颞骨胆脂瘤的影像学诊断价值  

Diagnostic value of imaging techniques for detecting temporal bone cholesteatoma

作　　者：丁娇娇 鲁秀敏 杨子涛[2] 张帆[3] 秦兆冰[3] 毕瑞鹏 DING Jiaojiao;LU Xiumin;YANG Zitao;ZHANG Fan;QIN Zhaobing;BI Ruipeng(Department of Otolaryngology,the Third People’s Hospital of Henan Province,Zhengzhou 450000,China;Department of Magnetic Resonance,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Otology,Ear,Nose and Throat Hospital,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省直第三人民医院耳鼻咽喉科,河南郑州450000 [2]郑州大学第一附属医院磁共振科,河南郑州450000 [3]郑州大学第一附属医院耳鼻喉医院耳科,河南郑州450000

出　　处：《中国耳鼻咽喉颅底外科杂志》2024年第6期31-35,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：2024年度郑州市医疗卫生领域科技创新指导计划项目(2024YLZDJH055)。

摘　　要：目的分析高分辨计算机断层扫描(HRCT)和MRI对颞骨胆脂瘤的临床诊断价值。方法选取2017年9月—2019年3月临床可疑胆脂瘤拟行手术治疗者107例(125耳),其中男62例,女45例,年龄3~79岁,平均年龄(40.14±18.8)岁。术前3 d至2周常规进行颞骨HRCT和MRI扫描。影像检查结果术前由放射科医师和耳科手术医师分别独立阅片评估记为可疑胆脂瘤和非胆脂瘤,术中发现记为胆脂瘤和非胆脂瘤组织,全部病变组织送病理进行组织学确诊。结果HRCT对胆脂瘤诊断的灵敏度为68.8%,特异度为39.6%,阳性预测值(PPV)为64.6%,阴性预测值(NPV)为44.2%;MRI-DWI对胆脂瘤诊断的灵敏度为96.1%,特异度为91.7%,PPV为94.9%,NPV为93.6%。比较初次和二次手术结果发现MRI-DWI对复发胆脂瘤诊断的准确率显著高于HRCT(P<0.05)。结论MRI-DWI对胆脂瘤诊断的准确性显著高于HRCT,尤其对术后复发病例的诊断更具优势。Objective To analyze the clinical diagnostic value of high resolution computed tomography(HRCT)and magnetic resonance imaging(MRI)in of temporal bone cholesteatoma.Methods A total of 107 patients(125 ears)with suspected cholesteatoma were recruited from September 2017 to March 2019,including 62 males and 45 females,aged from 3 to 79 years,with an average age of(40.14±18.8)years.Preoperative HRCT and MRI scans of temporal bone were performed 3 days to 2 weeks before operation.The results of the imaging scans were assessed by the radiologist and otological surgeon independently as suspected cholesteatoma and non-cholesteatoma.Intraoperative findings were recorded as cholesteatoma and non-cholesteatomatous tissues,which were confirmed by histopathology.Results The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)of HRCT for cholesteatoma were 68.8%,39.6%,64.6%and 44.2%respectively,while those of diffusion-weighted MRI(MRI-DWI)were 96.1%,91.7%,94.9%and 93.6%.Comparing the results of primary and secondary operations,the accuracy of MRI-DWI in the diagnosis of recurrent cholesteatoma was significantly higher than HRCT(P<0.05).Conclusion The accuracy of MRI-DWI in the diagnosis of cholesteatoma is significantly higher than that of HRCT,especially in the diagnosis of recurrent cases.

关 键 词：中耳疾病 胆脂瘤 高分辨计算机断层扫描 磁共振成像 弥散加权成像 

分 类 号：R764.04[医药卫生—耳鼻咽喉科]