摘要目的 探讨高分辨率CT(high-resolution CT,HRCT)检查在慢性化脓性中耳炎及胆脂瘤中耳炎软组织分型中的诊断价值.方法 对120例153耳慢性化脓性中耳炎和胆脂瘤中耳炎患者行HRCT检查,以原始轴位图像为基础,分别行轴位、冠状位多平面重建(multiplanar reconstructtion,MPR)及最大密度投影(maximum intensity projiection,MIP),观察软组织生长特点、窗宽窗位对软组织显影的影响、邻近主要解剖结构改变情况并与手术结果进行对比.结果 120例153耳中经HRCT诊断为胆脂瘤中耳炎109耳,其中27耳合并肉芽组织;慢性化脓性中耳炎44耳,其中合并肉芽组织形成33耳,仅有分泌物11耳.术后诊断为胆脂瘤中耳炎107耳,其中25耳合并肉芽组织;慢性化脓性中耳炎46耳,其中35耳合并肉芽组织,仅有分泌物11耳.HRCT诊断胆脂瘤中耳炎和慢性化脓性中耳炎的符合率为98.6%,对胆脂瘤、肉芽组织、分泌物诊断的约登指数分别为0.98、0.98、1.00.结论 HRCT轴位、冠状位MPR及MIP图像相结合对慢性化脓性中耳炎软组织诊断分型具有重要的价值,可常规应用于慢性化脓性中耳炎及胆脂瘤中耳炎的鉴别诊断,并制定相应手术计划.

abstractsObjective To evalute the efficacy of high-resolution CT(HRCT) in differential diagnosis and treatment of chronic suppurative otitis media and cholesteatoma otitis media by soft-tissue shadows. Methods HRCT scanning was performed in 120 cases, 153 ears, with chronic otitis suppurative media and cholesteatoma otitis media, of which original data were processed with multi-planar reconstructtion (MPR) and maximum intensity projection ( MIP) , the characteristics of the soft-tissue shadows' growth, window width or window leveling and bony destruction were respectively observed, as well as compared with the surgery findings. Results In 120 patients (133 ears), 109 ears were diagnosed as cholesteatoma otitis media, and 44 ears were diagnosed as chronic suppurative otitis media, among which 33 ears had granulation tissue and 11 ears had secretion. One hundred and seven ears were postoperatively diagnosed as cholesteatoma otitis media, among which 25 ears had granulation tissue. Among 46 ears of chronic suppurative otitis media, 35 ears had granulation tissue, and only 11 ears had secretion. A 98. 6% diagnostic accuracy can be reached with HRCT in diagnosing cholesteatoma otitis media and chronic suppurative otitis media. The Youden's index was 0. 98, 0. 98 and 1. 00 respectively with HRCT in diagnosing cholesteatoma, granulation tissue and secretion. Conclusions Combination of the three different imaging methods, axial images, coronal MPR images and MIP images, can improve the efficacy of the HRCT diagnosis and definite chronic otitis media, which can be routinely used for surgery plan.