【作者】 李强；

【导师】 崔建岭；

【作者基本信息】 河北医科大学 ， 影像医学与核医学， 2014， 硕士

【摘要】 目的：1研究儿童期咽扁桃体增生的影像学测量方法及各种影像学检查方法是否存在差异性。2研究正常组及增生组2~15岁儿童的咽扁桃体最厚处的上下径与鼻咽腔最大上下径的比值（A/N）与其年龄的相关曲线。3研究正常2~15岁儿童的咽扁桃体最厚处的上下径与鼻咽腔最大上下径的比值（A/N）的范围及2~15岁咽扁桃体增生患儿的最厚处的上下径与鼻咽腔最大上下径的比值（A/N）的范围。4通过对咽扁桃体增生患儿的咽扁桃体最厚处的上下径与鼻咽腔最大上下径的比值（A/N）的测量和计算，研究2~15岁儿童期咽扁桃体增生的影像学分度。5研究儿童咽扁桃体增生与上颌窦炎之间的相关性。6研究咽扁桃体增生的影像学分度（Ⅰ、Ⅱ、Ⅲ度）与儿童上颌窦炎的程度评分（0~5分）之间的相关性。方法：1研究对象的分组——选择2012年11月至2013年11月经河北省眼科医院耳鼻喉科通过临床检查确诊的并经过相关影像检查证实的100例儿童咽扁桃体增生患者进行研究，该组为增生组；选择经耳鼻喉科临床检查咽扁桃体正常并经影像学证实的100名正常儿童做对照，该组为正常组。2研究设备的选择及扫描基线的确定——①鼻咽部斜冠状面CT：使用德国西门子公司的Emotion欢悦全身单排螺旋CT扫描仪对儿童鼻咽部进行斜冠状位扫描，在CT定位像上划定基线，基线的选择方法是，首先在定位像上找到枕骨与蝶骨的结合点，另外找到咽扁桃体最凸点，将蝶骨与枕骨结合点和咽扁桃体最凸点连线，以该连线为基线进行逐层扫描。②副鼻窦横断面CT：使用德国西门子公司的Emotion欢悦全身单排螺旋CT扫描仪对患儿上颌窦进行横断面扫描，在CT定位像上划定基线，扫描基线与硬腭平面平行。③鼻咽部侧位X线片：使用韩国MIS公司出产的MISDR0808D18型数字化X线机对部分患儿进行鼻咽侧位DR摄影。3儿童咽扁桃体最厚处上下径与鼻咽最大上下径的比值（A/N）的测量方法——①在鼻咽部斜冠状面CT上，由于X射线直接垂直穿过咽扁桃体最大截面，所以，选取咽扁桃体厚度最大的层面对咽扁桃体进行测量，确定A值，继续测量该层面的鼻咽腔上下径的数据来确定N值。计算A/N比值。②对年龄偏小的儿童，行斜冠状位CT扫描确实不合作者，在鼻咽部侧位数字化X线片上，主要可以直观测量咽扁桃体的最大上下径和鼻咽腔的最大上下径，是一种粗略计算咽扁桃体A/N比值的方法。4上颌窦炎的CT诊断及其严重程度的影像学评分——上颌窦炎的CT特征性表现就是在窦腔可以看到软组织密度影，密度基本均匀。在CT机上圈划上颌窦窦腔内软组织影的体积，所有显示上颌窦的层面都要测量圈划，然后将双侧上颌窦所有圈划测得的软组织影的体积之和记作C值，同时将该儿童所有上颌窦层面窦腔的全部体积圈划，将两侧上颌窦窦腔所有层面圈划所得的体积之和记作D值，C/D的比值能客观的反映上颌窦炎的严重程度。C/D比值的范围为：0≤C/D≤1，C/D比值可用于上颌窦炎严重程度的影像学评分。5统计学分析——①按照特定时间段抽取20名儿童分别进行数字化X线鼻咽部侧位片及CT鼻咽部斜冠状面扫描，分别测定两种影像检查方式所得出的A/N比值，使用配对样本t检验，以观察这两种影像检查方式在咽扁桃体增生中测量A/N比值有无差异。②对于咽扁桃体A/N比值，将增生组和正常组所测得的A/N比值进行两样本t检验，设置P<0.01为差异有统计学意义。③对于增生组的100例患儿，将反映其上颌窦炎严重程度的C/D比值与该组患儿咽扁桃体的A/N比值相比较，做直线相关分析，计算Pearson相关系数r。④分析增生组咽扁桃体增生的分度评分与其并发上颌窦炎严重性评分的等级相关性。结果：1按照特定时间段抽取20名儿童分别进行数字化X线鼻咽部侧位片及CT鼻咽部斜冠状面扫描，分别测定两种影像检查方式所得出的A/N比值，使用配对样本t检验，结果显示数字化X线鼻咽部侧位片对A/N的测量结果与CT鼻咽部斜冠状面扫描对A/N的测量结果没有显著差异。2正常儿童A/N比值随年龄的变化趋势的散点图表明，A/N比值的最高峰出现在5岁，A/N比值在10~12岁间存在下降速率明显减慢的平台期。3咽扁桃体增生组与正常组进行A/N比值的两样本t检验，差异有显著的统计学意义。4结合咽扁桃体的鼻咽镜或或间接喉镜分度法，A/N比值在0.32~0.63间为正常，A/N比值在0.64~0.75之间为咽扁桃体轻度增生（I度），A/N比值在0.76~0.85之间为咽扁桃体中度增生（II度），A/N比值大于0.85时为咽扁桃体重度增生。5咽扁桃体增生患儿的A/N比值与C/D比值做直线相关分析，结果显示有统计学意义。6咽扁桃体增生的分度与C/D比值评分之间之间的相关性采用spearman等级相关分析及对应分析，结果显示其相关性非常显著。结论：1咽扁桃体增生的影像检查方法有多种，经典的是鼻咽侧位X线片测量法和CT的斜冠状面扫描，二者比较测量结果无差异性。2基于咽扁桃体增生相关影像的A/N测量对客观量化评价咽扁桃体增生的程度提供了可靠的依据。3正常儿童A/N比值随年龄的变化趋势的散点图表明，咽扁桃体所占鼻咽腔的比例最大时约是5岁左右，其变化在10~12岁时存在平台期。4咽扁桃体A/N比值正常值为0.32~0.63，A/N比值在0.64~0.75之间为咽扁桃体轻度增生，A/N比值在0.76~0.85之间为咽扁桃体中度增生，A/N比值大于0.85时为咽扁桃体重度增生。当A/N比值大于0.76且患儿有明显的气道阻塞症状时，应该视作手术切除咽扁桃体的指征。5儿童咽扁桃体增生的程度与儿童上颌窦炎的程度存在正相关。6儿童咽扁桃体增生的影像学分度与儿童上颌窦炎程度评分之间存在显著的相关性。更多还原

【Abstract】 Objective:1Study of childhood pharyngeal tonsil hyperplasia imaging measurementmethods and various imaging methods if there are differences.2Correlation curves up and down up and down the path with the largestdiameter of the nasopharynx ratio study normal and hyperplastic group ofchildren aged2to15thickest of the pharyngeal tonsils (A/N) and its age.3Drive up and down and up and down in normal children aged2-15thickest pharyngeal tonsil and nasopharynx maximum diameter verticaldiameter ratio (A/N) range and2~15year-old children with pharyngeal tonsilhyperplasia of the thickest nasopharynx maximum vertical diameter ratio (A/N)range.4Down through the pharyngeal tonsil hyperplasia in children withpharyngeal tonsils thickest diameter and nasopharynx maximum verticaldiameter ratio (A/N) measurement and calculation, study of children aged2~15pharyngeal tonsil hyperplasia degree image credits.5Correlation of pharyngeal tonsils of children between the maxillaryhyperplasia.6Research pharyngeal tonsil hyperplasia image credits degrees (Ⅰ, Ⅱ,Ⅲ degree) and