Service de radiologie 1, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Service de Chirurgie ORL, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Eur Arch Otorhinolaryngol. 2020 Jun;277(6):1601-1608. doi: 10.1007/s00405-020-05854-7. Epub 2020 Feb 18.
The aim of our study was to evaluate the importance of a non-injected T1-weighted spin-echo sequence (T1WSE) combined with a non-echo-planar diffusion-weighted (non-EPDW) sequence for the pre-operative detection of cholesteatoma by the radiologist on MRI, compared to surgery.
In this retrospective case review, 113 patients with chronic otitis underwent surgery (gold standard) for a clinical suspicion of cholesteatoma. Our primary outcome was to compare non-EPDW images + a contrast-free T1WSE sequence for cholesteatoma detection. Our secondary outcome was to quantify the signal intensity value of the suspected lesions, relative to the signal intensity of the cerebellum (Sic) to calculate Signal Intensity Ratios (SIR = SI/Sic). The SIR values of cholesteatomatous and non-cholesteatomatous tissue were compared to surgical findings. Receiver-operating characteristic curve analysis determined an optimum SIR cut-off value for the prediction of cholesteatoma.
The sensitivity (96.9%) of non-EPDW for the diagnosis of cholesteatoma was high, with good specificity (74.2%), and increased to 85.5% when combined to a T1WSE sequence. Additionally, the mean SIR values (on T1WSE) of cholesteatoma were significantly lower than non-cholesteatomatous tissue (p < 0.05). When nonEPDW and T1WSE were combined, a cut-off SIR value < 1.04, diagnosed cholesteatoma pre-operatively with very high specificity and sensibility (92.7% and 90.3% respectively).
Our study showed that combining a nonEPDW sequence with the quantitative analysis of contrast-free T1W SE sequence in pre-operative patients enables the correct diagnosis of cholesteatoma with good sensitivity and specificity (> 90%) and reduces risks of false-positive cases for surgeons.
本研究旨在评估放射科医师在 MRI 术前检测胆脂瘤时，使用非注射 T1 加权自旋回波序列（T1WSE）联合非回波平面扩散加权（non-EPDW）序列的重要性，与手术相比。
在这项回顾性病例研究中，113 例慢性中耳炎患者因临床怀疑胆脂瘤而行手术（金标准）。我们的主要结果是比较 non-EPDW 图像+无对比 T1WSE 序列在胆脂瘤检测中的作用。我们的次要结果是量化可疑病变的信号强度值，相对于小脑（Sic）的信号强度来计算信号强度比（SIR=SI/Sic）。胆脂瘤和非胆脂瘤组织的 SIR 值与手术结果进行比较。接收者操作特征曲线分析确定了预测胆脂瘤的最佳 SIR 截断值。
non-EPDW 对胆脂瘤的诊断灵敏度（96.9%）较高，特异性（74.2%）较好，与 T1WSE 联合时增加到 85.5%。此外，胆脂瘤的平均 SIR 值（在 T1WSE 上）显著低于非胆脂瘤组织（p<0.05）。当 non-EPDW 和 T1WSE 联合使用时，SIR 值<1.04 的截断值可在术前非常高的特异性和敏感性（分别为 92.7%和 90.3%）诊断胆脂瘤。
我们的研究表明，在术前患者中，将 non-EPDW 序列与无对比 T1WSE 序列的定量分析相结合，可以以良好的灵敏度和特异性（>90%）正确诊断胆脂瘤，并降低手术中假阳性病例的风险。
