Eggink Maura C, de Wolf Maarten J F, Ebbens Fenna A, de Win Maartje M L, Dikkers Frederik G, van Spronsen Erik
Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam University Medical Centre, Location University of Amsterdam, Amsterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Location University of Amsterdam, Amsterdam, The Netherlands.
Eur Arch Otorhinolaryngol. 2025 Feb;282(2):659-668. doi: 10.1007/s00405-024-08939-9. Epub 2024 Sep 13.
To analyse diagnostic accuracy of MRI-DWI in detecting residual disease after cholesteatoma surgery and propose an optimum follow-up (FU) scheme.
A retrospective chart review of patients who had cholesteatoma surgery in a tertiary referral centre. 3.0 T non-echo planar diffusion weighted imaging was performed as part of routine FU or indicated on the basis of clinical suspicion of disease. Imaging outcome was verified per-operatively during a second-look procedure or ossicular chain reconstruction. Diagnostic parameters were calculated and stratified by FU length.
For the FU of 664 cholesteatoma surgeries, 1208 MRI-DWI were obtained and 235 second-look procedures were performed. Most MRI-DWI were obtained within 1.5 yrs of surgery. In this period, significantly less true positive MRI-DWI and significantly more false negative MRI-DWI for residual disease were found compared to other FU periods. Scanning after approximately 3 yrs yielded a significantly higher rate of true positive MRI-DWI, while sensitivity surpassed 80%. Younger patients had a higher risk of developing residual disease. Patients undergoing canal wall up surgery, as well as patients < 12 yrs, were at risk for false negative MRI-DWI. Obliteration reduces the risk of residual disease, while leading to less false negative MRI-DWI.
A novel radiologic FU scheme for detecting residual disease is suggested for stable ears after cholesteatoma surgery: standard MRI-DWI approximately 3 and 5 yrs after primary surgery, as well as MRI-DWI after approximately 9 yrs for patients with specific risk factors (i.e., patients < 12 yrs or patients undergoing canal wall up surgery without obliteration).
分析磁共振成像扩散加权成像（MRI-DWI）在胆脂瘤手术后检测残留疾病的诊断准确性，并提出最佳随访方案。
对在一家三级转诊中心接受胆脂瘤手术的患者进行回顾性病历审查。3.0T非回波平面扩散加权成像作为常规随访的一部分进行，或根据临床疾病怀疑进行。成像结果在二次探查手术或听骨链重建术中进行术中验证。计算诊断参数并按随访时间分层。
对664例胆脂瘤手术进行随访，共获得1208次MRI-DWI检查，并进行了235次二次探查手术。大多数MRI-DWI检查在术后1.5年内进行。在此期间，与其他随访期相比，残留疾病的真阳性MRI-DWI显著减少，假阴性MRI-DWI显著增加。术后约3年进行扫描，真阳性MRI-DWI的发生率显著更高，而敏感性超过80%。年轻患者发生残留疾病的风险更高。接受外耳道上壁重建手术的患者以及年龄小于12岁的患者存在MRI-DWI假阴性风险。填塞可降低残留疾病的风险，同时减少MRI-DWI假阴性。
对于胆脂瘤手术后耳部稳定的患者，建议采用一种新的放射学随访方案来检测残留疾病：初次手术后约3年和5年进行标准MRI-DWI检查，对于具有特定风险因素的患者（即年龄小于12岁或接受外耳道上壁重建手术且未进行填塞的患者），在术后约9年进行MRI-DWI检查。
