Department of Radiology (J.C.B., J.I.L.)
Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, Rochester, Minnesota.
AJNR Am J Neuroradiol. 2021 Mar;42(3):573-577. doi: 10.3174/ajnr.A6911. Epub 2020 Dec 17.
Although multishot EPI (readout-segmented EPI) has been touted as a robust DWI sequence for cholesteatoma evaluation, its efficacy in disease detection compared with a non-EPI (eg, HASTE) technique is unknown. This study sought to compare the accuracy of readout-segmented EPI with that of HASTE DWI in cholesteatoma detection.
A retrospective review was completed of consecutive patients who underwent MR imaging for the evaluation of suspected primary or recurrent/residual cholesteatomas. Included patients had MR imaging examinations that included both HASTE and readout-segmented EPI sequences and confirmed cholesteatomas on a subsequent operation. Two neuroradiologist reviewers assessed all images, with discrepancies resolved by consensus. The ratio of signal intensity between the cerebellum and any observed lesion was noted.
Of 23 included patients, 12 (52.2%) were women (average age, 47.8 [SD, 25.2] years). All patients had surgically confirmed cholesteatomas: Six (26.1%) were primary and 17 (73.9%) were recidivistic. HASTE images correctly identified cholesteatomas in 100.0% of patients. On readout-segmented EPI sequences, 16 (69.6%) were positive, 5 (21.7%) were equivocal, and 2 (8.7%) were falsely negative. Excellent interobserver agreement was noted between reviews on both HASTE (κ = 1.0) and readout-segmented EPI (κ = 0.9) sequences. The average signal intensity ratio was significantly higher on HASTE than in readout-segmented EPI, facilitating enhanced detection (mean difference 0.5; 95% CI, 0.3-0.8; = .003).
HASTE outperforms readout-segmented EPI in the detection of primary cholesteatoma and disease recidivism.
尽管多回波 EPI（分段读出 EPI）已被吹捧为胆脂瘤评估的强大 DWI 序列，但与非 EPI（例如 HASTE）技术相比，其在疾病检测中的功效尚不清楚。本研究旨在比较分段读出 EPI 与 HASTE DWI 在胆脂瘤检测中的准确性。
对连续接受 MRI 检查以评估疑似原发性或复发性/残留胆脂瘤的患者进行了回顾性研究。纳入的患者均行 MRI 检查，包括 HASTE 和分段读出 EPI 序列，且术后均证实有胆脂瘤。两名神经放射科医生对所有图像进行评估，意见不一致时通过共识解决。记录小脑与任何观察到的病变之间的信号强度比。
23 例患者中，12 例（52.2%）为女性（平均年龄 47.8 [标准差 25.2] 岁）。所有患者均经手术证实有胆脂瘤：6 例（26.1%）为原发性，17 例（73.9%）为复发性。HASTE 图像可 100.0%正确识别胆脂瘤。在分段读出 EPI 序列上，16 例（69.6%）为阳性，5 例（21.7%）为不确定，2 例（8.7%）为假阴性。HASTE 和分段读出 EPI 序列的观察者间一致性均极好（κ = 1.0 和 κ = 0.9）。HASTE 的平均信号强度比明显高于分段读出 EPI，有助于增强检测（平均差异 0.5；95%CI，0.3-0.8；= 0.003）。
HASTE 在检测原发性胆脂瘤和疾病复发方面优于分段读出 EPI。
