影像学检查在慢性胆脂瘤型中耳乳突炎患者中的诊断价值

Diagnostic value of imaging examination in patients with chronic cholesteatomatous otitis media

摘要:

目的 分析CT+核磁共振DWI对慢性胆脂瘤型中耳乳突炎患者的诊断价值。方法 选取2019年2月—2022年7月楚雄州人民医院88例慢性中耳乳突炎患者，术前均接受CT、核磁共振DWI检查。比较CT、核磁共振DWI对慢性中耳乳突炎胆脂瘤的检出情况。分析慢性胆脂瘤型中耳乳突炎患者的CT及核磁共振DWI表现。以手术病理检查结果为金标准，比较CT、核磁共振DWI对慢性中耳乳突炎患者胆脂瘤病变的灵敏度、特异度及准确度。分析CT、核磁共振DWI与手术病理检查结果间的一致性。结果 CT检查灵敏度为51.7%、特异度为83.1%、准确度为72.7%，CT与手术病理检查结果间的一致性检验Kappa=0.360，差异具有统计学意义(P=0.001)，但一致性低。核磁共振DWI检查灵敏度62.1%、特异度89.8%、准确度为80.7%，核磁共振DWI与手术病理检查结果间的一致性检验Kappa=0.543，差异具有统计学意义(P<0.001)，一致性中等。结论 核磁共振DWI对慢性胆脂瘤型中耳乳突炎的诊断价值高于CT，但CT提供了更好的空间定位，二者是互补技术，二者的结合应用有助于对胆脂瘤和听骨链状态的术前评估，对术式及入路的选择有一定的指导价值。

关键词:中耳乳突炎;胆脂瘤;核磁共振弥散加权像;高分辨率CT

Abstract:

Objective To analyze the diagnostic value of computed tomography (CT) and diffusion-weighted magnetic resonance imaging (MRI-DWI) in patients with chronic cholesteatomatous otitis media. Methods A total of 88 patients with chronic otitis media were selected from the People’s Hospital of Chuxiong Yi Autonomous Perfecture from February 2019 to July 2022. All patients were examined by CT and MRI-DWI before operation. It was compared for the detection of chronic cholesteatomatous otitis media by CT and MRI-DWI. It was analyzed for the CT and MRI manifestations of patients with chronic cholesteatomatous otitis media. Using their pathological results as the gold standard, the sensitivity, specificity and accuracy of CT and MRI-DWI were compared for cholesteatoma lesions in patients with chronic cholesteatomatous otitis media. The consistency of MRI-DWI, CT and pathological results were analyzed. Results The sensitivity, specificity and accuracy of CT were 51.7%, 83.1% and 72.7% respectively. The Kappa value of the consistency test between CT and surgical pathological results was 0.360 (P=0.001). The difference was statistically significant, but the consistency was low. The sensitivity, specificity and accuracy of MRI-DWI were 62.1%, 89.8% and 80.7% respectively. The Kappa value of the consistency test between the results of MRI-DWI and pathological results was 0.543(P<0.001), and there was a statistical difference in Kappa value with moderate consistency. Conclusion The diagnostic value of MRI-DWI is higher than that of CT, but CT provides better spatial localization for chronic cholesteatomatous otitis media. They are complementary technologies, and their combined application is helpful for preoperative evaluation of cholesteatoma and ossicular chain status. It will provide a certain guiding value for the surgeon to choose a better surgical method and approach.

Key words:Chronic otitis media;Cholesteatoma;MRI diffusion-weighted imaging;High resolution computed tomography