Riste Saat ITKH, HUS. MRT-kool Kõrva ja temporaalluu MRT
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1 Kõrva ja temporaalluu MRT MRT-kool 2012 Riste Saat ITKH, HUS
2 Näidustused Tehnika Anatoomia Patoloogia Pseudolesioonid ja diagnostilised vead
3 Kõrva MRT näidustused n Sensorineuraalne kuulmislangus, tinnitus, vestibulaarsed häired h Temporaaluu ekspansiivsed lesioonid Komplitseerunud välis v lis- ja keskkõrva põletikud
4 MRT tehnika MRT tehnika Vähemalt üks sekvents kogu ajust 2-3mm lõigud temporaalluust Vähemalt üks kõrge resolutsiooniga 3D sekvents kõrvadest Vajadusel Gd Vajadusel DWI Vajadusel MRA
5 Tehnika: T2 ax
6 Tehnika: T1 ax
7 HR3D FT T2 ax (CISS/ DRIVE/ FIESTA)
8 HR 3D FT T1 Gd sag (SPGR, GRASS, MPRAGE)
9 SS-TSE DWI (non-epi) cor EPI-DWI ax Non-EPI DWI cor
10 TOF MRA
11 Anatoomia
12 Kõrva ja temporaalluu osad Kõrva ja temporaalluu osad T2 T1 Väliskõrv Keskkõrv Sisekõrv ja sisemine kuulmekäik Apex
13 Keskkõrv: anatoomia Keskkõrv: anatoomia
14 Keskkõrv: anatoomia T = trummiõõs (tympanum) ja kuulmeluukesed C = cochlea MAI = meatus acuticus internus V = vestibulum SCC = poolringkanalid (canales semicirculares) A = antrum mastoideum A T C SCC MAI V
15 Keskkõrv: patoloogia Keskkõrv: patoloogia Kolesteatoom ja epidermoid Põletikud: otiit, mastoidiit ja nende komplikatsioonid Neoplaasiad Paraganglioom Meningioom Schwannoom Adenoom Metastaasid, Lümfoom, L Rhabdomyosarkoom
16 Kolesteatoom (Williams Eur Radiol 2003;13: ) MR imaging using delayed CE SE T1 was able to detect residual or recurrent cholesteatoma as small as 3mm with high specificity: except for cholesteatoma, all other tissues that may be present in the tympanic cavity demonstrate a variable enhancement after contrast injection.
17 Middle Ear Cholesteatoma: Non Echo-planar Diffusion-weighted MR Imaging versus Delayed Gadolinium-enhanced T1-weighted MR Imaging Value in Detection De Foer B. Radiology: Volume 255: Number 3 June 2010 Delayed T1Gd Non-EPI DWI T1Gd+DWI PPV 88.0% 96.0% 96.3% NPV 27% 56.5% 59.6%
18 Retsidiivkolesteatoom
19 Retsidiivkolesteatoom
20 põletikud Otiit? Mastoidiit? Retentsioon?
21 Incidental diagnosis of mastoiditis on MRI. Polat S et al. Eur Arch Otorhinolaryngol Aug;268(8):
22 Mastoidiit, abstsess Mastoidiit, abstsess
23 Mastoidiit, abstsess Mastoidiit, abstsess
24 Tuumorid: paraganglioom
25 paraganglioom TOF-MRA TOF-MRA: MIP
26 Sisekõrv, MAI, PCN: probleemid Sisekõrv, MAI, PCN: probleemid Kaasasündinud või omandatud kuulmislangus Tinnitus Implantatsioonieelne kaardistamine Vestibulaarsed häired h Varasema juhuleiu täpsustamine t Perifeerne näon n onärvi parees
27 Sisekõrv: anatoomia
28 Harnsberger. Imaging Anatomy: H&N biology.clc.uc.edu
29 DRIVE
30 scala vestibuli scala tympani d. endolymphaticus cochlea vestibulum lat. SCC post. SCC
31 Sisekõrv: patoloogia Sisekõrv: patoloogia Kaasasündinud anomaaliad Labürintiit (Osteodüstroofiad) stroofiad) (Trauma) Neoplaasiad Schwannoom Sacculus endolymphaticuse tuumor
32 DRIVE Sisekõrva patoloogia: kongenitaalsed anomaaliad - LVA
33 Sisekõrva patoloogia: kaasasündinud anomaaliad - Mondini düsplaasia d DRIVE
34 CISS T1Gd 3d-MPR Sisekõrva patoloogia: äge labürintiit
35 Sisekõrva patoloogia: subakuutne fibroseeriv labürintiit CISS
36 CISS Sisekõrva patoloogia: osteodüstroofiad stroofiad - äge otoskleroos T1Gd 3d-MPR
37 Sisekõrva patoloogia: tuumorid - intrakohleaarne schwannoom T1Gd 3d-MPR CISS
38 Sisekõrva patoloogiad: neoplaasiad - sacculus endolymphaticuse tuumor PILDID:
39 Pseudolesioon: kollane luuüdi
40 n. vest. inf. Harnsberger. Imaging Anatomy: H&N n. cochl. n. fac.. n. vest. sup. n. cochlearis n. facialis n. vestibularis inf. n. vestibularis sup. Sisemine kuulmekäik ja PCN
