Value of CT plain scan and reconstruction in the diagnosis of ossicular chain lesions
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摘要:
目的探讨CT平扫及CT重建技术（包括容积重建和多平面重建）诊断听骨链病变的价值。 方法回顾分析2017年10月~ 2018年12月我院收治的120例患有听骨链病变的患者的临床资料，男性70例，女性50例，年龄19~66岁（40.11±13.02岁）。将CT平扫检查及CT重建技术所得的图像进行讨论和分析；应用Kappa评价方法对CT进行诊断一致性的分析，对比经CT平扫轴位、冠状位影像和CT重建技术影像对听骨链病变的诊断准确性、敏感性和特异性。 结果CT检查听骨链病变结构与术中对照符合率较高，其中砧骨的Kappa值超过0.75，锤骨、镫骨上部结构、锤砧关节、砧镫关节的Kappa值均超过0.40，显示CT对上述病变诊断的一致性较好。经CT平扫轴位、冠状位影像对听骨链病变的诊断灵敏性、特异性和准确性分别为85.00%、84.17%、86.67%，CT重建技术影像对听骨链病变的诊断灵敏性、特异性和准确性分别为88.33%、87.50%、89.17%。两者比较差异无统计学意义（P>0.05）；CT平扫轴位、冠状位影像联合CT重建技术影像对听骨链病变的诊断灵敏性、特异性和准确性分别为98.33%、98.33%、99.17%，明显高于单一的CT平扫轴位、冠状位影像或CT重建技术（P < 0.05）。 结论采用CT平扫检查和CT重建技术均可有效显示听骨链病变的影像学特点，但两者联合可以更有效的提高听骨链病变的诊断灵敏性、特异性和准确性，值得临床上广泛应用。 Abstract:ObjectiveTo explore the value of CT plain scan and CT reconstruction (including volume reconstruction and multiplanar reconstruction) in the diagnosis of ossicular chain lesions. MethodsThe clinical data of 120 patients with ossicular chain lesions admitted to the author's hospital from October 2017 to December 2018 were retrospectively analyzed. The images of CT plain scan and CT reconstruction were discussed and analyzed. The Kappa evaluation was used to analyze the consistency of CT diagnosis. The diagnostic accuracy, sensitivity and specificity of axial and coronal images in CT plain scan and the CT reconstruction images for ossicular chain lesions were compared. ResultsCoincidence rate of CT reconstruction with the intraoperative results in the diagnosis of the structure of the ossicular chain lesion was higher. The Kappa value of the anvil exceed 0.75, and the Kappa value of the malleus, topside structure of stapes, incudomalleolar joint, and ankle joint all exceed 0.40. CT had good consistency in the diagnosis of the above lesions. The diagnostic sensitivity, specificity and accuracy of axial and coronal images in CT plain scan for ossicular chain lesions were 85.00%, 84.17% and 86.67%, respectively. The sensitivity, specificity and accuracy of CT reconstruction in the diagnosis of ossicular chain lesions were 88.33%, 87.50% and 89.17%, respectively. The difference was not significant (P>0.05). The sensitivity, specificity and accuracy of axial and coronal images in CT plain scan combined with CT reconstruction were 98.33%, 98.33% and 99.17% respectively, which were significantly higher than those of axial and coronal images in CT plain scan and CT reconstruction techniques alone in the diagnosis of ossicular chain lesions (P < 0.05). ConclusionCT plain scan and CT reconstruction can effectively display the imaging characteristics of ossicular chain lesions. But the combination of the two techniques can effectively improve the sensitivity, specificity and accuracy in the diagnosis of ossicular chain lesions. -
图 1 男，24岁，听骨链病变CT表现
Figure 1. Male, 24 years old, CT expression of ossicular chain lesion
表 1 术中CT对听骨链病变结构的显示(n)
Table 1. Display of CT structure of ossicular chain lesion during operation
术中所见 CT检查 Kappa 完整 异常 锤骨 完整 25 19 0.497 破坏 24 52 砧骨 完整 28 19 0.839 破坏 20 53 镫骨上部结构 完整 32 23 0.665 破坏 19 46 锤砧关节 完整 34 23 0.501 破坏 20 43 砧镫关节 完整 33 25 0.692 破坏 19 43 
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表 2 不同影像对听骨链病变的诊断灵敏性、特异性、准确性比较[n (%), n=120]
Table 2. Comparison of sensitivity, specificity and accuracy of different images in the diagnosis of ossicular chain lesions
成像方式 灵敏性 特异性 准确性 CT平扫轴位、冠状位影像 102 (85.00) 101 (84.17) 104 (86.67) 重建技术影像 106 (88.33) 105 (87.50) 107 (89.17) CT平扫轴位、冠状位影像联合重建技术影像 118 (98.33)*# 118 (98.33)*# 119 (99.17)*# *P < 0.05 vs CT平扫轴位、冠状位影像; #P < 0.05 vs重建技术影像.
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