Pfeiffer Christoph J, Mihailovic Denis, Gehl Hans-Björn, Scholtz Lars-Uwe, Kilgue Alexander, Riemann Conrad, Voeltz Dina, Todt Ingo
Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Klinikum Bielefeld Mitte, Bielefeld University, Teutoburger Str. 50, 33604 Bielefeld, Germany.
Department of Radiology, Medical School OWL, Klinikum Bielefeld Mitte, Bielefeld University, Teutoburger Str. 50, 33604 Bielefeld, Germany.
J Clin Med. 2025 Apr 26;14(9):2995. doi: 10.3390/jcm14092995.
: Surgical removal is the treatment of choice for cholesteatoma control. Depending on the size, the surgery involves partial resection of the ossicular chain and, if necessary, the bony skull base. Titanium foreign materials (prostheses, meshes) can be used to restore sound transmission and to cover larger defects of the skull base. After the operation, recurrence and residual control are necessary. This can be achieved by means of second-look surgery or an MRI examination with a non-EPI DWI sequence. Similarly to other metal implants, artifacts may occur in the image due to the titanium used. In this study, we assessed the magnitude of the MRI hardware differences induced by titanium prostheses and meshes and whether these differences could obscure cholesteatoma detection. : 28 MRI examinations (T1-, T2-, non-EPI DWI sequences) in 14 males and 14 females (5.2-92.4 years) after cholesteatoma surgery and single-staged implantation of a PORP, TORP, or titanium mesh were considered. The size of the respective artifacts was measured, and the mean artifact sizes of the respective prosthesis types were compared. A second look surgery was performed in all cases due to the MRI result or clinical findings. Both were also compared. : Artifacts occurred in all titanium foreign bodies depending on the used MRI sequence (PORP, TORP, Mesh). We found a positive association between the size of the prosthesis and the size of the artifact. All subsequent second-look surgeries confirmed the MRI examinations according to a positive control for the presence of cholesteatoma. The detection rate was 82.1%. All false results were false negatives, and there were no positive results. : Titanium material-related artifacts might influence the MRI detectability of recurrent cholesteatoma. Small cholesteatoma might be missed by an MRI-based follow-up. This finding supports the reevaluation of single-stage versus staged reconstruction modern approaches.
手术切除是控制胆脂瘤的首选治疗方法。根据胆脂瘤大小，手术包括听骨链部分切除，必要时还包括颅底骨切除。可使用钛质异物（假体、网片）来恢复声音传导并覆盖较大的颅底缺损。术后，有必要进行复发和残留情况的控制。这可通过二次探查手术或采用非回波平面扩散加权成像序列的磁共振成像（MRI）检查来实现。与其他金属植入物类似，由于使用了钛，图像中可能会出现伪影。在本研究中，我们评估了钛质假体和网片引起的MRI硬件差异程度，以及这些差异是否会掩盖胆脂瘤的检测。：对14名男性和14名女性（年龄5.2 - 92.4岁）在胆脂瘤手术后单阶段植入部分听骨赝复物（PORP）、全听骨赝复物（TORP）或钛网后进行的28次MRI检查（T1、T2、非回波平面扩散加权成像序列）进行了分析。测量了各个伪影的大小，并比较了各假体类型的平均伪影大小。由于MRI结果或临床发现，所有病例均进行了二次探查手术。同时对二者进行了比较。：根据所使用的MRI序列（PORP、TORP、网片），所有钛质异物均出现了伪影。我们发现假体大小与伪影大小之间存在正相关。所有后续的二次探查手术均根据胆脂瘤存在的阳性对照证实了MRI检查结果。检测率为82.1%。所有假结果均为假阴性，无假阳性结果。：钛材料相关伪影可能会影响复发性胆脂瘤的MRI可检测性。基于MRI的随访可能会漏诊小的胆脂瘤。这一发现支持对单阶段与分期重建的现代方法进行重新评估。
