İzmir City Hospital, Clinic of Radiology, İzmir, Türkiye
İzmir City Hospital, Clinic of Otolaryngology Head and Neck Surgery, İzmir, Türkiye
Diagn Interv Radiol. 2024 Nov 6;30(6):370-377. doi: 10.4274/dir.2024.242767. Epub 2024 May 27.
To evaluate the diagnostic efficacy of multishot echo-planar imaging (EPI) [RESOLVE (RS)] and non-EPI (HASTE) diffusion-weighted imaging (DWI) in detecting cholesteatoma (CHO), and to explore the role of signal intensity (SI) ratio measurements in addressing diagnostic challenges.
We analyzed RS-EPI and non-EPI DWI images from 154 patients who had undergone microscopic middle ear surgery, with pathological confirmation of their diagnoses. Two radiologists, referred to as Reader A and Reader B, independently reviewed the images without prior knowledge of the outcomes. Their evaluation focused on lesion location, T1-weighted (T1W) signal characteristics, and contrast enhancement in temporal bone magnetic resonance imaging. Key parameters included lesion hyperintensity, size, SI, SI ratio, and susceptibility artifact scores across both imaging modalities.
Of the patients, 62.3% (96/154) were diagnosed with CHO, whereas 37.7% (58/154) were found to have non-CHO conditions. In RS-EPI DWI, Reader A achieved 89.6% sensitivity, 79.3% specificity, 87.8% positive predictive value (PPV), and 82.1% negative predictive value (NPV). Non-EPI DWI presented similar results with sensitivities of 89.6%, specificities of 86.2%, PPVs of 91.5%, and NPVs of 83.3%. Reader B’s results for RS-EPI DWI were 82.3% sensitivity, 84.5% specificity, 89.8% PPV, and 74.2% NPV, whereas, for non-EPI DWI, they were 86.5% sensitivity, 89.7% specificity, 93.3% PPV, and 80% NPV. The interobserver agreement was excellent (RS-EPI, κ: 0.84; non-EPI, κ: 0.91). The SI ratio measurements were consistently higher in non-EPI DWI (Reader A: 2.51, Reader B: 2.46) for the CHO group compared with RS-EPI. The SI ratio cut-off (>1.98) effectively differentiated hyperintense lesions between CHO and non-CHO groups, demonstrating 82.9% sensitivity and 100% specificity, with an area under the curve of 0.901 (95% confidence interval: 0.815–0.956; < 0.001). Susceptibility artifact scores averaged 1.18 ± 0.7 (Reader A) and 1.04 ± 0.41 (Reader B) in RS-EPI, with non-EPI DWI recording a mean score of 0.
Both RS-EPI and non-EPI DWI exhibited high diagnostic accuracy for CHO. While RS-EPI DWI cannot replace non-EPI DWI, their combined use improves sensitivity. SI ratio measurement in non-EPI DWI was particularly beneficial in complex diagnostic scenarios.
This study refines CHO diagnostic protocols by showcasing the diagnostic capabilities of both RS-EPI and non-EPI DWI and highlighting the utility of SI measurements as a diagnostic tool. These findings may reduce false positives and aid in more accurate treatment planning, offering substantial insights for clinicians in managing CHO.
评估多回波平面成像（EPI）[RESOLVE（RS）]和非 EPI（HASTE）扩散加权成像（DWI）在检测胆脂瘤（CHO）中的诊断效能，并探讨信号强度（SI）比值测量在解决诊断挑战中的作用。
我们分析了 154 例接受显微镜下中耳手术的患者的 RS-EPI 和非 EPI DWI 图像，这些患者的病理诊断均得到证实。两位放射科医生（称为读者 A 和读者 B）独立地在没有预先了解结果的情况下对图像进行了评估。他们的评估重点是病变位置、T1 加权（T1W）信号特征和颞骨磁共振成像的对比增强。关键参数包括病变高信号、大小、SI、SI 比值和两种成像方式的磁化率伪影评分。
在这 154 例患者中，62.3%（96/154）被诊断为 CHO，37.7%（58/154）被诊断为非 CHO 病变。在 RS-EPI DWI 中，读者 A 的敏感性为 89.6%，特异性为 79.3%，阳性预测值（PPV）为 87.8%，阴性预测值（NPV）为 82.1%。非 EPI DWI 呈现出相似的结果，敏感性为 89.6%，特异性为 86.2%，PPV 为 91.5%，NPV 为 83.3%。读者 B 在 RS-EPI DWI 中的结果为敏感性 82.3%，特异性 84.5%，PPV 为 89.8%，NPV 为 74.2%，而非 EPI DWI 的结果为敏感性 86.5%，特异性 89.7%，PPV 为 93.3%，NPV 为 80%。观察者间一致性极好（RS-EPI，κ：0.84；非 EPI，κ：0.91）。SI 比值测量在 CHO 组中，非 EPI DWI（读者 A：2.51，读者 B：2.46）的测量值始终高于 RS-EPI。SI 比值截断值（>1.98）有效地将 CHO 组和非 CHO 组的高信号病变区分开来，其敏感性为 82.9%，特异性为 100%，曲线下面积为 0.901（95%置信区间：0.815-0.956；<0.001）。RS-EPI 的磁化率伪影评分平均为 1.18±0.7（读者 A）和 1.04±0.41（读者 B），而非 EPI DWI 的平均评分则为 0。
RS-EPI 和非 EPI DWI 对 CHO 的诊断准确性均较高。尽管 RS-EPI DWI 不能替代非 EPI DWI，但联合使用可提高敏感性。非 EPI DWI 中的 SI 比值测量在复杂的诊断情况下特别有益。
本研究通过展示 RS-EPI 和非 EPI DWI 的诊断能力，并强调 SI 测量作为一种诊断工具的实用性，从而完善了 CHO 诊断方案。这些发现可能会减少假阳性并有助于更准确的治疗计划，为临床医生在管理 CHO 方面提供了有价值的见解。
