应用内耳钆增强磁共振观察单侧梅尼埃病患者双耳的膜迷路积水状况

刘宇鹏; 杨军; 贾欢; 施俊

doi:10.13201/j.issn.1001-1781.2016.16.008

应用内耳钆增强磁共振观察单侧梅尼埃病患者双耳的膜迷路积水状况

- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科上海交通大学医学院耳科学研究所(上海, 200092)

详细信息

通讯作者: 杨军,E-mail:otology-xinhua@hotmail.com

中图分类号: R764.33

收稿日期: 2016-02-29

Application of gadolinium enhanced magnetic resonance imaging of inner ear to observe bilateral inner ears hydrops in patients with unilateral Meniere’s disease

- Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University Ear Institute, Shanghai, 200092, China

More Information

Corresponding author: YANG Jun, E-mail: otology-xinhua@hotmail.com

Received Date: 29 February 2016

摘要

摘要: 目的:通过对单侧梅尼埃病患者双侧耳鼓室内注射钆造影剂后行内耳增强磁共振检查,分析梅尼埃病患者患耳的膜迷路积水与听力学、前庭检查结果的相关性,同时观察对侧无症状耳有无膜迷路积水。方法:收集单侧梅尼埃病患者31例,所有患者在鼓室内注射钆造影剂前行纯音听阈测试、耳蜗电图(ECochG)、颈性前庭诱发肌源性电位(cVEMP)。双耳鼓室内注射钆造影剂24 h后行三维快速液体衰减反转恢复核磁共振序列成像(3D-FLAIR MRI),对图像膜迷路积水进行评分。对患耳的评分结果与患者病史信息及听力学、前庭检查结果进行Spearman相关性分析。通过t检验对膜迷路积水健耳组和无膜迷路积水健耳组患者的年龄、病程、健耳听力水平进行显著性检验。结果:患耳平均听阈水平与耳蜗积水程度(r=0.383,P<0.05)、ECochG -SP/AP值与耳蜗积水程度(r=0.496,P<0.01)、VEMP双耳耳间峰值差异比(r=0.635,P<0.01)与前庭积水程度显著性相关。对侧无症状有膜迷路积水组和无症状无膜迷路积水组在病程[(6.7±6.3)年 vs (2.9±3.1)年]、患耳听力水平[(70.3±7.4)dB vs (52.5±3.8)dB]上有显著性差异(均P<0.05)。结论:耳蜗积水程度与听力、ECochG,前庭积水程度与cVEMP具有相关性,提示该影像学检查能在一定程度上反映梅尼埃病患者耳蜗-前庭功能水平。膜迷路积水与听力下降关系密切,但不一定会导致梅尼埃病症状的产生。病程长、患耳听力差者更倾向于发展为双侧膜迷路积水。
- 梅尼埃病 /
- 膜迷路积水 /
- 核磁共振 /
- 钆
Abstract: Objective:This study was designed to study the correlation between endolympahatic hydrops image results and auxiliary examinations by magnetic resonance imaging after intratympanic administration of gadolinium in both ears in unilateral Meniere's disease patients.Meanwhile, the contralateral endolympahatic hydrops of the "asym ptomatic" ear in patients with unilateral Meniere's was also observed.Method:Thirty-one patients with unilateral Meniere's disease were enrolled in this study. All the patients underwent pure tone audiometry, electrocochleography(ECochG), cervical-vestibular evoked myogenic potentials(cVEMP) before intratympanic gadolinium contrast agents injected. All the patients underwent three-dimensional fast fluid attenuated inversion recovery sequence magnetic resonance imaging(3D-FLAIR MRI) after intratympanic gadolinium contrast agents injected 24 hours. The images were graded in accordance with the severity of endolympatic hydrops. Spearman correlation analysis was performed between the scores of the images and results of auxiliary examination results. Meanwhile, Student's t test was performed for the significance test of the age, duration of the disease and the hearing level of the affected ears between the group with contralateral endolympatic hydrops and the group without contralateral endolympatic hydrops.Result:Pure tone average and the degree of the cochlear hydrops(r=0.383, P<0.05), the SP/AP ratio and the degree of the cochlear hydrops(r=0.496, P<0.01), and interaural amplitude difference and the degree of the vestibular hydrops(r=0.635, P<0.01) showed a significant correlation. The duration of the disease[(6.7±6.3) years vs(2.9±3.1) years, P<0.05] and the hearing level of the affected ear[(70.3±7.4)dB vs(52.5±3.8)dB, P<0.05)] showed a significant difference between the group with contralateral endolympatic hydrops and the group without contralateral endolympatic hydrops.Conclusion:Pure tone average and the degree of the cochlear hydrops,-SP/AP ratio and the degree of the cochlear hydrops, and interaural amplitude difference and the degree of the vestibular hydrops also showed a significant correlation, which suggesting that MRI image can reflect the auditory-vestibular function in patients with Meniere's disease. Endolympatic hydrops and hearing loss are closely related, but not necessarily result in Meniere's disease symptoms. Patients with longer duration of the disease and worse hearing in the affected ears are more likely to develop bilateral endolympatic hydrops.
- Meniere disease /
- membranous labyrinth hydrops /
- magnetic resonance imaging /
- gadolinium