children maxillary sinusitis severity score (0to5points)correlation.Methods:1Grouping research subjects-Choose November2012to November2013and after menstruation related imaging confirmed100cases of childrenin Ophthalmic Hospital of Hebei Province diagnosed by clinical examinationpharyngeal tonsil hyperplasia patients studied, the group hyperplasia; choose by ENT pharyngeal tonsil normal clinical examination and confirmed byimaging the100normal children as controls, the group was the control group.2Selecting and scanning equipment to determine the baseline study-①Nasopharynx oblique coronal CT: Use the German company SiemensEmotion joyous systemic single-slice spiral CT scanner for childrennasopharynx oblique coronal scan, the CT image positioning on delineationbaseline, baseline selection method is to first find the point in the occipital andsphenoid positioning like, in addition to find the most bumps pharyngealtonsils, the sphenoid and occipital binding sites and pharyngeal tonsils mostbump connection to the connection to drill baseline scan.②Paranasalsinuses Axial CT: Use the German company Siemens Emotion single slicespiral CT joyous body scanners perform cross-sectional scans of children withsinus delineate baseline positioning on CT images, scanning plane parallel tothe baseline and palate.③Nasopharyngeal lateral X-ray: South Koreancompanies use MIS produced MISDR0808D18type digital X-ray machine onthe part of children with nasopharyngeal lateral DR Photography.3Children thickest pharyngeal tonsil and nasopharynx maximum verticaldiameter vertical diameter ratio (A/N) measurement method-①In thenasopharynx oblique coronal CT, X-rays directly because the vertical crosssection through the pharyngeal tonsils maximum, so select the pharyngealtonsils maximum level measured thickness of the pharyngeal tonsils,determine the value of a, continue to measure the diameter of the upper andlower levels of the nasopharynx data to determine N values. Calculate the A/Nratio.②For children ages too small, the line oblique coronal CT scan reallysubstandard author on nasopharyngeal lateral digital X-ray films, mainly tovisually measure the maximum vertical diameter of the pharyngeal tonsilsmaximum vertical diameter and nasopharynx, and is a kind of a roughcalculation of the pharyngeal tonsils A/N ratio method.4CT diagnosis of maxillary sinusitis and severity of radiographic score-CT maxillary sinuses characteristic performance that can be seen in the softtissue density, density substantially uniform. The CT machine designated maxillary sinus cavity ring soft tissue volume of the maxillary sinus should alldisplay level measurement loop scheme, and then draw the circle of allbilateral maxillary soft tissue measured and recorded as the volume of the Cvalue, all aspects of the child while maxillary sinus volume circle draw all thecircles on both sides of the maxillary sinuses all levels of planning and theresulting volume recorded as D values, the ratio C/D can objectively reflectthe maxillary sinusitis range of severity. Range of C/D ratio is0≤C/D≤1,C/D ratio can be used to maxillary sinusitis radiographic severity score.5Statistical analysis-①Taken in accordance with a specific timeperiod20children were digitized X-ray radiographs of the nasopharynx andnasopharyngeal oblique coronal CT scan imaging were measured in two waysthe results of A/N ratio, using paired samples t test, to observe these twoimaging modalities in the pharyngeal tonsils measuring hyperplasia A/N ratioof whether the differences.