人工耳蜗植入术后CT影像学评估的临床价值及进展

doi:10.3969/j.issn.1674-8115.2023.12.001

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (12): 1463-1469.doi: 10.3969/j.issn.1674-8115.2023.12.001

• 前沿述评 •

人工耳蜗植入术后CT影像学评估的临床价值及进展

顾文汐¹^,²^,³(), 贾欢¹^,²^,³, 吴皓¹^,²^,³()

^1.上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科，上海 200011
^2.上海市耳鼻疾病转化医学重点实验室，上海 200125
^3.上海交通大学医学院耳科学研究所，上海 200125

收稿日期:2023-08-30 接受日期:2023-11-07 出版日期:2023-12-28 发布日期:2024-02-01
通讯作者: 吴皓 E-mail:GU_Wenxi@icloud.com;wuhao@shsmu.edu.cn
作者简介:顾文汐（1996—），女，博士生；电子信箱：GU_Wenxi@icloud.com。
基金资助:
上海市耳鼻疾病转化医学重点实验室(14DZ2260300);上海交通大学医学院转化医学协同创新项目(TM202011);上海交通大学医疗机器人研究院项目(IMR-NPH202001);上海市临床重点专科建设项目(shslczdzk00802);上海申康医院发展中心临床创新三年行动计划(SHDC2020CR1044B)

Clinical values and advances in computed tomography evaluation after cochlear implantation

GU Wenxi¹^,²^,³(), JIA Huan¹^,²^,³, WU Hao¹^,²^,³()

^1.Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
^2.Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200125, China
^3.Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China

Received:2023-08-30 Accepted:2023-11-07 Online:2023-12-28 Published:2024-02-01
Contact: WU Hao E-mail:GU_Wenxi@icloud.com;wuhao@shsmu.edu.cn
Supported by:
Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases(14DZ2260300);Translational Medicine Collaborative Innovation Project of Shanghai Jiao Tong University School of Medicine(TM202011);Project of Institute of Medical Robotics of Shanghai Jiao Tong University(IMR-NPH202001);Shanghai Key Clinical Specialty Construction Project(shslczdzk00802);Three-year Action Plan for Clinical Innovation of Shanghai Hospital Development Center(SHDC2020CR1044B)

摘要/Abstract

摘要：

人工耳蜗植入术是治疗重度及极重度感音神经性聋的儿童和成人患者的主要手段。电极在耳蜗内的位置是影响术后听力言语康复效果的重要因素之一，术后残余听力的保存与电极植入过程中对内耳结构的损伤程度密切相关，适当的植入深度和理想的电极位置对于良好的频率识别至关重要。植入后的影像学检查包括X线片和计算机断层扫描术（computed tomography，CT）。相比X线片，CT具有三维成像的优势。通过植入术后的CT影像学检查和评估，能够明确电极的完整程度，有助于确保手术的安全性和辅助术后调机或故障分析。基于CT影像学的三维重建方法让电极位置的评估更加直观和准确，有助于判断植入过程对于内耳精细结构损伤的程度，分析对听觉、言语预后的影响。人工耳蜗植入后的CT影像学评估在推动电极设计、改进柔手术技巧、推广机器人或手术导航等新手段的应用等方面功不可没，越来越受到有关研究者的关注。该文就人工耳蜗植入术后CT影像学评估的临床应用价值和技术进展等进行述评。

关键词: 人工耳蜗植入术, 计算机断层扫描术, 多平面重建, 三维融合重建

Abstract:

Cochlear implantation has been a standard rehabilitation for children and adult patients with severe to profound sensorineural deafness. The intracochlear localization of the electrode array is one of the key factors related to the postoperative auditory and speech outcomes. Preservation of the residual hearing is related to the trauma to the inner ear structures caused in the insertion process. Optimal insertion depth and positioning of the electrode array is important for frequency discrimination. The post-operative position of the electrode array is evaluated by using plain X ray or computed tomography (CT). Compared to the plain X ray, CT produces three-dimensional (3D) imaging. With the application of post-operative CT evaluation, the integrity of the electrode array can be verified for surgical safety and improving programming accuracy. Different 3D reconstruction techniques and methods based on the post-operative CT imaging have been proposed to facilitate the precise recognition of position of each electrode, thus helpful to evaluate the possible insertion trauma to inner ear structures and the potential effect on auditory and speech outcomes. The post-operative CT evaluation has helped the electrode array design, brought progress to the soft surgery procedure and promoted new technologies such as robotic surgery and navigation. Therefore, it is getting more and more attention. This article reviews the clinical application values and the progress of techniques in post-operative CT evaluation of cochlear implantation.

Key words: cochlear implantation, computed tomography (CT), multiplanar reconstruction, 3D fusion reconstruction

中图分类号:

R764.35

顾文汐, 贾欢, 吴皓. 人工耳蜗植入术后CT影像学评估的临床价值及进展[J]. 上海交通大学学报（医学版）, 2023, 43(12): 1463-1469.

GU Wenxi, JIA Huan, WU Hao. Clinical values and advances in computed tomography evaluation after cochlear implantation[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(12): 1463-1469.

图/表 3

图1 利用影像浏览器中的3D MPR模式分析人工耳蜗电极植入深度角Note： A. Sagittal view; the blue line passing the cochlear turn at 90° and 270°. B. Axial view; the blue line passing the center of round window (0?) and cochlear turn at 180?; an extra-cochlear electrode (red arrow). C. Coronal view showing the full length of the electrode array; insertion depth angle of the electrode array was 348? with the center of the axes at the center of the cochlea modiolus. Black arrow—the most apical electrode; RW—round window.

Fig 1 Insertion depth angle determined by the 3D MPR mode in medical image viewers

图2 影像浏览器中分析电极相对于基底膜的位置Note： A. Electrodes in the scala tympani. B. Electrodes in the scala vestibuli. C. Unable to determine the electrode array positioning. The red dotted lines mark the basal turns of cochlea and the blue dotted lines mark the middle of the basilar turns, i.e., the basal membranes. When the electrodes were above the blue line, they were supposed to be in the scala vestibuli; when they were below the blue line, they were supposed to be in the scala tympani.

Fig 2 Analysis of the electrode arrays positioning relative to the basilar membrane in medical image viewers

图3 自创三维融合重建软件分析电极在耳蜗内的具体位置Note：3D model of the electrode array and basilar membrane constructed by using a reconstruction fusion software is shown in the right below part. The electrode array (in blue) was fully under the basilar membrane (in red), suggesting a complete scala tympani insertion.

Fig 3 Analysis of the electrode array positioning relative to the basilar membrane by the self-created 3D reconstruction fusion software

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人工耳蜗植入术后CT影像学评估的临床价值及进展

Clinical values and advances in computed tomography evaluation after cochlear implantation

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