常规MRI及弥散加权成像诊断中耳胆脂瘤的应用价值研究

发布时间：2018-03-16 11:44

本文选题：胆脂瘤型中耳炎　切入点：磁共振成像　出处：《复旦大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的探讨常规MRI序列成像在胆脂瘤型中耳炎诊断中的应用价值。方法选取21位临床上初步怀疑胆脂瘤型中耳炎的患者行常规MRI序列检查(包括T,WI、T2WI、T1增强序列),后在患者知情同意条件下行患耳手术探查或鼓室成形术,并将术中标本送病理,最后将影像诊断与手术、病理结果进行对比。结果在21位患者中,患耳23,影像上病灶大小不等。在常规MRI序列上,23耳中有18耳符合胆脂瘤诊断标准,即T,WI上病灶相对脑组织显示低或等信号,T2WI上高信号,且T1增强无明显强化或边缘轻度强化；3耳影像上不典型,但术中及病理均证实有胆脂瘤；还有1耳假阴性。常规MRT序列诊断胆脂瘤型中耳炎的敏感性、特异性可分别达到86.4%、50.0%,阅片者间一致性极强。结论常规MRI序列对于中耳胆脂瘤的诊断具有较高敏感性,并能够清晰地显示较大胆脂瘤与周围组织间关系,阅片者间诊断一致性强,并且影像上病灶大小更接近实际,为手术治疗提供很有价值的影像信息,但其诊断特异性偏低,且对于3mm大小早期病灶难以辨别出。目的探讨弥散加权成像在胆脂瘤型中耳炎诊断中的应用价值。方法选取20位临床上初步怀疑胆脂瘤型中耳炎的患者行弥散加权成像(b=1000s/mm2),后在患者知情同意条件下行患耳手术探查或鼓室成形术,并将术中标本送病理,最后将影像诊断与手术、病理结果进行对比。结果在20位患者中有22耳行弥散加权成像检查,影像上病灶大小不等,其中20耳完全符合该序列诊断标准,即病灶相对于脑组织呈高信号(b=1000 s/mm2),而在ADC图上则为低或等信号,均诊断为胆脂瘤；1耳弥散加权成像上信号无相对增高,诊断为中耳乳突炎,还有1耳伪影明显难以诊断,两位阅片者间观点完全一致。弥散加权成像诊断胆脂瘤型中耳炎的敏感性、特异性可分别达到95.2%、100%。结论弥散加权成像对于中耳胆脂瘤的诊断具有高度敏感性、特异性,且不同阅片者间诊断一致性强,可以避免一些不必要的手术探查。但其空间分辨率低,对于中耳胆脂瘤的并发症或胆脂瘤与周围组织间关系的显示上效果差,不宜单独检查。目的分析在HRCT难以确诊的早期或临床不典型患者中,弥散加权成像组合CT在胆脂瘤型中耳炎诊断中的应用价值。方法选取慢性中耳炎患者9人,其术前均已行HRCT检查,且CT上不能确定是否为胆脂瘤病变或临床症状不符合胆脂瘤或需排除肿瘤病变者,随后均加做弥散加权成像,将其术前影像诊断信息与手术、病理结果对比,并汇总分析其对中耳病变性质,即是否为胆脂瘤(弥散加权成像为主)、位置及并发症(HRCT为主)诊断的准确性。结果9位患者中有9耳术前行弥散加权成像及HRCT组合检查,后行手术探查或鼓室成形术。在病灶性质的诊断上,即是否为胆脂瘤,DWI诊断结果与手术病理完全一致,敏感性、特异性均达到100%,而HRCT诊断结果中分别有2例假阴性、1例假阳性；在中耳乳突的骨质破坏的判断方面,HRCT优势明显,听骨链及周围骨质破坏情况与手术所见一致；在CT术前对病灶的位置诊断方面,影像上病变范围较术中所见偏大,但胆脂瘤病变位置基本一致。结论在HRCT难以确诊的早期或不典型患者中,弥散加权成像诊断中耳胆脂瘤的敏感性、特异性高,而CT对病灶空间位置、骨质破坏情况术前判断准确,两者组合检查在胆脂瘤型中耳炎临床诊疗中有较高的应用价值。
[Abstract]:Objective to evaluate the value of conventional MRI sequence imaging in the diagnosis of cholesteatoma otitis media.
Methods 21 patients clinically suspected cholesteatoma otitis media underwent conventional MRI scan (including T, WI, T2WI, T1 enhanced sequence), after informed consent of patients under the condition of the affected ear surgical exploration or tympanoplasty, and the intraoperative specimens were sent to pathology, the image diagnosis and surgery. Compared with pathological results.
The results of the 21 patients, 23 ear images, lesion size range. In conventional MRI sequences, 23 ears and 18 ears with cholesteatoma diagnosis standard, namely T, WI showed low signal lesions relative to brain tissue, T2WI high signal, and enhanced T1 showed no enhancement or slight strong edge 3; untypical, but in surgery and pathology confirmed cholesteatoma; and 1 false negative. The sensitivity of the conventional MRT sequence in the diagnosis of chronic otitis media with cholesteatoma, a specificity of 86.4% and 50% respectively, radiologists were extremely strong consistency.
Conclusion MRI sequence has high sensitivity in the diagnosis of middle ear cholesteatoma, and can clearly display the bold lipoma and surrounding tissues between readers, diagnostic consistency, and the image of lesion size is closer to the actual, to provide the image information is very valuable for surgical treatment, but its specificity is low, and for the 3mm size of early lesions difficult to identify.
Objective to evaluate the value of diffusion-weighted imaging in the diagnosis of cholesteatoma.
