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摘要: 目的 探究锥形束计算机断层扫描(CBCT)在颞骨细微结构测量的可行性及正常值范围。方法 15例福尔马林浸泡固定的人类尸头标本分别行CBCT、高分辨率CT、Micro CT扫描，对包括听骨链、耳蜗、半规管及面神经等在内的中内耳结构进行形态学测量，比较三种扫描方法所测结果间差异。结果 三种不同CT扫描所测参数组间对比除镫骨底板厚度(P < 0.01)及耳蜗底周管径(P < 0.01)外，余差异均无统计学意义。CBCT对面神经骨管缺损具有较好的诊断价值。结论 CBCT扫描时间短，辐射剂量小，成像质量高，能较准确地显示颞骨内各精细结构的形态特点，是耳科影像学的可靠评估方法。
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关键词:
- 锥形束计算机断层扫描 /
- 多平面重建 /
- 颞骨
Abstract: Objective To identified the feasibility and normal range of cone beam computer tomography(CBCT) in the measurement of temporal bone.Methods 15 formalin fixed human cadaver head specimens were scanned by CBCT, high resolution CT, and Micro CT, respectively. Morphological parameter measurements of the middle and inner ear structures including ossicular chain, cochlea, semicircular canal and facial nerve were performed, and the results measured by the three scanning methods were compared.Results None of the parameters measured by the three scanning methods were statistically significant except the thickness of stapes footplate(P < 0.01) and the diameter of cochlear basal turn(P < 0.01). CBCT was superior in detecting facial nerve bony canal dehiscence.Conclusion CBCT has the advantages of short scanning time, low radiation dose and high resolution. It can accurately display the morphological characteristics of the temporal bone structures, and is a reliable evaluation method for otological surgery. -
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表 1 不同CT扫描方法测得锤、砧、镫骨及面神经变异情况 x±s
部位 Micro CT CBCT HRCT P 锤骨柄长度/mm 4.40±0.22 4.47±0.37 4.38±0.27 >0.05 锤骨头长径/mm 3.33±0.20 3.33±0.14 3.38±0.18 >0.05 锤骨头宽径/mm 2.26±0.19 2.30±0.12 2.32±0.14 >0.05 砧骨长脚长度/mm 3.90±0.25 3.86±0.15 3.88±0.17 >0.05 砧骨短脚长度/mm 2.32±0.21 2.38±0.21 2.40±0.24 >0.05 砧骨长短脚夹角/(°) 116.72±2.63 116.63±1.16 116.18±1.69 >0.05 砧骨长脚下缘至底板距离/mm 3.66±0.24 3.70±0.15 3.70±0.10 >0.05 镫骨底板厚度/mm 0.29±0.05 0.38±0.04 0.44±0.04 < 0.01 镫骨底板长度/mm 2.57±0.25 2.61±0.16 2.57±0.17 >0.05 镫骨前后弓距离/mm 1.78±0.25 1.73±0.12 1.72±0.10 >0.05 砧镫关节角度/(°) 94.79±2.89 95.32±2.04 94.75±1.81 >0.05 面神经前膝角/mm 83.94±4.41 83.98±1.61 83.23±1.91 >0.05 面神经迷路段长/mm 2.80±0.24 2.75±0.24 2.83±0.27 >0.05 面神经鼓室段长/mm 10.27±0.25 10.12±0.32 10.25±0.23 >0.05 面神经后膝角/(°) 126.47±3.31 126.91±0.95 126.81±1.07 >0.05 与鼓索神经夹角/(°) 26.77±1.89 26.21±1.57 26.23±1.09 >0.05 
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表 2 不同CT扫描方法测得耳蜗、前庭、半规管变异情况
mm，x±s 部位 Micro CT CBCT HRCT P 耳蜗底周长径 8.85±0.55 8.86±0.54 8.85±0.49 >0.05 耳蜗底周宽径 6.64±0.43 6.52±0.32 6.57±0.38 >0.05 耳蜗底周管径 2.02±0.15 1.95±0.18 1.66±0.15 < 0.01 耳蜗底周上半周宽度 7.14±0.28 7.02±0.26 7.09±0.40 >0.05 耳蜗底转高度 2.07±0.15 2.07±0.10 2.04±0.14 >0.05 耳蜗中周高度 2.99±0.21 2.95±0.11 2.97±0.17 >0.05 耳蜗高度 3.68±0.19 3.64±0.18 3.63±0.23 >0.05 前庭长径 4.45±0.35 4.34±0.26 4.36±0.20 >0.05 前庭宽径 2.77±0.43 2.73±0.36 2.72±0.35 >0.05 上半规管高度 6.00±0.18 6.13±0.39 6.14±0.38 >0.05 上半规管宽度 5.88±0.32 5.92±0.18 5.86±0.32 >0.05 上半规管内径 0.92±0.12 0.96±0.07 0.98±0.05 >0.05 后半规管高度 5.45±0.65 5.47±0.54 5.43±0.68 >0.05 后半规管宽度 4.80±0.51 4.93±0.45 4.99±0.48 >0.05 后半规管内径 1.13±0.13 1.09±0.07 1.10±0.11 >0.05 外半规管高度 3.74±0.61 3.83±0.49 3.87±0.32 >0.05 外半规管宽度 3.42±0.30 3.43±0.61 3.49±0.28 >0.05 外半规管内径 1.17±0.12 1.16±0.12 1.14±0.06 >0.05
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表 3 CBCT和HRCT对面神经骨管完整性的判断
CT 敏感性/% 特异性/% 约登指数 Kappa值 P CBCT 70.0 94.7 0.647 0.680 >0.05 HRCT 50.0 94.7 0.447 0.485 >0.05
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