术前颞骨HRCT联合内耳MR在人工耳蜗植入患儿中的应用

武林; 贾慧惠; 陈萌萌; 顾维; 王爱平

doi:10.16766/j.cnki.issn.1674-4152.004342

术前颞骨HRCT联合内耳MR在人工耳蜗植入患儿中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004342

苏州大学附属儿童医院放射科，江苏苏州 215000

基金项目:

江苏省科技计划项目 BK20220734

详细信息

通讯作者:
王爱平，E-mail：69020765@qq.com

中图分类号: R764.431 R814.42
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- 文章访问数: 12
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出版历程
- 收稿日期: 2025-03-23
- 网络出版日期: 2026-04-01

Preoperative HRCT of temporal bone combined with inner ear MRI in patients with cochlear implantation

Department of Radiology, Children' s Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215000, China

摘要

摘要: 目的针对重度感音神经性耳聋患儿人工耳蜗植入术(CI)中解剖结构复杂、电极植入风险高的临床难点，探讨术前颞骨高分辨率CT(HRCT)与内耳MRI多模态影像联合评估的应用价值，为优化手术方案、降低并发症风险提供影像学依据。方法选取苏州大学附属儿童医院2021年1月—2024年12月行CI治疗的重度或极重度感音神经性耳聋患儿192例(215患耳)，对患儿行颞骨HRCT、内耳MR检查。比较2种方法对内耳畸形的诊断效能，以及电极植入异常情况；采用单因素和logistic回归分析研究电极植入异常的危险因素。结果 192例(215耳)患儿中内耳发育畸形共140例(159耳)，部分单侧畸形耳合并多种畸形；内耳MRI检查耳蜗畸形检出率低于颞骨HRCT(P＜0.05)。经颞骨HRCT联合内耳MRI检查，有29耳电极植入异常，其中不伴内耳畸形植入异常率为5.36%(3/56)，低于伴内耳畸形的16.35%(26/159，P＜0.05)。Logistic多因素回归分析结果显示，前庭导水管宽度较高、面神经管迷路段缺失率较高、内淋巴囊扩大程度较高、术中脑脊液压力水平较高、患儿年龄较大是电极植入异常的独立危险因素(P＜0.05)。结论术前颞骨HRCT联合内耳MRI可客观显示患儿内耳发育情况及解剖结构，且前庭导水管宽度、面神经管迷路段完整性、内淋巴囊扩大程度、术中脑脊液压力是电极植入异常的独立影响因素。
- 神经性耳聋 /
- 颞骨高分辨率CT /
- 内耳MR /
- 人工耳蜗植入
Abstract: Objective To address the clinical difficulties of complex anatomical structure and high risk of electrode implantation in children with severe sensorineural deafness during cochlear implantation, and to explore the application value of a combined assessment using high-resolution temporal bone CT (HRCT) and multimodal inner ear MRI before surgery, thereby providing imaging evidence for optimizing surgical planning and reducing the risk of complications. Methods A total of 192 children (215 affected ears) with severe or profound sensorineural deafness who underwent surgical CI treatment at the Children' s Hospital Affiliated to Soochow University from January 2021 to December 2024 were selected. All patients underwent temporal bone HRCT and inner ear MRI examinations. The diagnostic efficacy of the two methods for detecting inner ear malformations and abnormal electrode implantation were compared. Univariate and Logistic regression analyses were used to analyze the risk factors associated with abnormal electrode implantation. Results Among the 192 cases (215 ears) of children, a total of 140 cases (159 ears) had inner ear developmental malformations, with some unilateral malformed ears presenting with multiple malformations. The detection rate of cochlear malformation identified by inner ear MRI was significantly lower than that by HRCT of the temporal bone (P < 0.05). Transtemporal bone HRCT combined with inner ear MRI examination identified abnormal electrode implantation in 29 ears. Among them, the abnormal implantation rate without inner ear deformity was 5.36% (3/56), which was significantly lower than that in ears with inner ear deformity (16.35%, 26/159, P < 0.05). Logistic multivariate regression analysis showed that increased width of vestibular aqueduct, loss of the labyrinthine segment of the facial nerve canal, greater endolymphatic cyst expansion, elevated intraoperative cerebrospinal fluid pressure level, and older patient age were independent risk factors for abnormal electrode implantation (P < 0.05). Conclusion Preoperative temporal bone HRCT combined with inner ear MRI can objectively depict the development and anatomical structure of the inner ear in children. Moreover, the width of vestibular aqueduct, the integrity of the labyrinthine segment of the facial nerve canal, the degree of the endolymphatic sac enlargement, and the intraoperative cerebrospinal fluid pressure are independent risk factors for abnormal electrode implantation.
- Sensorineural deafnessi /
- High-resolution temporal bone CT /
- Inner ear MRI /
- Cochlear implantation

