Department of Otolaryngology, Ospedale B Ramazzini di Carpi, AUSL Modena, Carpi, Italy.
Department of Otolaryngology - Head and Neck Surgery, Azienda Ospedaliero Universitaria di Modena, Modena, Italy.
J Laryngol Otol. 2024 May;138(5):507-511. doi: 10.1017/S0022215123002001. Epub 2023 Nov 17.
To evaluate if fusion computed tomography-diffusion-weighted magnetic resonance imaging may have a role in the pre-operative assessment of congenital middle-ear cholesteatoma.
A retrospective chart review of surgically treated congenital middle-ear cholesteatoma patients over a 2-year timespan was conducted. Pre-operative staging was performed on computed tomography and fusion computed tomography-diffusion-weighted magnetic resonance imaging based on extension of the disease according to the ChOLE classification system and the Potsic classification system. Intra-operative staging was compared to imaging findings to evaluate accuracy of the two imaging modalities in predicting congenital middle-ear cholesteatoma extent.
Computed tomography was able to correctly predict congenital middle-ear cholesteatoma extent in three out of six cases according to the ChOLE classification system, all of which were staged as Ch1a and Ch1b on pre-operative computed tomography. Cases in which computed tomography was not able correctly to determine congenital middle-ear cholesteatoma extent were staged as Ch3 on pre-operative computed tomography. Fusion scans correctly determined congenital middle-ear cholesteatoma extent in all cases according to the ChOLE classification.
Fusion computed tomography-diffusion-weighted magnetic resonance imaging may be helpful in cases of congenital middle-ear cholesteatoma where pre-operative computed tomography shows mastoid and antrum opacification, in which computed tomography alone may overestimate cholesteatoma extension beyond the level of the lateral semi-circular canal.
评估融合 CT-弥散加权磁共振成像在先天性中耳胆脂瘤术前评估中的作用。
对 2 年内接受手术治疗的先天性中耳胆脂瘤患者进行回顾性图表审查。根据 ChOLE 分类系统和 Potsic 分类系统，根据疾病的扩展情况，在 CT 及融合 CT-弥散加权磁共振成像上进行术前分期。术中分期与影像学发现进行比较，以评估两种影像学方法在预测先天性中耳胆脂瘤范围方面的准确性。
根据 ChOLE 分类系统，CT 能正确预测 6 例中的 3 例先天性中耳胆脂瘤的范围，这 3 例在术前 CT 上均分期为 Ch1a 和 Ch1b。CT 不能正确确定先天性中耳胆脂瘤范围的病例在术前 CT 上分期为 Ch3。根据 ChOLE 分类，融合扫描能正确确定所有病例的先天性中耳胆脂瘤范围。
对于术前 CT 显示乳突和窦腔混浊的先天性中耳胆脂瘤病例，融合 CT-弥散加权磁共振成像可能有助于确定胆脂瘤是否延伸至外半规管水平以上，单凭 CT 可能会高估胆脂瘤的扩展范围。
