ESR必需品：欧洲头颈放射学学会的中耳胆道瘤练习建议的成像
ESR Essentials: imaging of middle ear cholesteatoma-practice recommendations by the European Society of Head and Neck Radiology
影响因子:4.70000
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
摘要
尽管非恶性，但由于局部骨侵蚀和感染，中耳胆汁脱瘤可能会导致重大并发症。胆碱瘤的治疗是手术，但残留疾病很常见，可能在临床上是隐秘的，尤其是在保留运河壁或采用重建技术时。成像在中耳胆碱a aid的临床诊断，鉴定并发症，计划手术并在随访时发现残留疾病的患者中起关键作用。计算机断层扫描是术前环境中的主要成像工具，因为它可以提供手术路线图和检测胆碱瘤的侵蚀并发症。磁共振成像具有非脱雪花扩散加权序列准确检测残留疾病的能力，这导致诊断范例的转变，用于胆汁疾病后的手术后随访，因此不再需要常规的“第二次前景”手术。以下实践建议旨在帮助放射线医生选择适当的成像方法，并了解评估前手术前后中耳胆道瘤的关键诊断注意事项。关键点：在术前环境中，CT是一线成像方式，MRI保留用于罕见的临床场景（低证据）。非雪花球成像（EPI）DWI是检测残留胆碱瘤的最佳MRI序列（中等证据）。非EPI DWI在胆道瘤术后监测中起着重要作用（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).