diagnosis result (Kappa=0.653,P<0.001). Comparison between the MD patients of EH-positive and EH-negative groups showed no statistically significant differences in patients’ age and gender, concomitant migraine and MD stage (P>0.05). Their differences in clinical course of MD and average pure tone threshold audiometry (PTA) were statistically significant (P<0.05).Conclusions With the help of the EH results detected by IV-Gd, inner ear MRI can effectively improve the diagnostic accuracy rate of MD. The course of MD and hearing loss may be related to EH. If possible, IV-Gd MRI should be used for further corroboration in patients with suspected MD.

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阿布利克木·依明,米日喀米力·玉苏甫,曲源,唐亮.经静脉内耳钆造影对疑似梅尼埃病的临床诊断价值[J].中国耳鼻咽喉颅底外科杂志,2022,28(2):8-12

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  • 收稿日期:2021-12-09
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  • 在线发布日期: 2022-05-02
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