儿童先天性感音神经性聋传导通路磁共振扩散张量成像参数与预后的关系

Relationship between diffusion tensor imaging parameters of conduction pathway and prognosis of congenital sensorineural hearing-loss in children

摘要:

目的 探讨儿童先天性感音神经性聋传导通路磁共振扩散张量成像（DTI）参数与预后的关系。方法 选取2017年1月—2020年3月收治的136例先天性感音神经性耳聋儿童归为观察组，均进行头部DTI检查，另选取同期因其他疾病行头部DTI检查的听力正常儿童118例为对照组，DTI检查内容包括双侧斜方体、颞横回、颞上回、内侧膝状体、听辐射、上橄榄核、窝背侧核、下丘、窝腹侧核、听神经区域的表现弥散系数（ADC）值与各向异性分数（FA）值。对比观察组与对照组以上各部位的ADC值和FA值。另治疗后随访1年，根据听觉行为分级标准评分（CAP）将观察组患儿分为预后良好组与预后不良组，对比预后良好组与预后不良组各部位的ADC值和FA值，并分析各部位的ADC值、FA值与CAP评分的相关性。结果 观察组颞横回、颞上回、听辐射、上橄榄核区的ADC值均高于对照组（P<0.05），斜方体、颞横回、颞上回、内侧膝状体、听辐射、上橄榄核、下丘区的FA值均低于对照组（P<0.05）。术后1年，观察组患儿预后良好率、预后不良率分别为65.44%（89/136）、34.56%（47/136）；预后不良组颞横回、颞上回、听辐射、上橄榄核区的ADC值均高于预后良好组（P<0.05），斜方体、颞横回、颞上回、内侧膝状体、听辐射、上橄榄核、下丘区的FA值均低于预后良好组（P<0.05）。经Pearson相关性分析，先天性神经感音性聋患儿颞横回、颞上回、听辐射、上橄榄核的ADC值与CAP评分均呈负相关性（P<0.05），斜方体、颞横回、颞上回、内侧膝状体、听辐射、上橄榄核、下丘区的FA值与CAP评分均呈正相关性（P<0.05）。结论 先天性感音神经性耳聋患儿听觉传导通路上颞横回、颞上回、听辐射、上橄榄核区、斜方体、内侧膝状体及下丘区的DTI参数异常变化与患儿术后听力恢复效果密切相关，临床上可将其作为治疗及预后评估的重要参考指标。

Abstract:

Objective To investigate the relationship between diffusion tensor imaging (DTI) parameters of magnetic resonance of conduction pathway and prognosis of congenital sensorineural hearing loss in children.Methods One hundred thirty-six children with congenital sensorineural hearing-loss treated and received head DTI in our hospital from Jan 2017 to March 2020 were selected as observation group, and 118 children with normal hearing who underwent head DTI due to other diseases during the same period were selected as control group. DTI parameters included the values of apparent dispersion coefficient (ADC) and fractional anisotropy (FA) of bilateral trapezoid body, transverse temporal gyrus, superior temporal gyrus, medial geniculate body, auditory radiation, superior olivary nucleus, dorsal fossa nucleus, inferior colliculus, ventral fossa nucleus and auditory nerve area. The ADC and FA values of the observation and control groups were compared. One year after treatment, the observation group was subdivided into good and poor prognosis groups according to the categories of auditory performance (CAP), and the ADC and FA values between the good and poor prognosis subgroups were compared, and the correlations between ADC value, FA value and CAP score were analyzed.Results The ADC values of transverse temporal gyrus, superior temporal gyrus, auditory radiation and superior olivary nucleus in the observation group were higher than those in the control group (all P<0.05), and the FA values of trapezoid body, transverse temporal gyrus, superior temporal gyrus, medial geniculate body, auditory radiation, superior olivary nucleus and inferior colliculus were lower than those in the control group (all P<0.05). One year after treatment, the rates of good and poor prognosis of the observation group were 65.44% (89/136) and 34.56% (47/136) respectively, and the ADC values of transverse temporal gyrus, superior temporal gyrus, auditory radiation and superior olivary nucleus in the poor prognosis subgroup were higher than those in the good prognosis subgroup (all P<0.05), while the FA values of trapezoid body, transverse temporal gyrus, superior temporal gyrus, medial geniculate body, auditory radiation, superior olivary nucleus and inferior colliculus in the poor prognosis subgroup were lower than those in the good prognosis subgroup (all P<0.05). Pearson correlation analysis showed that the ADC values of transverse temporal gyrus, superior temporal gyrus, auditory radiation and superior olivary nucleus in children with congenital sensorineural hearing loss were negatively correlated with CAP score (all P<0.05), while FA values of trapezoid body, transverse temporal gyrus, superior temporal gyrus, medial geniculate body, auditory radiation, superior olivary nucleus and inferior colliculus were positively correlated with CAP score (all P<0.05).Conclusion The abnormal changes of DTI parameters in the transverse temporal gyrus, superior temporal gyrus, auditory radiation, superior olivary nucleus, trapezoid body, medial geniculate body and inferior colliculus in the auditory conduction pathway of children with congenital sensorineural hearing loss are closely related to the effect of postoperative hearing recovery, which can be used as important reference indexes for treatment and prognosis evaluation in clinic.