Application Of Diffusion Weighted Imaging In Accurate Diagnosis Of Cholesteatoma Of The Middle Ear

Objective:Diffusion Weighted Imaging(DWI)is a non-invasive MRI method that can quantitatively analyze the diffusion movement of water molecules in vivo.Cholesteatoma can show significant high signal on DWI,so it has high diagnostic value for middle ear cholesteatoma.However,currently,clinicians have insufficient understanding of it.This study was to explore the accuracy of DWI combined with temporal bone high resolution computed tomography(HRCT)in the location of the primary middle ear cholesteatoma,to evaluate the diagnostic efficacy of DWI in middle ear cholesteatoma and the value of non-invasive diagnostic criteria clinical application in determining whether cholesteatoma is recurrent,and to provide powerful basis for aural surgeon to preoperatively diagnose and locate the middle ear cholesteatoma,select the reasonable operation and avoid invalid secondary surgery.Methods:A total of 149 patients with suspected initial cholesteatoma and 22 patients with suspected recurrent cholesteatoma(the first operationswere open mastoidectomy with autologous musculoskeletal membrane flap filled the cavity and the reconstruction of external auditory canal wall,and the skin of the external auditory canal walland tympanic membrane were intact)were selected,and all of them underwent HRCT,conventional MRI and DWI examination.According to the imaging findings,two radiologists with more than 5 years of experience in aural imaging performed blind review.1.Using SPSS25.0 software,and taking the pathological diagnosis as the gold standard,chi-square test was used to the diagnostic results of HRCT and DWI of 149 patients with suspected initial cholesteatoma.The sensitivity,specificity,positive predictive value,negative predictive value and consistency Kappa value of HRCT and DWI in the diagnosis of primary cholesteatoma of the middle ear were calculated respectively,so as to confirm the diagnostic efficacy of DWI in primary cholesteatoma of the middle ear.2.Based on the intraoperative findings,the DWI and HRCT images of the patients with primary cholesteatoma of the middle ear confirmed by postoperative pathology were combined to evaluate the consistency between the lesion location and invasion range of the primary cholesteatoma and intraoperative lesions,and to calculate the accuracy of the combined localization.3.Chi-square test was used to the diagnostic results of HRCT and DWI of 22 patients with suspected recurrent cholesteatoma.The sensitivity,specificity,positive predictive value,negative predictive value and consistency Kappa value of HRCT and DWI in the diagnosis of recurrent cholesteatoma of the middle ear were calculated respectively,in order to determine the value of DWI in accurate diagnosis of recurrent cholesteatoma of middle ear.Results:1.In patients with suspected incipient cholesteatoma,the sensitivity,specificity,positive predictive value and negative predictive value of HRCT were67.9%,60.0%,93.8%,17.3%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of DWI were 87.3%,80.0%,97.5%,41.4%,respectively.The Kappa values consistent with the pathological results were0.146 and 0.456,respectively.Chi-square test confirmed that there were differences in the diagnosis between groups(P=0.02 < 0.05).The results showed that DWI was more effective than HRCT in the diagnosis of primary cholesteatoma of the middle ear.2.There were 134 patients with primary middle ear cholesteatoma were diagnosed by postoperative pathology,and the accuracy of DWI combined with HRCT localization was 90.3% compared with the intraoperative findings.3.In patients with suspected recurrent cholesteatoma,the sensitivity,specificity,positive predictive value and negative predictive value of HRCT were27.8%,75.0%,83.3%,18.8%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of DWI were 100%,75.0%,94.7%,100%,respectively.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).The results showed that the diagnostic value of DWI was significantly better than HRCT in patients with recurrent cholesteatoma,and it played a key role in determining whether cholesteatoma recurred or not.Conclusions:1.The diagnostic efficiency of DWI was significantly better than HRCT in primary cholesteatoma of middle ear.2.DWI combined with HRCT can accurately locate the location of primary cholesteatoma,define the scope of invasion and the relationship with adjacent bone,so as to guide the precise selection of surgical approach.3.Cholesteatoma is characterized by significant high signal image on DWI,which can be effectively differentiated from musculoosteal flap and granulation tissue,so as to realize accurate diagnosis of recurrent middle ear cholesteatoma by DWI,and it can provide a strong basis for determining whether cholesteatoma has recurred to avoid unnecessary secondary exploration surgery.4.DWI is of high diagnostic value in middle ear cholesteatoma,which is worthy of extensive clinical application.