Balik Ayse Ozlem, Seneldir Lutfu, Verim Aysegul, Zer Toros Sema
University of Health Sciences Turkey, Haydarpasa Numune Training and Research Hospital, Clinic of Radiology, Istanbul, Turkey.
University of Health Sciences Turkey, Haydarpasa Numune Training and Research Hospital, Clinic of Otorhinolaryngology, Istanbul, Turkey.
Medeni Med J. 2022 Mar 18;37(1):13-20. doi: 10.4274/MMJ.galenos.2022.28928.
In recent years, the fusion of computed tomography (CT) and non-echo-planar diffusion-weighted magnetic resonance imaging (non-EPI DWI) has been preferred in cholesteatoma localizations. This study aimed to investigate the role of CT and non-EPI DWI fusion imaging in cholesteatoma localizations.
This retrospective study included 39 patients who underwent chronic otitis media operation [mean age of 35.10±15.33 years (18-67 years), 64.1% female, and 35.9% male] and had preoperative high-resolution temporal bone CT and non-EPI DWI examinations. Images were sent to the Advantage Workstation VolumeShare 7 for fusion. These selected images were fused on the workstation and were manually corrected by the radiologist. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies of fused images of CT and non-EPI DWI were evaluated according to anatomic cholesteatoma localizations based on surgical data.
The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies of non-EPI DWI for detecting cholesteatomas were 97.14%, 75.00%, 97.14%, 75.00%, and 94.87%, respectively. Three true-negative, one false-positive, and one false-negative case were observed according to surgical results in detecting the presence of a cholesteatoma with non-EPI DWI. Moderate agreement was determined between the surgical and radiological results in detecting the presence of a cholesteatoma (k=0.721). Detecting the lesion of localization on the fused images compared to surgical found an almost perfect agreement in the mastoid antrum (k=0.948), strong agreement in the hypotympanum and mastoid cells (k=0.894), moderate agreement in the epitympanum (k=0.653), and weak agreement in those in the mesotympanum (k=0.540).
The surgeons' determinations are supported by the guidance of temporal CT and non-EPI DWI fused images. Therefore, preferring the fusion imaging technique could increase the quality of life by reducing unnecessary operations.
近年来，计算机断层扫描（CT）与非回波平面扩散加权磁共振成像（非EPI DWI）融合技术在胆脂瘤定位中更受青睐。本研究旨在探讨CT与非EPI DWI融合成像在胆脂瘤定位中的作用。
本回顾性研究纳入了39例行慢性中耳炎手术的患者[平均年龄35.10±15.33岁（18 - 67岁），女性占64.1%，男性占35.9%]，这些患者术前均接受了高分辨率颞骨CT及非EPI DWI检查。图像被发送至Advantage Workstation VolumeShare 7进行融合。在工作站上对这些选定图像进行融合，并由放射科医生进行手动校正。根据基于手术数据的解剖学胆脂瘤定位，评估CT与非EPI DWI融合图像的敏感性、特异性、阳性和阴性预测值以及诊断准确性。
非EPI DWI检测胆脂瘤的敏感性、特异性、阳性和阴性预测值以及诊断准确性分别为97.14%、75.00%、97.14%、75.00%和94.87%。根据手术结果，在通过非EPI DWI检测胆脂瘤的存在时，观察到3例假阴性、1例假阳性和1例假阴性病例。在检测胆脂瘤的存在方面，手术结果与放射学结果之间存在中度一致性（k = 0.721）。与手术结果相比，在融合图像上检测定位病变时，乳突窦显示几乎完美的一致性（k = 0.948），下鼓室和乳突气房显示强一致性（k = 0.894），上鼓室显示中度一致性（k = 0.653），中鼓室显示弱一致性（k = 0.540）。
颞骨CT与非EPI DWI融合图像的引导为外科医生的判断提供了支持。因此，采用融合成像技术可通过减少不必要的手术来提高生活质量。