Methods 20 patients clinically suspected patients underwent diffusion-weighted imaging of cholesteatoma (b=1000s/mm2), after informed consent of patients under the condition of the affected ear surgical exploration or tympanoplasty, and the intraoperative specimens were sent to pathology, the imaging diagnosis and surgery, compared with pathological results.
Results 22 ears underwent diffusion-weighted imaging in 20 patients, imaging lesions of varying size, of which 20 ears completely accord with the sequence of diagnostic criteria, namely with respect to the brain lesions showed high signal (b=1000 s/mm2), and on the ADC chart is low or signal were diagnosed as cholesteatoma tumor; signal 1 the ear on diffusion-weighted imaging without the relative increase in diagnosis of otitis media, and 1 ear artifacts is difficult to diagnose, two radiologists were exactly the same point of view. The sensitivity of diffusion weighted imaging in diagnosis of chronic otitis media with cholesteatoma, specificity can reach 95.2% 100%. respectively.
Conclusion diffusion-weighted imaging has high sensitivity and specificity for diagnosis of cholesteatoma, and between different viewers diagnostic consistency, to avoid unnecessary surgical exploration. But its low spatial resolution, the effect of cholesteatoma of the middle ear cholesteatoma and surrounding tissue complications or the relationship between display, not a single check.
Objective to analyze the value of diffusion weighted imaging combined with CT in the diagnosis of cholesteatoma type otitis media in HRCT undiagnosed early or clinical atypical patients.
Methods 9 patients with chronic otitis media, the preoperative were examined by HRCT and CT can not determine whether the cholesteatoma lesions or clinical symptoms do not meet the need to exclude cholesteatoma or tumor, were subsequently combined with diffusion weighted imaging, the preoperative diagnosis and surgical pathology information, comparison and summary the analysis of middle ear lesions, whether for cholesteatoma (diffusion-weighted imaging mainly), location and complications (HRCT) diagnostic accuracy.
Results of 9 patients with 9 ears of DWI and HRCT examination underwent surgical exploration or tympanoplasty. In the diagnosis of tumors, whether for cholesteatoma, DWI diagnosis and pathological results completely consistent, sensitivity, specificity reached 100%, and the diagnostic results of HRCT in 2 cases respectively. Negative and 1 false positive; in the middle ear and mastoid bone damage judgment, HRCT obvious advantages, the ossicular chain and the surrounding bone destruction and surgical findings; location diagnosis of lesions in CT images before surgery, intraoperative findings, the lesion is relatively large, but in cholesteatoma position is consistent.
Conclusion in the early diagnosis of atypical or difficult to HRCT patients, the sensitivity of diffusion weighted imaging in diagnosis of cholesteatoma of the middle ear, high specificity, and CT on the spatial location of lesions, bone damage, preoperative accurate judgment, the application value of combined examination was high in clinical diagnosis and treatment of cholesteatoma otitis media.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764

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