Imaging Diagnostic Value Of CT And MRI In Middle Ear Cholesteatoma

Objective:To explore the value of HRCT and MRI examination in the diagnosis of middle ear cholesteatoma and provide reliable basis for clinical diagnosis.Materials and methods:In this study,51 ears of 51 patients with the suspicious of middle ear cholesteatoma were included in the study(male: female ≈ 3: 2,mean age 46(±12)years).All patients underwent HRCT,conventional MRI and early enhancement,SE-EPI DWI examination.The examination method and diagnostic data were divided into four groups:A(HRCT),B(routine MRI plain scan combined with DWI)C(conventional MRI plain scan and enhancement),D(HRCT with conventional MRI plain scan and enhancement with DWI).Two imaging physicians with more than 5 years experience in the diagnosis of auricular images were selected to read the films.For each patient,the radiologist classified the examination into one of the four following categories depending on the probability of cholesteatoma:‘certainly no’,‘unlikely’,‘probable’ or ‘certainly yes’,expressed by ‘0’,‘1’,‘2’,‘3’ respectively.‘0’is the negative result while ‘1’,‘2’,‘3’is the positive.The results of imaging diagnosis were compared with those of the intraoperative and pathological findings.Using SPSS18.0 statistical software,the sensitivity,specificity,positive predictive value and negative predictive value of four methods for the diagnosis of cholesteatoma were analyzed.Make ROC curve and calculate the area under the curve(AUC),to explore the value of different imaging methods in the detection of middle ear cholesteatoma.In addition,In addition,the preoperative diagnosis of complications of 41 patients with cholesteatoma proved by pathology was analyzed retrospectively,and the diagnostic value of HRCT,conventional MRI and early enhancement in the diagnosis of complications of middle ear cholesteatoma was discussed.Results:The sensitivity of A,B,C,D for the detection of middle ear cholesteatoma is 92.7%,80.5%,95.1%,100.0% respectively.The specificity is 40.0%,100.0%,70.0%,90.0% respectively.The positive predictive value is 86.4%,100.0%,92.9%,97.6% respectively.The negative predictive value is 57.1%,55.6%,77.8%,100.0% respectively.The AUC was 0.840,0.902,0.950,1.000 respectively.41 cholesteatoma patients of the 51 patients was proved by pathology,with 26 of witch were confirmed with complications,while some patients with multiple complications : Meningeal nudity were confirmed in 20 patients,both HRCT and controversial MRI plain scan plus enhanced scan made the correct diagnosis before surgical operation.18 cases of facial nerve canal bone destruction were diagnosed by HRCT before operation,while 0 cases were diagnosed by MRI.HRCT definitely diagnosed all of 10 cases of semicircular canal fistula,while MRI made suggestive diagnosis in 5 cases for the lateral semicircular canal.In addition,MRI made definite diagnosis in 1 case of brain abscess,3 cases of retroauricular subperiosteal abscess,1 case of cervical space abscess and 1 case of epidural abscess,which were not diagnosed by HRCT.Conclusion:HRCT and MRI are complementary to each other.Combined application of HRCT and MRI is an ideal imaging method for middle ear cholesteatoma.