Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Pediatr Otorhinolaryngol. 2022 Jul;158:111172. doi: 10.1016/j.ijporl.2022.111172. Epub 2022 May 4.
Non-echo-planar diffusion weighted magnetic resonance imaging (Non-EPI DWI MRI) is commonly used for follow-up after cholesteatoma surgery. MRI has a critical role in the evaluation of residual disease, where physical examination will commonly demonstrate an intact tympanic membrane. The aim of our study was to assess the timing of residual cholesteatoma identification on serial MRI scans and the yield of MRI follow up after canal wall up tympano-mastoidectomy.
A retrospective chart review of children that underwent canal wall up tympano-mastoidectomy due to cholesteatoma in Schneider Children's Medical Center during 2004-2016, and were followed up both clinically and with MRI.
Seventy-seven children (89 ears) were included, who altogether underwent 166 surgeries (77 revisions). Average follow-up was 66 ± 34.4 months. During follow up, 244 scans were performed; 19 cases of residual disease were diagnosed by MRI and confirmed in surgery. The mean time from surgery and an MRI positive for residual disease was 29.7 ± 16 months (range: 10-66). In 9/19 cases (47%), at least one negative MRI preceded the scan positive for residual disease, and in 4 cases at least two initial scans were negative.
MRI plays an important role in the diagnosis of residual disease after cholesteatoma surgery. In our cohort. Almost half of the cases diagnosed with residual disease had at least one negative scan prior to the positive one, emphasizing the importance of close radiological follow-up with serial scans after surgery.
非回波平面弥散加权磁共振成像（Non-EPI DWI MRI）常用于胆脂瘤手术后的随访。MRI 在评估残留病变方面具有重要作用，而体格检查通常显示鼓膜完整。本研究的目的是评估连续 MRI 扫描中残留胆脂瘤的识别时间以及完壁式鼓室乳突根治术后 MRI 随访的效果。
回顾性分析 2004 年至 2016 年在施耐德儿童医疗中心因胆脂瘤而行完壁式鼓室乳突根治术并接受临床和 MRI 随访的儿童患者的病历。
共纳入 77 例（89 耳）患儿，共行 166 次手术（77 次翻修）。平均随访时间为 66±34.4 个月。在随访期间，共进行了 244 次扫描；19 例 MRI 诊断为残留病变并经手术证实。从手术到 MRI 诊断为残留病变的平均时间为 29.7±16 个月（范围：10-66）。在 19 例（47%）中，至少有一次 MRI 检查为阴性，随后才出现阳性结果，4 例至少有两次初始 MRI 检查为阴性。
MRI 在胆脂瘤手术后残留病变的诊断中具有重要作用。在本研究队列中，近一半诊断为残留病变的病例在阳性 MRI 扫描前至少有一次阴性扫描，这强调了手术后进行密切的放射学随访和连续扫描的重要性。