②For pharyngeal tonsil A/N ratio, the hyperplasiagroup and normal group measured the A/N ratio of the two-sample t test,setting P <0.01was considered statistically significant.③For the100casesof children with hyperplasia will reflect the severity of maxillary sinusitis C/Dratio in the group of children with pharyngeal tonsils A/N ratio compared to astraight line correlation analysis, calculated Pearson correlation coefficient r.④Analysis hyperplasia pharyngeal tonsil hyperplasia of maxillary sinusitiscomplicated by their scores rank correlation between the severity score.Results：1Taken in accordance with a specific time period20children weredigitized X-ray radiographs of the nasopharynx and nasopharyngeal obliquecoronal CT scan imaging were measured in two ways the results of A/N ratio,using paired samples t test, the results showed no significant difference in thenasopharynx of digital X-ray measurements on lateral radiographs A/N andnasopharynx oblique coronal CT scan of the A/N of the measurement results.2Normal children A/N ratio of the general trend of the age chart indicates,A/N ratio of the highest peak in the age of5, A/N ratio of the existence of theplatform in the rate of decline slowed down between10to12years old. 3Pharyngeal tonsil hyperplasia group and normal group A/N ratio of thetwo-sample t test, the difference was significant statistically significant.4Combined pharyngeal tonsil nasopharyngoscopy or indirectlaryngoscopy indexing, A/N ratio of0.32to0.63as normal, A/N ratio in therange of0.64to0.75when the pharyngeal tonsil mild hyperplasia (I degree),A/N ratio in the range of0.76to0.85when the pharyngeal tonsil moderatehyperplasia (II degree), A/N ratio is greater than0.85for the pharyngealtonsils severe hyperplasia.5Pharyngeal tonsil hyperplasia in children with A/N ratio and the C/Dratio do linear correlation analysis, the results showed a statisticallysignificant.6Correlation between the use of the pharyngeal tonsil hyperplasiaindexing and C/D ratio between the scores spearman rank correlation analysisand correspondence analysis showed significant correlation between its.Conclusions：1Pharyngeal tonsil hyperplasia imaging method for a variety of classicnasopharyngeal lateral X-ray measurement and oblique coronal CT scan, thetwo comparison measurements showed no difference.2Based pharyngeal tonsil hyperplasia related images A/N measurement ofobjective and quantitative evaluation of the degree of pharyngeal tonsilhyperplasia provide a reliable basis.3Normal children A/N ratio trends show scattergrams of age, themaximum proportion of the pharyngeal tonsil nasopharynx share is about5years old, and the variation in the presence of the platform10to12years old.4Pharyngeal tonsils A/N ratio of normal to0.32~0.63, A/N ratio between0.64~0.75pharyngeal tonsil mild hyperplasia, A/N ratio between0.76~0.85moderate hyperplasia of the pharyngeal tonsils, A/N when the ratio is greaterthan0.85for the pharyngeal tonsils severe hyperplasia. Pharyngeal tonsilremoval surgery indications for A/N ratio is greater than0.76and childrenwith significant symptoms of airway obstruction.5There was a positive correlation with the degree of degree child maxillary hyperplasia pharyngeal tonsil children.6There is a significant correlation between the proliferation of images ofchildren pharyngeal tonsil credit degree and extent of child sinus inflammationscore.更多还原