磁共振弥散加权成像在中耳胆脂瘤精准诊断中的应用价值  

Application of diffusion weighted imaging in accurate diagnosis of middle ear cholesteatoma

作　　者：郭芳 张德军[1] 傅则名[1] 郭颖媛[1] 万怡宁 管国芳[1] 吕俊峰[2] 陈秀英[2] Guo Fang;Zhang Dejun;Fu Zeming;Guo Yingyuan;Wan Yining;Guan Guofang;Lyu Junfeng;Chen Xiuying(Department of Otorhinolaryngology Head and Neck Surgery,the Second Hospital of Jilin University,Changchun 130041,China;Department of Radiology,the Second Hospital of Jilin University,Changchun 130041,China)

机构地区：[1]吉林大学第二医院耳鼻咽喉头颈外科,长春130041 [2]吉林大学第二医院放射线科,长春130041

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第11期1037-1042,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨磁共振弥散加权成像(diffusion weighted imaging,DWI)联合颞骨高分辨CT(high resolution computed tomography,HRCT)定位初发中耳胆脂瘤的准确性以及对胆脂瘤术后随访复查的价值。方法选取初发胆脂瘤患者134例、疑似复发性胆脂瘤患者22例,均行HRCT、常规核磁平扫及DWI检查。以术中所见及病理诊断为基础,将DWI与HRCT图像结合,评估初发胆脂瘤病灶位置及侵袭范围与术中病变的符合度。将HRCT、DWI对复发性中耳胆脂瘤的诊断结果进行统计学分析,评估二者诊断效能。结果DWI联合HRCT定位初发胆脂瘤位置的准确率为90.3%。HRCT、DWI诊断复发性中耳胆脂瘤敏感度、特异度、阳性预测值、阴性预测值分别为27.8%、75.0%、83.3%、18.8%和100%、75.0%、94.7%、100%,与病理结果的一致性Kappa值分别为0.024和0.843,卡方配对检验证实组间诊断差异具有统计学意义(P<0.001)。结论联合DWI的高敏感度及HRCT的高分辨率,能够提高初发胆脂瘤术前定位的准确性,可用于指导手术方案的选择。DWI对复发性中耳胆脂瘤的诊断价值较高,可为二次手术探查提供参考。Objective To evaluate the accuracy of diffusion weighted magnetic resonance imaging(DWI-MRI)combined with high resolution temporal bone CT(HRCT)in the location diagnosis of middle ear cholesteatoma and its value in the postoperative follow-up.Methods 134 patients with inital cholesteatoma and 22 patients with suspected recurrent cholesteatoma were selected for HRCT,conventional MRI and DWI examination.Based on the intraoperative and pathological diagnosis,DWI and HRCT images were combined to evaluate the consistency between the lesion location and invasion area of the initial cholesteatoma and intraoperative lesions.The results of HRCT and DWI in the diagnosis of recurrent middle ear cholesteatoma were statistically analyzed to evaluate their diagnostic efficacy.Results The accuracy rate of DWI combined with HRCT was 90.3%.The sensitivity,specificity,positive predictive value and negative predictive value of HRCT and DWI in the diagnosis of recurrent middle ear cholesteatoma were 27.8%,75.0%,83.3%,18.8%and 100%,75.0%,94.7%and 100%,respectively,and the Kappa values consistent with the pathological results were 0.024 and 0.843,respectively.Chi-square test confirmed that there were differences in the diagnosis between groups(P<0.001).Conclusions Combined with the high sensitivity of DWI and the high resolution of HRCT,the accuracy of preoperative positioning of the newly diagnosed cholesteatoma can be improved and surgery strategy can be guided.DWI is also of high diagnostic value for recurrent cholesteatoma in the middle ear.

关 键 词：胆脂瘤 中耳 磁共振成像 弥散 体层摄影术 X线计算机 

分 类 号：R764.2[医药卫生—耳鼻咽喉科]