Edfeldt Lennart, Strömbäck Karin, Danckwardt-Lillieström Niklas, Rask-Andersen Helge, Abdsaleh Shahin, Wikström Johan
Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden.
Acta Otolaryngol. 2013 Jun;133(6):574-83. doi: 10.3109/00016489.2012.762118.
Non-echo planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) increases the number of detected cholesteatoma after one-step canal wall-down (CWD) obliteration surgery for cholesteatoma compared with clinical evaluation alone.
To evaluate the use of DW-MRI for detection of cholesteatoma after surgical treatment using a CWD obliteration technique.
Thirty-eight adult patients (41 ears) treated with an identical one-step CWD obliteration surgical technique were included in a prospective and blinded study. All patients were investigated with non-EPI and EPI DW-MRI 1-9 months after the clinical examination. Follow-up time after primary surgery varied between 10 and 234 months. DW-MRI was assessed by two neuroradiologists and compared with clinical results. Inter-rater agreement was calculated. Positive non-EPI DW-MRI cases underwent revision surgery within 18-159 days after imaging.
Seven of 41 cases were evaluated as positive for cholesteatoma on non-EPI DW-MRI. Since one patient refused surgery six of these seven cases underwent surgical revision and all were verified. There was agreement between clinical and non-EPI findings in five of eight cases. EPI findings correlated poorly with non-EPI and clinical findings. Inter-rater agreement (Cohen's kappa) was 0.91 for non-EPI DW-MRI (p < 0.001) and -0.062 for EPI DW-MRI (p = 0.43).
与单纯临床评估相比，非回波平面（non-EPI）扩散加权（DW）磁共振成像（MRI）增加了胆脂瘤一期外耳道后壁下（CWD）根治性手术术后检测到的胆脂瘤数量。
评估DW-MRI在使用CWD根治性技术进行手术治疗后检测胆脂瘤的应用。
38例成年患者（41耳）接受了相同的一期CWD根治性手术技术治疗，纳入一项前瞻性双盲研究。所有患者在临床检查后1至9个月接受非EPI和EPI DW-MRI检查。初次手术后的随访时间在10至234个月之间。两名神经放射科医生对DW-MRI进行评估，并与临床结果进行比较。计算评分者间的一致性。非EPI DW-MRI检查呈阳性的病例在成像后18至159天内接受翻修手术。
41例中有7例在非EPI DW-MRI上被评估为胆脂瘤阳性。由于一名患者拒绝手术，这7例中的6例接受了手术翻修，均得到证实。8例中有5例临床和非EPI检查结果一致。EPI检查结果与非EPI及临床检查结果相关性较差。非EPI DW-MRI的评分者间一致性（Cohen's kappa）为0.91（p < 0.001），EPI DW-MRI为-0.062（p = 0.43）。