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参考文献(33)

[1]	中华耳鼻咽喉头颈外科杂志编辑委员会.中华医学会耳鼻咽喉科学分会.梅尼埃病的诊断依据和疗效评估(2006年,贵阳)[J].中华耳鼻咽喉头颈外科杂志,2007,42(3):163-164.
[2]	NAKASHIMA T,NAGANAWA S,SUGIURA M,et al.Visualization of membranous hydrops in patients with Meniere's disease[J].Laryngoscope,2007,117:415-420.
[3]	陈曦,张晓东,顾晰,等.经鼓室钆注射内耳成像技术在梅尼埃病患者中的临床应用[J].中华医学杂志,2011,91(46):3246-3249.
[4]	史宏璐,张道宫,王光彬,等.经鼓室注射对比剂内耳增强三维快速液体衰减反转恢复MR检查诊断梅尼埃病[J].中华放射学杂志,2012,46(10):881-885.
[5]	黄秋红,邱泽恒,张志钢,等.耳蜗电图Sp/Ap面积比在梅尼埃病诊断中的作用[J].临床耳鼻咽喉头颈外科杂志,2011,25(1):8-10.
[6]	RAUCH S D,ZHOU G,KUJAWA S G,et al.Vestibular evoked myogenic potentials show altered tuning in patients with Ménière's disease[J].Otol Neurotol,2004,25:333-338.
[7]	吴子明,张素珍,周娜,等.几项耳功能检查在梅尼埃病诊断中的意义[J].临床耳鼻咽喉科杂志,2006,20(10):433-435.
[8]	MELKI S J,LI Y,SEMAAN M T,et al.A mouse model validates the utility of electrocochleography in verifying endolymphatic hydrops[J].J Assoc Res Otolaryngol,2014,15:413-421.
[9]	BIXENSTINE P J,MANIGLIA M P,VASANJI A,et al.Spiral ganglion degeneration patterns in membranous hydrops[J].Laryngoscope,2008,118:1217-1223.
[10]	DEVAIAH A K,DAWSON K L,FERRARO J A,et al.Utility of area curve ratio electrocochleography in early Meniere disease[J].Arch Otolaryngol Head Neck Surg,2003,129:547-551.
[11]	张道宫,史宏璐,樊兆民,等.经鼓室钆注射内耳成像磁共振检查在梅尼埃病中的应用[J].中华耳鼻咽喉头颈外科杂志,2013,48(8):628-633.
[12]	GIBSON W P,MOFFAT D A,RAMSDEN R T.Clinical electrocochleography in the diagnosis and management of Meneère's disorder[J].Audiology,1977,16:389-401.
[13]	WELGAMPOLA M S,COLEBATCH J G.Characteristics and clinical applications of vestibular-evoked myogenic potentials[J].Neurology,2005,64:1682-1688.
[14]	KATAYAMA N,YAMAMOTO M,TERANISHI M,et al.Relationship between membranous hydrops and vestibular-evoked myogenic potential[J].Acta Otolaryngol,2010,130:917-923.
[15]	GURKOV R,FLATZ W,LOUZA J,et al.In vivo visualization of endolyphatic hydrops in patients with Meniere's disease:correlation with audiovestibular function[J].Eur Arch Otorhinolaryngol,2011,268:1743-1748.
[16]	WANG H M,TSAI S M,CHIEN C Y,et al.Analysis of auditory and vestibular function in patients with unilateral Meniere's disease[J].Acta Otolaryngol,2012,132:1246-1251.
[17]	MERCHANT S N,ADAMS J C,NADOL J B Jr.Pathophysiology of Meniere's syndrome:are symptoms caused by membranous hydrops[J]?Otol Neurotol,2005,26:74-81.
[18]	HORNER K C.Functional changes associated with experimentally induced membranous hydrops[J].Hear Res,1993,68:1-18.
