Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
Cochlear Ltd., Sydney, Australia.
BMC Med Imaging. 2023 Sep 29;23(1):143. doi: 10.1186/s12880-023-01102-6.
A manual evaluation of the CI electrode position from CT and DVT scans may be affected by diagnostic errors due to cognitive biases. The aim of this study was to compare the CI electrode localization using an automated method (image-guided cochlear implant programming, IGCIP) with the clinically established manual method.
This prospective experimental study was conducted on a dataset comprising N=50 subjects undergoing cochlear implantation with a Nucleus® CI532 or CI632 Slim Modiolar electrode. Scalar localization, electrode-to-modiolar axis distances (EMD) and angular insertion depth (aDOI) were compared between the automated IGCIP tool and the manual method. Two raters made the manual measurements, and the interrater reliability (±1.96·SD) was determined as the reference for the method comparison. The method comparison was performed using a correlation analysis and a Bland-Altman analysis.
Concerning the scalar localization, all electrodes were localized both manually and automatically in the scala tympani. The interrater differences ranged between ±0.2 mm (EMD) and ±10° (aDOI). There was a bias between the automatic and manual method in measuring both localization parameters, which on the one hand was smaller than the interrater variations. On the other hand, this bias depended on the magnitude of the EMD respectively aDOI. A post-hoc analysis revealed that the deviations between the methods were likely due to a different selection of mid-modiolar axis.
The IGCIP is a promising tool for automated processing of CT and DVT scans and has useful functionality such as being able to segment the cochlear using post-operative scans. When measuring EMD, the IGCIP tool is superior to the manual method because the smallest possible distance to the axis is determined depending on the cochlear turn, whereas the manual method selects the helicotrema as the reference point rigidly. Functionality to deal with motion artifacts and measurements of aDOI according to the consensus approach are necessary, otherwise the IGCIP is not unrestrictedly ready for clinical use.
从 CT 和 DVT 扫描中手动评估 CI 电极位置可能会受到认知偏差导致的诊断错误的影响。本研究的目的是比较使用自动方法（图像引导人工耳蜗编程，IGCIP）与临床既定的手动方法进行 CI 电极定位。
本前瞻性实验研究共纳入 50 例接受 Nucleus® CI532 或 CI632 Slim 调制极人工耳蜗植入的患者。对自动 IGCIP 工具和手动方法的标量定位、电极到调制极轴的距离（EMD）和角插入深度（aDOI）进行了比较。两名评估者进行了手动测量，并确定了评估者间的可靠性（±1.96·SD）作为方法比较的参考。使用相关分析和 Bland-Altman 分析进行了方法比较。
在标量定位方面，所有电极均在人工耳蜗植入术的鼓室内进行了手动和自动定位。评估者间的差异在±0.2mm（EMD）和±10°（aDOI）之间。自动和手动方法在测量这两种定位参数时都存在偏差，一方面，这种偏差小于评估者间的差异。另一方面，这种偏差取决于 EMD 或 aDOI 的大小。事后分析表明，两种方法之间的偏差可能是由于选择了不同的中调制极轴。
IGCIP 是一种用于 CT 和 DVT 扫描自动处理的有前途的工具，它具有有用的功能，例如能够使用术后扫描分割耳蜗。在测量 EMD 时，IGCIP 工具优于手动方法，因为它根据耳蜗的转数确定与轴的最小距离，而手动方法则刚性地选择螺旋孔作为参考点。需要具备处理运动伪影的功能和根据共识方法测量 aDOI，否则 IGCIP 还不能不受限制地用于临床。
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