Review

ESR基础知识：中耳胆脂瘤成像——欧洲头颈放射学会的实践建议

ESR Essentials: imaging of middle ear cholesteatoma-practice recommendations by the European Society of Head and Neck Radiology

DOI 原文链接

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EUROPEAN RADIOLOGY

影响因子:4.7

分区:医学2区 Top / 核医学2区

发表日期:2025 Apr

作者: Philip Touska, Steve E J Connor

DOI: 10.1007/s00330-024-11021-x

摘要

虽然中耳胆脂瘤非恶性，但由于局部骨侵蚀和感染，可引起严重并发症。胆脂瘤的治疗主要为外科手术，但残留病灶较为常见，尤其在保留声道壁或采用重建技术时可能临床隐匿。影像在中耳胆脂瘤的管理中起关键作用——帮助临床诊断、识别并发症、规划手术及在随访中检测残留病灶。计算机断层扫描（CT）是术前首选的影像工具，能提供手术指南，并检测胆脂瘤的侵蚀性并发症。非平面弥散加权成像（非EPI DWI）在准确检测残留病灶方面表现出色，已引发诊断范式的转变，使常规的“二次手术”不再必需。本指南旨在帮助放射科医师选择适当的影像手段，理解评估术前和术后中耳胆脂瘤的关键诊断要点。重点内容包括：在术前，CT为一线影像方式，MRI主要用于少见的临床情景（证据较少）。非EPI扩散加权成像是检测残留胆脂瘤的最佳MRI序列（中等证据）。非EPI DWI在术后胆脂瘤的随访中扮演重要角色（中等证据）。

Abstract

Although non-malignant, middle ear cholesteatoma can result in significant complications due to local bone erosion and infection. The treatment of cholesteatoma is surgical, but residual disease is common and may be clinically occult, particularly when the canal wall is preserved or reconstructive techniques are employed. Imaging plays a pivotal role in the management of patients with middle ear cholesteatoma-aiding clinical diagnosis, identifying complications, planning surgery, and detecting residual disease at follow-up. Computed tomography is the primary imaging tool in the preoperative setting since it can provide both a surgical roadmap and detect erosive complications of cholesteatoma. The ability of magnetic resonance imaging with non-echoplanar diffusion-weighted sequences to accurately detect residual disease has led to a shift in the diagnostic paradigm for post-surgical follow-up of cholesteatoma, such that routine "second-look" surgery is no longer required. The following practice recommendations are aimed at helping the radiologist choose appropriate imaging approaches and understand the key diagnostic considerations for the evaluation of pre- and post-surgical middle ear cholesteatoma. KEY POINTS: In the preoperative setting, CT is the first-line imaging modality and MRI is reserved for rare clinical scenarios (low evidence). Non-echoplanar imaging (EPI) DWI is the optimal MRI sequence for the detection of residual cholesteatoma (moderate evidence). Non-EPI DWI plays an important role in the postoperative surveillance of cholesteatoma (moderate evidence).