Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk, Belgium.
Radiology. 2010 Jun;255(3):866-72. doi: 10.1148/radiol.10091140.
To retrospectively compare non-echo-planar (non-EP) diffusion-weighted (DW) imaging, delayed gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging, and the combination of both techniques in the evaluation of patients with cholesteatoma.
This institutional review board-approved study, for which the need to obtain informed consent was waived, included 57 patients clinically suspected of having a middle ear cholesteatoma without a history of surgery and 63 patients imaged before "second-look" surgery. Four blinded radiologists evaluated three sets of MR images: a set of delayed gadolinium-enhanced T1-weighted images, a set of non-EP DW images, and a set of both kinds of images. Overall sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV), as well as intra- and interobserver agreement, were assessed and compared among methods. To correct for the correlation between different readings, a generalized estimating equations logistic regression model was fitted. Results were compared with surgical results, which were regarded as the standard of reference.
Sensitivity, specificity, NPV, and PPV were significantly different between the three methods (P < .005). Sensitivity and specificity, respectively, were 56.7% and 67.6% with the delayed gadolinium-enhanced T1-weighted images and 82.6% and 87.2% with the non-EP DW images. Sensitivity for the combination of both kinds of images was 84.2%, while specificity was 88.2%. The overall PPV was 88.0% for delayed gadolinium-enhanced T1-weighted images, 96.0% for non-EP DW images, and 96.3%for the combination of both kinds of images. The overall NPV was 27.0% for delayed gadolinium-enhanced T1-weighted images, 56.5% for non-EP DW images, and 59.6% for the combination of both kinds of images.
MR imaging for detection of middle ear cholesteatoma can be performed by using non-EP DW imaging sequences alone. Use of the non-EP DW imaging sequence combined with a delayed gadolinium-enhanced T1-weighted sequence yielded no significant increases in sensitivity, specificity, NPV, or PPV over the use of the non-EP DW imaging sequence alone.
回顾性比较非回波平面（non-EP）弥散加权（DW）成像、钆延迟增强 T1 加权磁共振（MR）成像以及这两种技术联合应用在评估胆脂瘤患者中的作用。
本研究经机构审查委员会批准，由于无需获得知情同意，共纳入 57 例临床疑似中耳胆脂瘤且无手术史的患者和 63 例行“二次探查”手术前的患者。4 名盲法阅片的放射科医生评估了 3 组 MR 图像：一组是钆延迟增强 T1 加权图像，一组是非 EP-DW 图像，一组是这两种图像的联合图像。评估并比较了这 3 种方法的总体敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）以及组内和组间的一致性。为校正不同阅读之间的相关性，拟合了广义估计方程逻辑回归模型。结果与手术结果进行比较，后者被视为金标准。
3 种方法的敏感性、特异性、NPV 和 PPV 均有显著差异（P <.005）。钆延迟增强 T1 加权图像的敏感性和特异性分别为 56.7%和 67.6%，非 EP-DW 图像的敏感性和特异性分别为 82.6%和 87.2%。两种图像联合的敏感性为 84.2%，而特异性为 88.2%。钆延迟增强 T1 加权图像的总体 PPV 为 88.0%，非 EP-DW 图像的总体 PPV 为 96.0%，两种图像联合的总体 PPV 为 96.3%。钆延迟增强 T1 加权图像的总体 NPV 为 27.0%，非 EP-DW 图像的总体 NPV 为 56.5%，两种图像联合的总体 NPV 为 59.6%。
磁共振成像检测中耳胆脂瘤可单独使用非 EP-DW 成像序列。与单独使用非 EP-DW 成像序列相比，联合使用非 EP-DW 成像序列和钆延迟增强 T1 加权序列并未显著提高敏感性、特异性、NPV 或 PPV。
