Dubrulle Frederique, Souillard Raphaelle, Chechin David, Vaneecloo François M, Desaulty Alain, Vincent Christophe
Department of Radiology, Centre Hospitalier Universitaire, Lille, France.
Radiology. 2006 Feb;238(2):604-10. doi: 10.1148/radiol.2381041649. Epub 2005 Nov 22.
To prospectively evaluate a fast spin-echo (SE) diffusion-weighted sequence for magnetic resonance (MR) imaging of recurrent cholesteatoma in patients who have undergone middle ear surgery.
The study was approved by the institutional review board, and informed consent was obtained from all patients. Twenty-four patients (10 female and 14 male patients; mean age, 44 years) who had undergone resection of cholesteatoma were referred for MR imaging. MR imaging was performed with a 1.5-T unit by using unenhanced diffusion-weighted fast SE imaging at b factors of 0 and 800 sec/mm(2), unenhanced T2-weighted fast SE imaging, unenhanced T1-weighted SE imaging, and delayed contrast material-enhanced T1-weighted imaging. Two radiologists evaluated the diffusion-weighted fast SE images for the presence of a high-signal-intensity cholesteatoma. Results from MR imaging were compared with reports from second- or third-look surgery. Interobserver agreement was assessed with the kappa statistic.
A recurrent cholesteatoma was correctly identified in 13 of 14 patients with diffusion-weighted fast SE images obtained with a b factor of 800 sec/mm(2), for a positive predictive value of 93%. In patients without recurrent cholesteatoma, all diffusion-weighted fast SE MR images obtained with a b factor of 800 sec/mm(2) were correctly interpreted as showing no high signal intensity. Thus, the negative predictive value was 100%. Sensitivity and specificity were 100% (13 of 13 patients) and 91% (10 of 11 patients), respectively. Interobserver agreement was excellent (kappa = 0.92). The smallest recurrent cholesteatoma was 5 mm in diameter, and this was correctly detected with the diffusion-weighted fast SE sequence.
Diffusion-weighted fast SE imaging enables the depiction of recurrent cholesteatoma in patients who have undergone middle ear surgery.
前瞻性评估快速自旋回波（SE）扩散加权序列用于接受中耳手术患者复发性胆脂瘤的磁共振（MR）成像。
本研究经机构审查委员会批准，所有患者均签署知情同意书。24例接受过胆脂瘤切除术的患者（10例女性，14例男性；平均年龄44岁）被转诊进行MR成像。使用1.5-T设备进行MR成像，采用b值为0和800 sec/mm²的非增强扩散加权快速SE成像、非增强T2加权快速SE成像、非增强T1加权SE成像以及延迟对比剂增强T1加权成像。两名放射科医生评估扩散加权快速SE图像中高信号强度胆脂瘤的存在情况。将MR成像结果与二次或三次手术报告进行比较。采用kappa统计量评估观察者间的一致性。
在14例使用b值为800 sec/mm²获得扩散加权快速SE图像的患者中，13例正确识别出复发性胆脂瘤，阳性预测值为93%。在无复发性胆脂瘤的患者中，所有使用b值为800 sec/mm²获得的扩散加权快速SE MR图像均被正确解读为无高信号强度。因此，阴性预测值为100%。敏感性和特异性分别为100%（13例患者中的13例）和91%（11例患者中的10例）。观察者间一致性极佳（kappa = 0.92）。最小的复发性胆脂瘤直径为5 mm，使用扩散加权快速SE序列可正确检测到。
扩散加权快速SE成像能够显示接受中耳手术患者的复发性胆脂瘤。
