ESR 要点:欧洲头颈放射学会推荐的中耳胆脂瘤影像学实践建议。
ESR Essentials: imaging of middle ear cholesteatoma-practice recommendations by the European Society of Head and Neck Radiology.
发表日期:2024 Aug 26
作者:
Philip Touska, Steve E J Connor
来源:
EUROPEAN RADIOLOGY
摘要:
虽然中耳胆脂瘤是非恶性的,但由于局部骨质侵蚀和感染,可能会导致严重的并发症。胆脂瘤的治疗是手术治疗,但残留疾病很常见,并且在临床上可能是隐匿性的,特别是当保留管壁或采用重建技术时。影像学在中耳胆脂瘤患者的治疗中发挥着关键作用,有助于临床诊断、识别并发症、规划手术以及随访时检测残留疾病。计算机断层扫描是术前的主要成像工具,因为它可以提供手术路线图并检测胆脂瘤的糜烂性并发症。磁共振成像具有非回波平面扩散加权序列准确检测残留病变的能力,导致胆脂瘤术后随访的诊断范式发生转变,使得常规的“二次检查”手术不再是必需的。以下实践建议旨在帮助放射科医生选择合适的成像方法并了解评估中耳胆脂瘤术前和术后的关键诊断注意事项。要点:在术前设置中,CT 是一线影像学检查方式,MRI 则用于罕见的临床情况(低证据)。非回波平面成像 (EPI) DWI 是检测残留胆脂瘤的最佳 MRI 序列(中等证据)。非 EPI DWI 在胆脂瘤术后监测中发挥着重要作用(中等证据)。© 2024。Crown。
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).© 2024. Crown.