Objective: To investigate the hemodynamic characteristics of transverse sinus with sigmoid sinus wall dehiscence (SSWD) of pulsatile tinnitus (PT) based on 4D flow MRI. Methods: Retrospective analysis was performed on all patients admitted to Beijing Friendship Hospital, Capital Medical University from January 2019 to January 2021 for dehiscent sigmoid plate pulsatile tinnitus. A total of 26 patients (sides) who met the criteria and underwent 4D flow MRI were included. A total of 26 subjects (46 sides), matched 1∶1 according to gender and age, were included in the normal healthy control group. Nonparametric rank sum test, Student's t test, and ANOVA were performed by SPSS 19.0 software. Binary Logistic regression was applied to the data with statistical significance. Results: There were more patients with dominant drainage on the affected side in PT group than in control group (73.1% vs. 42.3%). The incidence of transverse with a focal intraluminal filling defect and tapered stenosis was higher than that in control group (21.7% vs. 69.2%; 17.4% vs. 42.3%). Average through-plane velocity and maximum through-plane velocity in PT group were higher than those in control group [(33.75±13.88) cm/s vs. (15.84±7.21) cm/s; (93.19±33.55) cm/s vs. (40.40±14.40) cm/s]. The middle part and proximal end of Flowavg (ml/s) in PT group were larger than those in control group [4.69 (2.87; 5.62) ml/s vs. 2.76 (1.67; 4.99) ml/s; 3.41 (2.16; 5.47) ml/s vs. 2.67 (1.68; 4.41) ml/s]. In control group, the velocity of transverse sinus changed relatively gently, while in PT group, the velocity of proximal sinus increased significantly. Binary Logistic regression showed that SSWD PT was independently correlated with proximal maximum flow velocity [OR=1.086(1.029-1.146),P=0.003]. Conclusion: 4D flow MRI showed that the dominant drainage and higher velocity at the proximal end of the transverse sinus might be an important hemodynamic characteristics of dehiscent sigmoid plate pulsatile tinnitus.
目的： 基于4D血流MRI检查技术探索乙状窦周骨壁缺失（sigmoid sinus wall dehiscence，SSWD）导致的搏动性耳鸣（pulsatile tinnitus，PT）患者的患侧横窦血流动力学特点。 方法： 回顾性分析2019年1月至2021年1月所有因单侧PT就诊于首都医科大学附属北京友谊医院且确诊为SSWD性PT的患者的临床资料。其中行4D血流MRI检查的共26例，女24例，男2例，年龄（35.8±8.1）岁；按照性别年龄匹配1∶1纳入健康对照组26名（46侧），其中女24名，男2名，年龄（31.8±4.4）岁。利用4D血流MRI技术采集2组横窦数据。应用SPSS19.0软件对指标进行非参数秩和检验、t检验、方差分析。同时，将存在统计学意义的数据进行二元Logistic分析。 结果： PT组患侧优势引流者19例（73.1%），多于对照组的11名（42.3%），横窦丘形狭窄及锥形狭窄发生率多于对照组（69.2% 比21.7%；42.3% 比17.4%）。PT组近心端经平面平均血流速度Vtp-avg及经平面最大血流速度Vtp-max大于对照组［（33.75±13.88）cm/s 比（15.84±7.21）cm/s；（93.19±33.55）cm/s 比（40.40±14.40）cm/s］。PT组中间部及近心端的最大血流率Flowmax大于对照组［4.69（2.87；5.62）ml/s比2.76（1.67；4.99）ml/s；3.41（2.16；5.47）ml/s比2.67（1.68；4.41）ml/s］。对照组横窦速度变化相对较平缓，而PT组近心端速度明显增大。SSWD性PT与近心端最大血流速度［OR=1.086（1.029~1.146），P=0.003］独立相关。 结论： 横窦回流优势侧与近心端血流速度增大可能是引起SSDW性PT的重要血流动力学原因。.