Lingam R K, Connor S E J, Casselman J W, Beale T
London Northwest Healthcare NHS Trust, London, UK.
King's College Hospital NHS Foundation Trust, London, UK.
Clin Radiol. 2018 Jan;73(1):35-44. doi: 10.1016/j.crad.2017.09.002. Epub 2017 Sep 29.
Imaging of middle-ear cholesteatoma with diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI), and inner-ear endolymphatic hydrops (in Ménière's disease) with post-gadolinium high-resolution MRI, are reviewed. DWI MRI provides for a more specific diagnosis of tympano-mastoid cholesteatoma. There is an established and increasing role of DWI MRI in detecting both primary and postoperative cholesteatoma, localising disease, and planning surgery. The contemporary diagnostic accuracy of DWI is reviewed, pitfalls in interpretation are described, and potential future developments are highlighted. High-resolution post-gadolinium MRI of the inner ear is being explored for diagnosing endolymphatic hydrops. There is now increasing data to validate the application of three-dimensional (3D)-fluid attenuated inversion recovery (FLAIR) sequences, performed at 4 hours post-intravenous gadolinium, in the setting of potential Ménière's disease. The clinical context and the evolution of these MRI techniques are discussed. Current MRI-based grading schemes for endolymphatic hydrops are described, together with the available data on their clinical implications.
本文综述了采用扩散加权成像（DWI）磁共振成像（MRI）对中耳胆脂瘤的成像，以及采用钆增强高分辨率MRI对内耳内淋巴积水（梅尼埃病）的成像。DWI MRI能更准确地诊断鼓室-乳突胆脂瘤。DWI MRI在检测原发性和术后胆脂瘤、疾病定位以及手术规划方面的作用已得到确立且日益重要。本文回顾了DWI的当代诊断准确性，描述了解读中的陷阱，并强调了未来可能的发展。内耳钆增强高分辨率MRI正用于诊断内淋巴积水。目前有越来越多的数据证实，在疑似梅尼埃病的情况下，静脉注射钆剂4小时后进行三维（3D）液体衰减反转恢复（FLAIR）序列成像的应用价值。本文讨论了这些MRI技术的临床背景和发展情况。介绍了目前基于MRI的内淋巴积水分级方案以及关于其临床意义的现有数据。
