The value of HRCT in predicting cerebrospinal fluid gusher during cochlear implantation
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摘要: 目的 探讨颞骨高分辨率CT(HRCT)多平面重组对内耳畸形患者人工耳蜗植入术中脑脊液井喷的预测价值。方法 回顾性分析33例(36耳)行CI内耳畸形患者的临床资料，评估其对CI中脑脊液井喷的预测价值。结果 蜗孔宽度(P=0.024，OR=1.735)、内听道底上下径(P=0.022，OR=6.119)是内耳畸形患者CI中脑脊液井喷的独立危险因素。蜗孔宽度预测术中井喷的AUC=0.851，敏感度为93.33%，特异度为61.90%；内听道底上下径预测术中井喷的AUC=0.848，敏感度为80.00%，特异度为80.95%；蜗孔宽度联合内听道底上下径预测术中井喷的AUC=0.930，敏感度为80.00%，特异度为95.24%。结论 基于颞骨HRCT的蜗孔宽度联合内听道底上下径预测模型对内耳畸形患者CI中“井喷”具有重要预测价值。Abstract: Objective To investigate the predictive value of temporal bone high-resolution CT(HRCT) multiplanar reconstruction(MPR) for cerebrospinal fluid(CSF) gusher during cochlear implantation in patients with inner ear malformation.Methods The clinical data of 33 patients(36 ears) with inner ear malformation who underwent cochlear implantation were retrospectively analyzed. The predictive value of HRCT for cerebrospinal fluid gusher during cochlear implantation was evaluated.Results The width of the cochlear foramen(P=0.024, OR=1.735) and the diameter of the inner auditory meatus(P=0.022, OR=6.119) were independent risk factors for CSF gusher during cochlear implantation. The area under the curve(AUC) of cochlear foramen width in predicting intraoperative gusher was 0.851, the sensitivity was 93.33%, and the specificity was 61.90%. The AUC of the upper and lower diameter of the internal auditory canal for predicting intraoperative gusher was 0.848, the sensitivity was 80.00%, and the specificity was 80.95%. The AUC of cochlear foramen width combined with the upper and lower diameters of the internal auditory meatus for predicting intraoperative gusher was 0.930, the sensitivity was 80.00%, and the specificity was 95.24%.Conclusion Based on temporal bone HRCT, the prediction model of cochlear foramen width combined with the upper and lower diameter of the internal auditory canal has crucial predictive value for the "gusher" during cochlear implantation in patients with inner ear malformation.
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表 1 井喷组与对照组内耳测量指标比较
测量指标/mm 井喷组(n=15) 非井喷组(n=21) P 蜗孔宽度 2.58±0.33 1.96±0.50 ＜0.001 内听道长度 9.52±2.24 8.86±2.06 0.365 内听道口径 7.76±1.56 7.09±1.97 0.286 内听道宽度 5.29±1.35 4.84±1.26 0.312 内听道底上下径 4.91±1.53 3.30±0.84 ＜0.001 内听道底前后径 4.81±1.02 3.98±0.96 0.018 前庭水管宽度 1.54±0.97 1.04±1.14 0.182 耳蜗水管口径 1.83±0.67 1.77±1.27 0.860 
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表 2 CI中脑脊液井喷相关危险因素的多因素分析
预测因素 回归系数 标准误 P OR OR(95% CI) 下限 上限 蜗孔宽度 0.551 0.245 0.024 1.735 1.074 2.803 内听道上下径 1.811 0.789 0.022 6.119 1.303 28.728 内听道前后径 0.652 0.747 0.382 1.920 0.444 8.294
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表 3 不同内耳测量指标对预测CI中脑脊液井喷的效能比较
指标 AUC(95% CI) 最佳截断值 敏感度/% 特异度/% 阳性预测值/% 阴性预测值/% P 蜗孔宽度 0.851(0.729~0.972) 2.13 93.33 61.90 66.7 76.2 ＜0.001 内听道底上下径 0.848(0.719~0.976) 3.71 80.00 80.95 66.7 90.5 ＜0.001 蜗孔宽度联合内听道底上下径 0.930(0.850~1.000) 0.58 80.00 95.24 80.0 90.5 ＜0.001
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