El-Badry Mohamed M, Osman Nasr M, Mohamed Haytham Mamdouh, Rafaat Fatma M
Otolaryngology Department, Audiology Unit, Minia University, Minia, Egypt.
Radiology Department, Minia University, Minia, Egypt.
Int J Pediatr Otorhinolaryngol. 2016 Feb;81:84-91. doi: 10.1016/j.ijporl.2015.12.012. Epub 2015 Dec 30.
The main objective of the current work is to increase the sensitivity of the radiological diagnosis of the large vestibular aqueduct syndrome (LVAS). The specific aims were to compare between the two famous criteria to diagnose large vestibular aqueduct (LVA), (i.e., Valvassori and Cincinnati), to correlate between vestibular aqueduct (VA) measurements in the axial view and those in 45° oblique reformate in children with LVAS, and to define radiological criteria to diagnose LVA in the 45° oblique reformate.
The study group included 61 children with LVAS according to Cincinnati criteria (greater than 0.9mm at the midpoint or greater than 1.9mm at the operculum in the axial view). All participants were subjected to full Audiological evaluation and CT scanning in axial plane. The axial data were then transferred to workstation for post-processing with 3D reformatting software (Baxara 3D) in order to obtain the 45° oblique reformates. VA measurements were done at 4 points: midpoint and operculum in both the axial plane and the 45° oblique reformate.
Only 81% of ears of children with LVAS (99 ears) fit Valvassori criterion (i.e., larger than 1.5mm at midpoint), while 19% (23 ears) of them were missed. There were statistically significant correlations among the diameters of the VA in the axial view (both in the midpoint and operculum) and their counterparts in the 45° oblique reformate. Values equal to or greater than 1.2mm in the midpoint and 1.3mm in the operculum are proposed to be the criteria to diagnose LVA in the 45° oblique reformate. Finally, no significant correlations were found between the degree of hearing loss and VA diameters at the axial or 45° oblique reformate.
Cincinnati criteria are more sensitive than Valvassori criterin in the diagnosis of LVAS. We recommend the application of Cincinnati criteria instead of Valvassori criteria in order not miss cases with LVAS. Measurement of VA in the 45° oblique reformate is a reliable method to diagnose LVA. Criteria to diagnose LVA in the 45° oblique reformate were proposed.
当前研究的主要目的是提高大前庭导水管综合征（LVAS）的放射学诊断敏感性。具体目标包括比较两种著名的大前庭导水管（LVA）诊断标准（即瓦尔瓦索里标准和辛辛那提标准）；关联LVAS患儿轴位视图与45°斜位重组视图中前庭导水管（VA）的测量值；确定45°斜位重组视图中诊断LVA的放射学标准。
研究组纳入61例符合辛辛那提标准（轴位视图中点处大于0.9mm或壶腹处大于1.9mm）的LVAS患儿。所有参与者均接受全面的听力学评估和轴位CT扫描。然后将轴位数据传输至工作站，使用3D重组软件（Baxara 3D）进行后处理，以获取45°斜位重组图像。在4个点测量VA：轴位平面和45°斜位重组视图中的中点和壶腹。
LVAS患儿中仅81%的耳（99耳）符合瓦尔瓦索里标准（即中点处大于1.5mm），19%（23耳）漏诊。轴位视图（中点和壶腹处）VA直径与其45°斜位重组视图中的对应值之间存在统计学显著相关性。建议将中点处等于或大于1.2mm、壶腹处等于或大于1.3mm作为45°斜位重组视图中诊断LVA的标准。最后，在轴位或45°斜位重组视图中，听力损失程度与VA直径之间未发现显著相关性。
辛辛那提标准在LVAS诊断中比瓦尔瓦索里标准更敏感。为避免漏诊LVAS病例，我们建议应用辛辛那提标准而非瓦尔瓦索里标准。在45°斜位重组视图中测量VA是诊断LVA的可靠方法。提出了45°斜位重组视图中诊断LVA的标准。
