摘要：
Objective To explore the imaging characteristics of large vestibular aqueduct syndrome(LVAS) patients and their relationship with the acoustically evoked short latency negative response (ANSR),so as to provide reference for the diagnosis of LVAS.Methods Clinical data of 174 patients(334 ears) with LVAS diagnosed and treated by the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Guangxi Medical University,from October 2009 to December 2017 were retrospectively analyzed,including 117 males and 57 females,aged from 5 months to 47 years old,with the median age of 4 years and 4 months.ABR and imaging data of patients were collected.Midpoint diameter and the outlet diameter of the vestibular aqueduct were measured on CT images,the midpoint diameter of the intraosseous parts and the extraosseous parts of enlarged endolymphatic sac(EES) were measured on MRI images.The correlation between the above measurements was analyzed by Pearson test using SPSS 17.0.According to whether ASNR was detected in ABR,the above data were divided into two groups,and the differences of the above imaging measurements were compared by the Independent-Sample Test.Results The average midpoint diameter of the vestibular aqueduct was (1.87±0.58) mm (~ ± s,the following was the same),and the outlet diameter was (3.07±0.99) mm on CT;the average midpoint diameter of the intraosseous parts in enlarged endolymphatic sac(EES) was (2.39± 1.37) mm,and the extraosseous parts was (2.50±2.18) mm on MRI.There was a correlation between the four measurements (P＜0.05),among which the midpoint diameter of vestibular aqueduct was strongly positively correlated with the outlet diameter (r=0.760),and the remaining pairs were weakly correlated.ASNR was detected in 241 ears (72.16％,241/334) and undetected in 93 ears (27.84％,93/334) of the 334 ears with LVAS.Midpoint diameter and the outlet diameter of the vestibular aqueduct in no ASNR group were smaller than the ASNR group,and the difference was statistically significant (t value was 2.814 and 2.754,P＜0.05).There was no significant difference in the midpoint diameter of the intraosseous parts and the extraosseous parts of enlarged endolymphatic sac between the two groups,and the difference was no statistically significant(t value was 0.101 and 0.683,P＞0.05).Conclusions There is a strong positive correlation between the midpoint diameter of vestibular aqueduct and the outlet diameter in LVAS patients.There is a certain correlation between the size of vestibular aqueduct and the size of endolymphatic sac.The smaller the diameter of vestibular aqueduct,the lower the occurrence rate of ASNR.%目的 探讨大前庭水管综合征(large vestibular aqueduct syndrome,LVAS)患者的影像学特征及其与声诱发短潜伏期负反应(acoustically evoked short latency negative response,ASNR)之间的关系,为LVAS的诊断提供参考依据.方法 回顾性分析2009年10月至2017年12月期间广西医科大学第一附属医院耳鼻咽喉头颈外科诊治的174例(334耳)LVAS患者的临床资料,其中男117例、女57例,年龄5个月～47岁,中位年龄4岁4个月.收集患者听性脑干反应(ABR)以及影像学检查资料.在CT图像上测量前庭水管中点直径和前庭水管外口直径,在MRI图像上测量内淋巴囊骨内部分最大中点直径和骨外部分最大中点直径,采用SPSS 17.0软件Pearson检验分析上述测量值之间的相关性.按照ABR检查是否引出ASNR分成两组,采用独立样本t检验比较上述影像学测量值的组间差异.结果 CT前庭水管中点直径为(1.87±0.58) mm((x)±s,下同),外口直径为(3.07±0.99) mm;MRI内淋巴囊骨内部分最大中点直径为(2.39±1.37) mm,骨外部分最大中点直径为(2.50±2.18) mm;4个测量值之间均存在相关性(P值均＜0.05),其中前庭水管中点直径与外口直径呈强正相关(r=0.760),其余两两之间呈弱相关.334耳LVAS患耳中241耳(72.16％,241/334)可检测到ASNR,93耳(27.84％,93/334)未引出ASNR;未引出ASNR组患耳的前庭水管中点和外口直径均小于ASNR组,差异有统计学意义(t值分别为2.814和2.754,P值均＜0.05);两组患耳内淋巴囊骨内和骨外部分最大中点直径无明显区别,差异均无统计学意义(t值分别为0.101和0.683,P值均＞0.05).结论 LVAS患者前庭水管中点直径与外口直径呈强正相关,前庭水管大小与内淋巴囊大小之间存在一定的相关性.前庭水管直径越小,引出ASNR的概率越低.
