Akkari M, Gabrillargues J, Saroul N, Pereira B, Russier M, Mom T, Gilain L
Service d'ORL et chirurgie cervico faciale, université Clermont 1, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France.
Service de neuroradiologie, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2014 Jun;131(3):153-8. doi: 10.1016/j.anorl.2013.08.002. Epub 2014 Apr 5.
To evaluate the reliability of magnetic resonance imaging (MRI) for the diagnosis of middle ear cholesteatoma and to determine the contribution of each MRI sequence.
A series of 97 cases was reviewed, corresponding to 89 patients (43 women, 46 men). Each patient was assessed by the following MRI protocol: T1-weighted, T2-weighted, early contrast-enhanced T1-weighted, delayed contrast-enhanced T1-weighted, and diffusion-weighted sequences. All patients were operated, for the first time in 16 cases and for second-look surgery in 81 cases. Radiological findings were compared to surgical and histological findings. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each sequence.
Seventy-four cholesteatomas were diagnosed at surgery. These lesions had a mean diameter of 8.29±5.46mm. The smallest cholesteatoma in this series was 2mm in diameter. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences had a sensitivity of 84.9% and 90.4%, a specificity of 87.5% and 75%, a positive predictive value of 95.4% and 91.7%, and a negative predictive value of 65.6% and 72%, respectively. T1-weighted, T2-weighted, and early contrast-enhanced T1-weighted sequences had a low specificity.
MRI is a reliable imaging modality for the diagnosis of middle ear cholesteatoma. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences were discriminant. In the context of postoperative follow-up of cholesteatoma, these sequences allow better selection of cases requiring second-look surgery.
评估磁共振成像（MRI）诊断中耳胆脂瘤的可靠性，并确定每个MRI序列的作用。
回顾了97例病例，对应89名患者（43名女性，46名男性）。每位患者均接受以下MRI检查方案：T1加权、T2加权、早期增强T1加权、延迟增强T1加权和扩散加权序列。所有患者均接受了手术，其中16例为首次手术，81例为二次探查手术。将影像学检查结果与手术及组织学检查结果进行比较。计算每个序列的敏感性、特异性、阳性预测值和阴性预测值。
手术诊断出74例胆脂瘤。这些病变的平均直径为8.29±5.46mm。本系列中最小的胆脂瘤直径为2mm。扩散加权和延迟增强T1加权序列的敏感性分别为84.9%和90.4%，特异性分别为87.5%和75%，阳性预测值分别为95.4%和91.7%，阴性预测值分别为65.6%和72%。T1加权、T2加权和早期增强T1加权序列的特异性较低。
MRI是诊断中耳胆脂瘤的可靠影像学方法。扩散加权和延迟增强T1加权序列具有鉴别能力。在胆脂瘤术后随访中，这些序列有助于更好地选择需要二次探查手术的病例。
