非回波平面扩散加权磁共振成像提高了胆脂瘤一步法外耳道壁下闭合手术后的随访准确性。

Non-echo planar diffusion-weighted MRI increases follow-up accuracy after one-step step canal wall-down obliteration surgery for cholesteatoma.

作者信息

Edfeldt Lennart, Strömbäck Karin, Danckwardt-Lillieström Niklas, Rask-Andersen Helge, Abdsaleh Shahin, Wikström Johan

机构信息

Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden.

出版信息

Acta Otolaryngol. 2013 Jun;133(6):574-83. doi: 10.3109/00016489.2012.762118.

DOI:10.3109/00016489.2012.762118

PMID:23675808

Abstract

CONCLUSION

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.

OBJECTIVE

To evaluate the use of DW-MRI for detection of cholesteatoma after surgical treatment using a CWD obliteration technique.

METHODS

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.

RESULTS

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).

摘要

结论

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。

目的

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。

方法

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。

结果

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）。