Conventional Mri And Diffusion-weighted Imaging In The Diagnosis Of Cholesteatoma Value Of Research

Objective To evaluate the value of conventional MRI in the diagnosis of cholesteatoma otitis media.Methods A preoperative conventional MRI scan,which includes T1WI T2 WI strengthened T1,was performed in 21 patients clinically suspected cholesteatoma otitis media. Later all of them went through operation exploration or tympanoplasty under informed consent. The findings on MRI were then matched with the results of surgery and pathology.Results Among the 21 patients,totally there were 23 ears with otitis media, of which all were then operated, and the nidus in middle ears differed in size on MRI.18 of the ears accorded with the diagnostic standards on conventional MRI (the nidus show low or equal signal on T1WI contrast to brain tissue,high signal on T2WI,and no evident strengthening or just a little on the edge on strengthened T1); 3 untypical, however, all of them were confirmed with cholesteatoma in surgery and pathology; another one with false negative. Sensitivity and specificity of conventional MRI in diagnosing cholesteatoma otitis media are respectively 86.4% and 50.0%, and diagnosis between different viewers show intense consistency.Conclusions Conventional MRI has high sensitivity in diagnosing cholesteatoma otitis media, and can distinguish the great nidus from the tissues surrounding it easily,and shows strong consistency between different viewers and the volumes of the nidus are more accurate. All of the characteristics may provide very useful informations for surgeons. However,the specificity of it is low, and it can't find out the 3mm-nidus for some early patients. Objective To evaluate the value of diffusion weighted imaging (DWI) in the diagnosis of cholesteatoma otitis media.Methods A preoperative DWI scan was performed in 20 patients clinically suspected cholesteatoma otitis media. Later all of them went through operation exploration or tympanoplasty under informed consent. The findings on DWI were then matched with the results of surgery and pathology.Results Among the 20 patients,totally there were 22 ears with otitis media, of which all were then operated, and the nidus in middle ears differed in size on DWI.20 of the ears accorded with the diagnostic standards on DWI, that are showing high signal on DWI(b=1000 s/mm2) contrast to brain tissue, while low or equal signal on apparent diffusion coefficient (ADC). All of the them were confirmed with cholesteatoma in surgery and pathology. And the other one show low signal intensity, which was considered with inflammation. Another one with artifact could not be diagnosed. The two viewers had absolutely the same diagnoses on all the cases. Sensitivity and specificity of DWI in diagnosing cholesteatoma of middle ears get to 95.2% and 100%.Conclusions Diffusion weighted imaging has high sensitivity and specificity in diagnosing cholesteatoma of middle ears and the diagnosis base on it are steady between different viewers, so it can help avoid some unnecessary operation explorations to patients. However, it has low space resolution and may not find out the complications of cholesteatoma or distinguish it from the tissues around it.Thereby,DWI should not be used alone. Objective To evaluate the value of DWI and CT in diagnosing cholesteatoma otitis media in patients,who clinically have untypical symptoms or whose otitis media may just occured,about which HRCT can't diagnose precisely.Methods Select 9 patients with chronic otitis media, who had been subjected to HRCT and couldn't be assured or just suspicious clinically. Then all of them added with preoperative DWI scan. Later the findings on DWI and HRCT were then matched with the results of surgery and pathology. And evaluate the accuracy of them as a whole in judging the lesion properties--cholesteatoma or not (mainly based on DWI), position and complications (mainly based on HRCT).Results Among the 9 patients,totally there were 9 ears with otitis media, all were subjected to DWI and HRCT and then operated. In judging the lesion properties--cholesteatoma or not,the findings on DWI kept in line with the results of surgery and pathology,and the sensitivity and specificity both get to 100%, while a false positive and two false negative occurred on HRCT; in judging bone destruction situation of middle ears and mastoids, HRCT has the advantages in showing the destruction of auditory ossicle, which is entirely consistent with the findings in surgery; and preoperative judgement of cholesteatoma position are almost right,though the lesions on HRCT are often bigger than the actual.Conclusions In patients who clinically have untypical symptoms or the otitis media may be at an early stage, DWI has high sensitivity and specificity of detecting cholesteatoma in middle ears while HRCT can analyse accurately the space position of the lesions as well as bone destruction situation,so the two combined may have great potential in dealing with cholesteatoma.