血-迷路屏障通透性与突聋发病机制及预后的关系:在3D real IR的发现

Relation of Blood-labyrinth Barrier Permeability to the Pathogenesis of Sudden Sensorineural Hearing Loss: Findings on Three-dimensional Real Inversion Recovery Imaging MRI

张呈辉;任芳芳;王伟韬;郝芳;冀少杰

1:郑州大学第五附属医院耳鼻喉科

摘要
目的 分析突聋患者的内耳钆造影MRI三维真实重建反转恢复(three dimensional real inversion recovery, 3D real IR)成像上的表现,探讨血-迷路屏障的通透性与突聋发病机制及其预后的关系。方法 对41例单侧突聋患者行内耳钆造影MRI,测量患耳和健耳的耳蜗信号强度,并测量延髓信号强度,分别计算出耳蜗/延髓比值(cochlear/medulla ratio, CM ratio),以CM比值作为血-迷路屏障通透性的标志物,分析突聋患者患耳、健耳CM比值的不对称程度与疗效之间的关系。结果 41例患者中,33例(80.48%)患耳的CM比值高于健耳,差异有统计学意义(P<0.05);患耳CM比值为健耳的1.5倍以下者18例,治疗有效率为77.78%(14/18);患侧CM比值不高于健侧者8例,治疗有效率为100%;达到健耳的1.5倍至1.75倍之间者7例,治疗有效率为100%(7/7);达到健耳的1.75倍至2.0倍之间者2例,治疗有效率为50%(1/2);达到健耳的2.0倍以上者14例,治疗有效率为14.28%(12/14);差异有统计学意义(P<0.05)。结论 内耳3D Real IR可显示突聋患者血-迷路屏障通透性的改变,80.48%的突聋患者患侧耳蜗出现高信号,患耳CM比值达健耳的1.75倍以上者多数预后不良。
关键词
突聋;血-迷路屏障通透性;内耳三维真实重建反转恢复成像;耳蜗/延髓比值;预后
基金项目(Foundation):
河南省重点研发与科技攻关项目(232102310164)
作者
张呈辉;任芳芳;王伟韬;郝芳;冀少杰
参考文献

1 张子豪,蒋涛.磁共振成像用于突发性聋诊断的研究进展[J].听力学及言语疾病杂志,2021,29(1):90-93.

2 Kim DS,Park DW,Kim TY,et al.Characteristic MR findings suggesting presumed labyrinthine hemorrhage[J].Acta Otolaryngol,2017,137(12):1226-1232.

3 Pakdaman MN,Ishiyama G,Ishiyama A,et al.Blood-labyrinth barrier permeability in Meniere’s disease and idiopathic sudden sensorineural hearing loss:findings on delayed postcontrast 3D-FLAIR MRI[J].AJNR,2016,37(10):1903-1908.

4 Wang JL,Ren TL,Sun WF,et al.Post-contrast 3D-FLAIR in idiopathic sudden sensorineural hearing loss[J].Eur Arch Otorhinolaryngol,2019,276(5):1291-1299.

5 Byun H,Chung JH,Lee SH,et al.The clinical value of 4-hour delayed-enhanced 3D-FLAIR MR images in sudden hearing loss[J].Clin Otolaryngol,2019,44(3):336-342.

6 Deng WT,Lin XJ,Su Y,et al.Comparison between 3D-real IR MRI sequences with visual classification method in the imaging of endolymphatic hydrops in Meniere’s disease[J].Am J Otolaryngol,2022 ,43(6):1-5.

7 Tagaya M,Yamazaki M,Teranishi M,et al.Endolymphatic hydrops and blood-labyrinth barrier in Meniere’s disease[J].Acta Otolaryngol,2011,131:474-479.

8 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头颈外科学分会.突发性聋的诊断和治疗指南(2015)[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):443-444.

9 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头颈外科分会.内耳内淋巴积水磁共振影像评估中国专家共识(2020)[J].中华耳鼻咽喉头颈外科杂志,2020,55(9):809-813.

10 Nakashima T,Naganawa S,Sugiura M,et al.Visualization of endolymphatic,hydrops in patients with Meniere’s disease[J].Laryngoscope,2007,117(3):415-420.

11 Liu Y,Zhao PJ,Zhao DH,et al,The reliability of 3T MRI in detecting endolymphatic hydrops in the Meniere’s disease and sudden sensorineural hearing loss[J].J Otol Rhinol,2015,4(6):1-4.

12 Floc’h JL,Tan W,Telang RS,et al.Markers of cochlear inflammation using MRI[J].J Magn Reson Imaging,2014,39:150-161.

13 Tarshish Y,Leschinski A,Kenna M,et al.Pediatric sudden sensorineural hearing loss:diagnosed causes and response to intervention[J].Int J Pediatr Otorhinolaryngol,2013,77(4):553-559.

14 Kikidis D,Nikolopoulos TP,Kampessis G,et al.Sudden sensorineural hearing loss:subclinical viral and toxoplasmosis infections as aetiology and how they alter the clinical course[J].ORL J Otorhinolaryngol Relat Spec,2011,73(2):110-115.

15 Zhang BY,Young YH.Geriatric sudden deafness[J].Am J Otolaryngol,2021,42(4):1-4.

16 Si JP,Jiang H,Li YY.Correlation between effectual time and the curative effect in patients with all frequency descending sudden deafness after treatment[J].Am J Otolaryngol,2020,41(5):1-3.

17 Choi HG,Min C,Kim SY.Air pollution increases the risk of SSNHL:a nested case-control study using meterorological data and national sample cohort data[J].Sci Rep,2019,9(1):1-8.

18 郭良蓉,田永胜,马荣,等.内耳道膜迷路磁共振三维快速液体衰减反转恢复序列检查在突发性聋中的应用[J].中国耳鼻咽喉头颈外科,2019,26(5):252-255.

19 Lammers M,Young E,Fenton D,et al.The prognositic value and pathophysiologic significance of three-dimensional fluid-attenuated inversion recovery ( 3D-FLAIR ) magnetic resonance imaging in idiopathic sudden sensorineural hearing loss:a systematic review and meta-analysis[J].Clin Otolaryngol,2019,44(6):1017-1025.

20 Ryu IS,Yoon TH,Ahn JH,et al.Three-dimensional fluid- attenuated inversion recovery magnetic resonance imaging in sudden sensorineural hearing loss:correlations with audiologic and vestibular testing[J].Otol Neurotol,2011,32(8):1205-1209.

21 王明明,孔晓,胡娜,等.内耳血迷路屏障变化与突发性聋患者临床特征及预后的相关性分析[J].中华耳鼻咽喉头颈外科杂志,2022,57(8):937-942.

22 杨安妮,李琦,李湘平.突发性聋预后研究进展[J].中华耳科学杂志,2021,19(2):306-310.