Patel Bhavesh, Hall Andrew, Lingam Ravi, Singh Arvind
Clinic of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital and Central Middlesex Hospital, Harrow, United Kingdom.
Clinic of Radiology, Northwick Park Hospital and Central Middlesex Hospital, Harrow, United Kingdom.
J Int Adv Otol. 2018 Aug;14(2):263-266. doi: 10.5152/iao.2018.5033.
To our knowledge, there is no study exploring specifically the diagnostic performance of diffusion-weighted imaging (DWI) in patients with previous canal wall down (CWD) surgery when combined with appropriate clinical evaluation. The aim of the present study was to evaluate the performance of DWI in the detection of residual or recurrent disease in patients who have had a previous CWD mastoidectomy.
We identified 13 patients with a CWD mastoidectomy subsequently having at least one further DWI prior to further mastoid exploration that generated a total of 20 patient episodes. Magnetic resonance imaging was performed on a 1.5 T superconductive unit using a standard head matrix coil. Coronal 2 mm thick TSE T2-weighted images (TR: 4640 ms; TE: 103 ms; matrix: 245,384; field of view: 150×200 mm) were performed. Operative findings were reviewed for all 20 patient episodes to compare DWI findings with intraoperative findings. Based on this, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.
DWI had a sensitivity of 93%, specificity of 60%, PPV of 87%, NPV of 75%, and accuracy of 80%.
Given the high sensitivity of DWI in the detection of residual or recurrent disease, the present study supports DWI as a useful tool in the detection of residual or recurrent cholesteatoma in cases following CWD surgery, where clinical acumen suggests an ongoing disease process despite no overt cholesteatoma being visible.
据我们所知，尚无研究专门探讨弥散加权成像（DWI）结合适当临床评估在既往行开放式乳突根治术（CWD）患者中的诊断性能。本研究的目的是评估DWI在检测既往接受过CWD乳突切除术患者的残留或复发性疾病中的性能。
我们确定了13例行CWD乳突切除术的患者，这些患者在进一步的乳突探查之前至少接受了一次DWI检查，共产生20例患者事件。使用标准头部矩阵线圈在1.5T超导单元上进行磁共振成像。进行了冠状面2mm厚的TSE T2加权图像（TR：4640ms；TE：103ms；矩阵：245,384；视野：150×200mm）。对所有20例患者事件的手术结果进行了回顾，以比较DWI结果与术中结果。基于此，计算了敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
DWI的敏感性为93%，特异性为60%，PPV为87%，NPV为75%，准确性为80%。
鉴于DWI在检测残留或复发性疾病方面具有较高的敏感性，本研究支持DWI作为检测CWD手术后残留或复发性胆脂瘤的有用工具，在临床敏锐度提示存在持续疾病过程但未见明显胆脂瘤的情况下。
