Tolisano Anthony M, Hunter Jacob B, Sakai Mark, Kutz Joe Walter, Moore William, Pinho Marco, Isaacson Brandon
1 Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
2 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Ann Otol Rhinol Laryngol. 2019 Sep;128(9):862-868. doi: 10.1177/0003489419848462. Epub 2019 May 8.
Compare experts' ability to differentiate malignant and benign causes of facial nerve paralysis (FNP) using the initial presenting magnetic resonance image (MRI) for each patient.
This retrospective case-controlled study compared MRIs for 9 patients with a malignant cause for FNP, 8 patients with Bell's palsy, and 9 cochlear implant patients serving as controls. The initial presenting MRI for each condition was used such that raters were evaluating real-world rather than optimal studies. Three blinded expert raters independently evaluated each segment of the facial nerve for abnormalities, provided a diagnosis, and graded MRI quality. Cohen's and Light's kappa were used to calculate interrater reliability and overall index of agreement, respectively.
MRI protocols for the malignancy group were universally suboptimal. There was poor agreement among raters for abnormalities of the facial nerve along the brainstem (0.13), geniculate (0.10), tympanic segment (0.12), and mastoid segment (0.13); moderate agreement along the cisternal segment (0.58) and internal auditory canal (0.55); and fair agreement along the labyrinthine segment (0.26) and extratemporal segment (0.36). Agreement regarding final diagnosis was fair (0.37) when compared to the true diagnosis. There were 2 false negative interpretations (failure to correctly identify malignancy) and 1 false positive interpretation.
MRI for FNP is often initially performed with an incorrect protocol and thus may fail to reliably differentiate neoplastic from inflammatory FNP even when interpreted by experienced clinicians. Nevertheless, expert readers correctly diagnosed 87.5% of malignant causes of FNP despite these limitations.
比较专家利用每位患者初次就诊时的磁共振成像（MRI）鉴别面神经麻痹（FNP）恶性病因与良性病因的能力。
这项回顾性病例对照研究比较了9例FNP恶性病因患者、8例贝尔麻痹患者以及9例作为对照的人工耳蜗植入患者的MRI。使用每种情况初次就诊时的MRI，以便评估者评估的是实际临床情况而非理想研究。三名不知情的专家评估者独立评估面神经各节段是否存在异常，做出诊断，并对MRI质量进行分级。分别使用科恩kappa系数和莱特kappa系数计算评估者间的可靠性和总体一致性指数。
恶性肿瘤组的MRI检查方案普遍欠佳。评估者对于脑干段（0.13）、膝状神经节段（0.10）、鼓室段（0.12）和乳突段（0.13）面神经异常的一致性较差；对于脑池段（0.58）和内耳道段（0.55）的一致性中等；对于迷路段（0.26）和颞外段（0.36）的一致性一般。与真实诊断相比，最终诊断的一致性一般（0.37）。有2例假阴性解读（未能正确识别恶性肿瘤）和1例假阳性解读。
FNP的MRI检查最初常采用不正确的方案，因此即使由经验丰富的临床医生解读，也可能无法可靠地区分肿瘤性FNP与炎性FNP。尽管存在这些局限性，专家阅片者仍正确诊断出了87.5%的FNP恶性病因。
