Plouin-Gaudon Isabelle, Bossard Denis, Ayari-Khalfallah Sonia, Froehlich Patrick
Department of Pediatric Otolaryngology and Head and Neck Surgery, Centre Hospitalier de Valence, Valence, France.
Arch Otolaryngol Head Neck Surg. 2010 Sep;136(9):878-83. doi: 10.1001/archoto.2010.151.
To evaluate the efficiency of diffusion-weighted magnetic resonance imaging (MRI) and high-resolution computed tomographic (CT) scan coregistration in predicting and adequately locating primary or recurrent cholesteatoma in children.
Prospective study.
Tertiary care university hospital.
Ten patients aged 2 to 17 years (mean age, 8.5 years) with cholesteatoma of the middle ear, some of which were previously treated, were included for follow-up with systematic CT scanning and MRI between 2007 and 2008.
Computed tomographic scanning was performed on a Siemens Somaton 128 (0.5/0.2-mm slices reformatted in 0.5/0.3-mm images). Fine cuts were obtained parallel and perpendicular to the lateral semicircular canal in each ear (100 × 100-mm field of view). Magnetic resonance imaging was undertaken on a Siemens Avanto 1.5T unit, with a protocol adapted for young children. Diffusion-weighted imaging was acquired using a single-shot turbo spin-echo mode. To allow for diagnosis and localization of the cholesteatoma, CT and diffusion-weighted MRIs were fused for each case.
In 10 children, fusion technique allowed for correct diagnosis and precise localization (hypotympanum, epitympanum, mastoid recess, and attical space) as confirmed by subsequent standard surgery (positive predictive value, 100%). In 3 cases, the surgical approach was adequately determined from the fusion results. Lesion sizes on the CT-MRI fusion corresponded with perioperative findings.
Recent developments in imaging techniques have made diffusion-weighted MRI more effective for detecting recurrent cholesteatoma. The major drawback of this technique, however, has been its poor anatomical and spatial discrimination. Fusion imaging using high-resolution CT and diffusion-weighted MRI appears to be a promising technique for both the diagnosis and precise localization of cholesteatomas. It provides useful information for surgical planning and, furthermore, is easy to use in pediatric cases.
评估磁共振扩散加权成像（MRI）与高分辨率计算机断层扫描（CT）扫描配准在预测和准确确定儿童原发性或复发性胆脂瘤位置方面的效率。
前瞻性研究。
三级医疗大学医院。
纳入10例年龄在2至17岁（平均年龄8.5岁）的中耳胆脂瘤患者，其中部分患者曾接受过治疗，于2007年至2008年期间接受系统性CT扫描和MRI随访。
使用西门子Somaton 128进行计算机断层扫描（以0.5/0.3毫米图像重新格式化0.5/0.2毫米切片）。在每只耳朵平行和垂直于外侧半规管获取精细图像（视野为100×100毫米）。使用西门子Avanto 1.5T设备进行磁共振成像，采用适合幼儿的方案。采用单次激发快速自旋回波模式获取扩散加权成像。为实现胆脂瘤的诊断和定位，对每个病例的CT和扩散加权MRI进行融合。
在10名儿童中，融合技术实现了正确诊断和精确定位（下鼓室、上鼓室、乳突隐窝和鼓窦入口），后续标准手术证实了这一点（阳性预测值为100%）。在3例病例中，根据融合结果充分确定了手术入路。CT-MRI融合图像上病变大小与围手术期发现相符。
成像技术的最新进展使扩散加权MRI在检测复发性胆脂瘤方面更有效。然而，该技术的主要缺点是其解剖和空间分辨能力较差。高分辨率CT与扩散加权MRI的融合成像似乎是一种用于胆脂瘤诊断和精确定位的有前景的技术。它为手术规划提供了有用信息，而且在儿科病例中易于使用。