41 VII VIII PCN porus, ülaosa VII n. v. sup. närvid porus, alaosa VIII n. cochl. n. v. inf.
42 MAI ja PCN: patoloogia MAI ja PCN: patoloogia Kuulmisnärvi kaasasündinud düsplaasiad d Aplaasia Hüpoplaasia Põletikulised haigused, neuriidid Neuriit Granulomatoossed põletikud Ekspansioonid Epidermoid Arahnoidaaltsüst st Neoplaasiad Schwannoom Meningioom Lipoom Hemangioom Kartsinomatoos, lümfoom l
43 T1Gd 3d-MPR schwannoom
44 schwannoom T2 T1Gd DRIVE T1
45 NF II NF II DRIVE T1Gd 3d-MPR bilateraalne!
46 PCA meningioom T1 T2 T1Gd
47 PCA epidermoid T2 FSE CISS T1Gd 3d-MPR
48 PCA epidermoid EPI DWI b=1000 ADC
49 AICA aneurüsm T2 T1 T1Gd
50 lipoom DRIVE T1
51 Bonneville 2007
52 DRIVE hypoplasia n. cochlearis dex *
53 n. facialise neuriit T1Gd 3d-MPR
54 Bilat. n. facialise neuriit (neuroborrelioos) Bilat. n. facialise neuriit (neuroborrelioos) T1Gd 3d-MPR
55 DRIVE neurosarkoidoos T1Gd 3d-MPR
56 Temporaalapex: patoloogia Temporaalapex: patoloogia Pseudoleesioonid Asümmeetriline luuüdi / pneumatisatsioon Vedelikuretentsioon (trapped fluid) Põletikulised haigused temporaalapitsiit Ekspansioonid Kolesteatoom ja epidermoid Kolesteroolgranuloom Neoplaasiad Kondrosarkoom Meningioom Metastaasid, müeloom m L-rakuline histiotsütoos, toos, hiidrakuline tuumor sarkoom
57 Pseudolesioon: trapped fluid Pseudolesioon: trapped fluid T2 flair T1 T1Gd DWI ADC
58 Kolesteroolgranuloom T2fs T1 T1fs nat
59 Temporaalapitsiit T1Gd
60 kondrosarkoom T2 T1fsGd
61 Summa HR 3D sekventsid (T2 ja T1Gd) Keskkõrv: : kõik, mis pole MRT-s s must, on patoloogiline. Tõlgendus! Keskkõrv Sisekõrv ja sisemine kuulmekäik ik: : kas normaalne anatoomia on tuvastatav? Signaal ja kontrasteerumine? DWI (non-epi): retsidiivkolesteatoom ja temporaalluu lesioonide dif.dgn.
62 Kirjandus: Harnsberger et al. Diagnostic Imaging: Head and Neck Som, Curtin. Head and Neck Imaging Swartz. Sensorineural hearing deficit: a systematic approach based on imaging findings. Radiographics 1996 Bonneville et al. Imaging of cerebellopontine angle lesions: an update Part 1: Eur Radiol Oct;17(10): Epub 2007 Jun 12 Part 2: Eur Radiol Nov;17(11): Casselman, Mukherji. Cranial Nerves. Neuroim Clin of NA Anatomy/Temporal-Bone Bone-CT
63 Tänan!
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