Zhou Shuang Yuan, Liu Heng, Jiang Lu, Nie Ze Qun, Li Juan, Yu Xin Chen, Liu Xiao Min, Su Yin Jie, Mei Ling Yun
Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Eur Radiol. 2025 Jul 19. doi: 10.1007/s00330-025-11815-7.
To investigate the diagnostic performance of dual-layer spectral detector CT (DLCT) in differentiating middle ear cholesteatoma and chronic suppurative otitis media (CSOM).
This prospective, institutional review board-approved study consecutively enrolled patients with suspected middle ear cholesteatoma or CSOM from January to July 2024. All participants underwent DLCT scanning before surgery. Clinical average hearing threshold (AHT) was collected. Four blinded readers, with 2, 3, 11, and 13 years of experience, independently provided diagnoses, based on high-resolution CT (HRCT) or HRCT combined spectral images (integrated mode). Virtual mono-energetic images (VMIs) at 40 keV, spectral attenuation slope (λHU), and effective atomic number (Zeff) were measured. Intraoperative or pathological findings served as reference standards. Receiver operating characteristic (ROC) curve analysis was used.
Sixty-six participants (median age, 47.0 [33.0-55.0] years; 23 men, 33 with cholesteatoma) were included. The sensitivity of the integrated mode was 87.9%, significantly higher than HRCT alone (68.2%; p < 0.001), while specificities were 73.5% and 79.5% (p = 0.169), respectively. Diagnostic confidence scores of the integrated mode were significantly higher (p < 0.001). The Zeff, λHU, and VMI 40 keV of cholesteatoma were significantly lower (p < 0.001) than those of CSOM. AUCs of combined spectral model, integrated model and integrated model + AHT were 0.820 (95% CI: 0.744-0.882, p = 0.01), 0.817 (95% CI: 0.744-0.891, p = 0.017),0.853 (95% CI: 0.789-0.917, p = 0.001), respectively, all significantly higher than that of conventional HRCT (AUC = 0.741; 95% CI: 0.657-0.813).
HRCT combined with spectral images enhances the sensitivity of cholesteatoma diagnosis, and DLCT multi-parameters can quantitatively distinguish cholesteatoma from CSOM.
Question HRCT is limited in differentiating middle ear cholesteatoma and CSOM. Findings Integrating HRCT and spectral images in DLCT increases the diagnostic sensitivity for cholesteatoma. Clinical relevance DLCT can provide valuable multi-parametric images. Its combination with HRCT significantly improves the diagnostic performance of middle ear cholesteatoma and CSOM, which may help clinicians make reasonable treatment plans.
探讨双层光谱探测器CT（DLCT）在鉴别中耳胆脂瘤和慢性化脓性中耳炎（CSOM）方面的诊断性能。
本前瞻性、经机构审查委员会批准的研究于2024年1月至7月连续纳入疑似中耳胆脂瘤或CSOM的患者。所有参与者在手术前行DLCT扫描。收集临床平均听力阈值（AHT）。四名分别具有2年、3年、11年和13年经验的盲法阅片者基于高分辨率CT（HRCT）或HRCT联合光谱图像（整合模式）独立给出诊断。测量40 keV的虚拟单能量图像（VMI）、光谱衰减斜率（λHU）和有效原子序数（Zeff）。术中或病理结果作为参考标准。采用受试者操作特征（ROC）曲线分析。
纳入66名参与者（中位年龄47.0[33.0 - 55.0]岁；男性23名，胆脂瘤患者33名）。整合模式的灵敏度为87.9%，显著高于单纯HRCT（68.2%；p < 0.001），而特异度分别为73.5%和79.5%（p = 0.169）。整合模式的诊断置信度评分显著更高（p < 0.001）。胆脂瘤的Zeff、λHU和40 keV的VMI显著低于CSOM（p < 0.001）。联合光谱模型、整合模型和整合模型 + AHT的曲线下面积（AUC）分别为0.820（95%CI：0.744 - 0.882，p = 0.01）、0.817（95%CI：0.744 - 0.891，p = 0.017）、0.853（95%CI：0.789 - 0.917, p = 0.001），均显著高于传统HRCT的AUC（AUC = 0.741；95%CI：0.657 - 0.813）。
HRCT联合光谱图像可提高胆脂瘤诊断的灵敏度，DLCT多参数可定量区分胆脂瘤与CSOM。
问题HRCT在鉴别中耳胆脂瘤和CSOM方面存在局限性。发现将HRCT与DLCT中的光谱图像相结合可提高胆脂瘤的诊断灵敏度。临床意义DLCT可提供有价值的多参数图像。其与HRCT的联合显著提高了中耳胆脂瘤和CSOM的诊断性能，这可能有助于临床医生制定合理的治疗方案。
