4DCT在咽鼓管功能障碍患者咽鼓管功能评估中的应用

目的　通过4DCT（four-dimensional CT）动态评估咽鼓管功能障碍（Eustachian tube dysfuction，ETD）患者Valsava动作时的咽鼓管（Eustachian tube，ET）功能。方法　2018年11月～2019年3月期间就诊于首都医科大学附属北京安贞医院的ETD患者15例，无中耳疾病的志愿者15名。使用咽鼓管测压（tubomanometry，TMM），七项咽鼓管功能障碍评分量表（the seven-item Eustachian tube dysfunction questionnaire，ETDQ-7）和咽鼓管评分量表-7（the Eustachian tube score-7，ETS-7）等方法对所有对象咽鼓管功能做初步评价。嘱患者做Valsava动作，行ADCT动态扫描，记录ET开放过程，重建图像。测量ET数值，判断阻塞部位，进行统计学分析。结果　正常对照组可观察到ET全长，ETD组均有不同程度的阻塞。ETD组ET长度和角度显著大于对照组（44.41±2.21）mm vs（40.60±2.20）mm，P＜0.01；（168.73±4.66）mm vs（162.88±5.44）mm，P <0.01]，前鼓室部直径显著小于对照组（3.5±0.8）mm vs（5.3±1.1）mm，P <0.001]。结论　ET长度越长、角度越大，越容易发生ETD。ADCT动态扫描可准确评估ETD患者ET阻塞部位，对咽鼓管球囊扩张术适应证具有指导意义，辐射剂量低，可作为ET常规检查方法。

Evaluation of Eustachian tube function in patients with Eustachian tube dysfunction using a four-dimensional CT scanner

OBJECTIVE To evaluate the Eustachian tube(ET)function during Valsava maneuver in patients with Eustachian tube dysfunction(ETD)using four-dimensional CT(4DCT).METHODS Fifteen patients with ETD and fifteen healthy volunteers were admitted to Beijing Anzhen Hospital from November 2018 to March 2019.A preliminary evaluation of the ET function was performed on all subjects using TMM,ETDQ-7,and ETS-7.The 4DCT was used for dynamic scanning.Patients performed Valsava maneuver during the scanning process and the whole opening process of the ET were recorded and reconstructed at intervals of 0.1s.MPR(multi-planar reconstruction technique)was used for reconstruction by Vitrea workstation.The ET angle,length,curvature,the pretympanic diameter were measured.The site of the ET obstruction and the maximum part of the patency were determined.The t-test and correlation analysis were used to compare the function of the ET between different groups.RESULTS The full length of ET could be observed in the normal control group,and there were different degrees of obstruction in the ETD group.In the ETD group,10(93.3%)obstruction site was in the cartilaginous portion and one in the isthmus portion.The ETl and ETαin the ETD group was significantly greater than that in the control group(44.41±2.21)mm vs(40.60±2.20)mm,P<0.01;(168.73±4.66)mm vs(162.88±5.44)mm,P<0.01].The pretympanic diameter in the ETD group was significantly shorter than that of the control group(3.5±0.8)mm vs(5.3±1.1)mm,P<0.001].CONCLUSION The longer the ET length,the greater the ET angle,the more susceptive it is to develop ETD.4DCT dynamic scanning can accurately assess the site of ET obstruction in ETD patients,thus it can offer guidance for balloon dilatation eustachian tuboplasty.Since the radiation dose is lower than that of the general head scan,4DCT can be used as a routine examination method for ET function.