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图 1 双侧耳蜗与前庭形态异常及内淋巴囊扩大表现

注：右侧耳蜗似见蜗神经进入，左侧外耳道外侧端未见蜗神经显示；双侧耳蜗偏小、前庭偏大；双侧内淋巴囊明显扩大。

Figure 1. Abnormalities in the morphology of both cochleas and vestibules, as well as enlargement of the endolymphatic sacs

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图 2 双侧前庭导水管扩大及相关结构异常表现

注：双侧前庭导水管扩大；双侧耳蜗顶圈、中圈骨性分隔显示欠清；双侧蜗神经孔未见明显显示；右侧颈静脉球高位。

Figure 2. Dysplasia of bilateral vestibular aqueducts and associated structural abnormalities

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图 3 右侧耳蜗发育不良及相关结构异常表现

注：右侧耳蜗发育不良，蜗神经孔未见；右侧内听道狭窄。

Figure 3. Abnormal development of the right cochlea and associated structural abnormalities

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表 1 颞骨HRCT和内耳MRI对内耳畸形的检查状况

Table 1. The examination status of inner ear malformations using temporal bone HRCT and inner ear MRI

畸形类型	影像学表现	患耳(耳)
耳蜗畸形	Michel畸形(迷路完全未发育)	2
	共同腔畸形(耳蜗与前庭融合成-囊腔)	5
	耳蜗完全未发育	8
	耳蜗发育不全	9
	不完全分隔Ⅰ型即耳蜗与前呈囊状	5
	不完全分隔Ⅱ型即Mondini畸形	13
	蜗神经孔狭窄	4
前庭畸形	Michel畸形(前庭与耳蜗)	2
	共同腔畸形(耳蜗前融合成一囊腔)	4
	前庭扩大畸形	10
	前庭发育不全	2
半规管发育畸形	半规管缺如	6
	半规管发育不全	11
	半规管扩大	4
内听道畸形	内听道狭窄(＜3 mm)	9
	内听道扩大(＞7 mm)	5
	重复畸形	3
听神经畸形	耳蜗神经缺如	12
	耳蜗神经发育不良	8
面神经位置异常	面神经鼓室段低位	7
	面神经神经段向前移	3
前庭导水管畸形		27

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表 2 颞骨HRCT和内耳MRI内耳畸形检出率比较[耳(%)]

Table 2. Comparison of the detection rate of inner ear malformations by temporal bone HRCT and inner ear MRI[ear(%)]

内耳畸形分类	耳数	颞骨HRCT检查检出	内耳MRI检查检出	χ²值	P值
耳蜗畸形	46	32(69.57)	27(58.70)	4.122	0.042
前庭畸形	18	11(61.11)	14(77.78)	2.333	0.127
半规管畸形	21	10(47.62)	12(57.14)	0.043	0.835
内听道畸形	17	4(23.53)	6(35.29)	2.579	0.108
前庭导水管畸形	27	15(55.56)	20(74.07)	2.000	0.157
听神经畸形	20	0	19(95.00)	0.026	0.873
面神经位置异常	10	0	8(80.00)	0.222	0.637

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表 3 重度或极重度感音神经性耳聋患儿CI术后电极植入异常情况[耳(%)]

Table 3. Abnormal conditions of electrode implantation in children with severe or extremely severe sensorineural deafness after CI surgery[ear(%)]

组别	耳数	位置异常	未完全植入	形态异常	总发生
不伴内耳畸形	56	0	0	3(5.36)	3(5.36)
伴内耳畸形	159	2(1.26)	14(8.81)	10(6.29)	26(16.35)
注：2组总发生率比较，χ²=4.290，P=0.038。

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表 4 内耳畸形电极植入风险单因素分析

Table 4. Univariate analysis of the risk of electrode implantation for inner ear malformations

组别	耳数	年龄(x±s，岁)	前庭导水管宽度[耳(%)]	面神经管迷路段缺失[耳(%)]	内淋巴囊扩大[耳(%)]	术中脑脊液压力(x±s，mmH₂O)
异常组	26	4.15±1.21	18(69.23)	12(46.15)	15(57.69)	12.47±3.12
正常组	133	3.19±1.07	45(33.83)	18(13.53)	32(24.06)	9.81±2.45
统计量		4.094^a	11.390^a	15.117^b	11.815^b	4.826^a
P值		＜0.001	0.001	＜0.001	0.001	＜0.001
注：^a为t值，^b为χ²值。1 mmH₂O=0.098 kPa。

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表 5 内耳畸形电极植入风险的多因素logistic回归分析

Table 5. Multivariate logistic regression analysis of the risk of electrode implantation for inner ear deformities

变量	B	SE	Waldχ²	P值	OR值	95% CI
前庭导水管扩大	1.289	0.579	4.95	0.026	3.629	1.166~11.295
面神经管迷路段缺失	1.355	0.604	5.038	0.025	3.876	1.187~12.652
内淋巴囊扩大	1.267	0.563	5.054	0.025	3.549	1.176~10.709
术中脑脊液压力	0.362	0.110	10.901	0.001	1.436	1.159~1.781
患儿年龄	0.784	0.277	8.042	0.005	2.191	1.274~3.768

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