Wang Jiahao, Liu Yunfu, Ma Xiaobo, Liu Zhaohui, Lu Xiaomei, Zhang Yongxian, Liu Dandan, Niu Yantao
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing 100050, China (J.W., Y.N.).
Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No.1 DongJiaoMinXiang Street, DongCheng District, Beijing 100730, China (Y.L., Z.L., Y.Z., D.L.).
Acad Radiol. 2025 Sep;32(9):5488-5496. doi: 10.1016/j.acra.2025.05.044. Epub 2025 Jun 9.
Accurate early localization of temporal bone cholesteatoma is essential for determining the most appropriate surgical approach. Dual-layer detector spectral CT (DLCT) with multi-parameter spectral imaging has significantly improved soft tissue resolution. This study aims to investigate the value of dual-layer detector spectral CT multimodal parameters in the localization diagnosis of cholesteatoma of the temporal bone.
A retrospective analysis was conducted on dual-layer spectral CT images of 45 patients with middle ear or external auditory canal cholesteatoma, collected between May 2024 and March 2025. The surgeon recorded the extent of cholesteatoma involvement during surgery. Regions of interest (ROIs) were placed on corresponding lesions in different anatomical locations on the spectral CT images, including cholesteatoma tissue and non-cholesteatoma tissues (such as cholesterol granulomas and inflammatory fluids). These lesions were then compared to the histologically and surgically confirmed components at the same anatomical sites. For each ROI, conventional CT value (CT), the 40 keV single-energy CT value (CT), effective atomic number (Z), electron density (ED), and the 40-80keV slope (λ) were recorded and used to compare the DLCT parameters of different pathological components at various anatomical sites.
A total of 45 cholesteatoma patients were included in this study, comprising 106 cholesteatoma lesions and 70 non-cholesteatoma lesions. The λ, CT, and Z showed statistically significant differences between the two groups and demonstrated optimal diagnostic performance, with AUC values of 0.839, 0.856, and 0.869, respectively. The subjective diagnostic accuracy of DLCT for cholesteatoma lesions was 89.8%, with a sensitivity of 82.86%, specificity of 93.33%, positive predictive value (PPV) of 86.14%, and negative predictive value (NPV) of 91.59%. The Kappa value for the agreement with intraoperative findings was 0.809. No significant difference was observed in CT and ED between the two groups.
Dual-layer detector spectral CT demonstrates high accuracy in the locational diagnosis of temporal bone cholesteatoma. It has significant potential for preoperative evaluation of cholesteatoma lesions, assisting surgeons in selecting the optimal surgical approach.
准确早期定位颞骨胆脂瘤对于确定最合适的手术入路至关重要。具有多参数光谱成像的双层探测器光谱CT（DLCT）显著提高了软组织分辨率。本研究旨在探讨双层探测器光谱CT多模态参数在颞骨胆脂瘤定位诊断中的价值。
对2024年5月至2025年3月期间收集的45例中耳或外耳道胆脂瘤患者的双层光谱CT图像进行回顾性分析。外科医生记录手术中胆脂瘤的累及范围。在光谱CT图像上不同解剖位置的相应病变处放置感兴趣区域（ROI），包括胆脂瘤组织和非胆脂瘤组织（如胆固醇肉芽肿和炎性液）。然后将这些病变与相同解剖部位经组织学和手术证实的成分进行比较。对于每个ROI，记录常规CT值（CT）、40keV单能量CT值（CT）、有效原子序数（Z）、电子密度（ED）以及40 - 80keV斜率（λ），并用于比较不同解剖部位不同病理成分的DLCT参数。
本研究共纳入45例胆脂瘤患者，包括106个胆脂瘤病变和70个非胆脂瘤病变。两组之间的λ、CT和Z显示出统计学显著差异，并表现出最佳诊断性能，AUC值分别为0.839、0.856和0.869。DLCT对胆脂瘤病变的主观诊断准确率为89.8%，敏感性为82.86%，特异性为93.33%，阳性预测值（PPV）为86.14%，阴性预测值（NPV）为91.59%。与术中发现的一致性的Kappa值为0.809。两组之间的CT和ED未观察到显著差异。
双层探测器光谱CT在颞骨胆脂瘤的定位诊断中显示出高准确性。它在胆脂瘤病变的术前评估中具有巨大潜力，有助于外科医生选择最佳手术入路。
