非平面回波弥散加权成像技术在岩骨胆脂瘤术前诊断及术后随访中的应用价值  

The Value of Non-Echo Planar Diffusion-Weighted MRI in the Diagnosis and Follow-up of Petrous Bone Cholesteatoma

作　　者：何郡 彭安全[1] 胡俊蛟 汪芹[1] 张智雯 黄超[1] 蒋文琪 潘雪迎[1] HE Jun;PENG Anquan;HU Junjiao;WANG Qin;ZHANG Zhiwen;HUANG Chao;JIANG Wenqi;PAN Xueying(Department of Otolaryngology-Head and Neck Surgery,Second Xiangya Hospital,Central South University,Changsha,Hunan 410011,China;Department of Radiology,Second Xiangya Hospital,Central South University,139 Middle Renmin Road,Changsha,Hunan 410011,China)

机构地区：[1]中南大学湘雅二医院耳鼻咽喉头颈外科,长沙410011 [2]中南大学湘雅二医院放射科,长沙410011

出　　处：《中华耳科学杂志》2022年第3期513-517,共5页Chinese Journal of Otology

摘　　要：目的探索非平面回波弥散加权成像(non-echo planar diffusion-weighted magnetic resonance imaging,non-EPI DWI)在岩骨胆脂瘤(petrous bone cholesteatoma,PBC)术前诊断及术后随访中的应用价值。方法选取22例PBC患者,术前及术后进行多次动态non-EPI DWI扫描,评估DWI在术前诊断及术后随访监测残留或复发胆脂瘤中的作用。结果22例患者术前颞骨DWI扫描均呈高信号,手术及病理证实为PBC,DWI诊断PBC敏感性为100%。术后行DWI动态随访3-48个月,平均28.8个月。随访中先后共7例(31.8%)病人的颞骨DWI出现白色高信号,其中术后12个月内发现2例,术后24个月内发现3例,术后48个月内发现2例,均经二次手术证实为胆脂瘤,1例术后6个月反复感染者DWI显示等信号,手术探查未见胆脂瘤残留,敏感性和特异性为100%。其余病例多次颞骨DWI未见白色高信号且仍在密切随访中。结论非平面回波弥散加权成像在岩骨胆脂瘤诊断中显示高敏感性和特异性,术后动态随访能及时检查出残留或复发的PBC,可避免不必要的二次手术探查。Objective To evaluate the value of non-echo planar diffusion-weighted magnetic resonance imaging(non-EPI DWI)in preoperative diagnosis and postoperative follow-up of petrous bone cholesteatoma(PBC).Methods A total of 22 patients were enrolled and underwent repeat follow-up DWI for the diagnosis of PBC and detection of residual and/or recurrent cholesteatoma.Results Preoperative DWI scans presented hyperintensity in all 22 patients,in whom cholesteatoma was histologically confirmed and surgically removed.The diagnostic sensitivity for PBC reached 100%.Postoperative DWI was performed at an interval from 3 to 48 months following surgery in all patients(average of 28.8 months).A high white signal was detected in 7 cases(31.8%)who were confirmed to have residual/recurrent cholesteatoma by revision surgery.Among these 7 patients,the residual/recurrent lesions were identified within 12,24 and 48 months in 2,3 and 2 patients,respectively.One patient underwent revision surgery due to wound infection at six months with no residual cholesteatoma detected,in whom repeat DWI showed a low signal intensity.The sensitivity and specificity of repeat DWI in detecting residual/recurrent disease reached 100%.Cases revealing hypointensity on DWI were kept under close follow-up.Conclusion The present study indicates that non-EPI DWI shows a high sensitivity and specificity in the diagnosis of PBC and repeat DWI can provide a reliable imaging evidence of residual/recurrent PBC,avoiding unnecessary second-look surgery.

关 键 词：非平面回波弥散加权成像 岩骨胆脂瘤 应用价值 

分 类 号：R764[医药卫生—耳鼻咽喉科]