[19]	CUREOGLU S,SCHACHERN P A,PAUL S,et al.Cellular changes of Reissner's membrane in Meniere's disease:human temporal bone study[J].Otolaryngol Head Neck Surg,2004,130:113-119.
[20]	SALVINELLI F,TRIVELLI M,GRECO F,et al.Unilateral membranous hydrops:what about the contralateral ear[J]?Rev Laryngol Otol Rhinol(Bord),2002,123:71-75.
[21]	FRIEDRICHS I,THORNTON A R.Membranous hydrops in asymptomatic ears in unilateral Ménière's disease[J].Laryngoscope,2001,111:857-860.
[22]	RAUCH S D,ZHOU G,KUJAWA S G,et al.Vestibular evoked myogenic potentials show altered tuning in patients with Ménière's disease[J].Otol Neurotol,2004,25:333-338.
[23]	CONLON B J,GIBSON W P.Meniere's disease:the incidence of hydrops in the contralateral asymptomatic ear[J].Laryngoscope,1999,109:1800-1802.
[24]	SEO T,SAKA N,SAKAGAMI M.Furosemideloading vestibular evoked myogenic potential testing can suggest developing bilateral involvement of unilateral Meniere's disease[J].Acta Otolaryngol,2012,132:632-636.
[25]	TAKUMIDA M,KAKIGI A,TAKEDA T,et al.Ménière's disease:a long-term follow-up study of bilateral hearing levels[J].Acta Otolaryngol,2006,126:921-925.
[26]	KARIYA S,CUREOGLU S,FUKUSHIMA H,et al.Histopathologic changes of contralateral human temporal bone in unilateral Ménière's disease[J].Otol Neurotol,2007,28:1063-1068.
[27]	YAZAWA Y,KITAHARA M.Bilateral membranous hydrops in Menière's disease:review of temporal bone autopsies[J].Ann Otol Rhinol Laryngol,1990,99(7 Pt 1):524-528.
[28]	TAKUMIDA M,AKAGI N,ANNIKO M.Effect of inner ear blood flow changes in Ménière's model mice[J].Acta Otolaryngol,2009,129:244-253.
[29]	KAKIGI A,SALT A N,TAKEDA T.Effect of artificial endolymph injection into the cochlear duct on perilymph potassium[J].ORL J Otorhinolaryngol Relat Spec,2010,71 Suppl 1:16-18.
[30]	TAKUMIDA M,KAKIGI A,TAKEDA T,et al.Ménière's disease:a long-term follow-up study of bilateral hearing levels[J].Acta Otolaryngol,2006,126:921-925.
[31]	PEREZ R,CHEN J M,NEDZELSKI J M.The status of the contralateral ear in established unilateral Menière's disease[J].Laryngoscope,2004,114:1373-1376.
[32]	HOUSE J W,DOHERTY J K,FISHER L M,et al.Meniere's disease:prevalence of contralateral ear involvement[J].Otol Neurotol,2006,27:355-361.
[33]	BELINCHON A,PEREZ-GARRIGUES H,TENIAS J M.Evolution of symptoms in Ménière's disease[J].Audiol Neurootol,2012,17:126-132.