RESUMO
OBJECTIVE: The aim of this study is to assess the usefulness and reliability of this technique in our center, correlating the radiological and surgical findings and to study the influence of the learning curve by comparing the initial results with a radiological analysis performed 3 years after. STUDY DESIGN: Retrospective cohort study. METHODS: 67 patients with clinical cholesteatoma suspicion were included in the study, 24 with previously not operated cholesteatoma and 43 with suspicion of recurrent or residual cholesteatoma. All of them underwent diffusion-weighted magnetic resonance imaging, comparing these results with the histological confirmation after surgery. At 3 years, a blind radiological review of these cases was performed and the results were compared with those obtained after the first assessment to objectify the influence of the learning curve. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of the total sample were 93.9, 77.8, 92 and 82.4. The overall results after the blind review of the cases were 95.9, 94.4, 97.9 and 89.5, respectively. CONCLUSION: The diffusion-weighted magnetic resonance imaging is a very useful technique during the diagnostic process of doubtful cases of cholesteatoma, especially in cases of follow-up. As for the influence of the learning curve, we observed a clear improvement in the specificity of the test.
Assuntos
Colesteatoma da Orelha Média/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Curva de Aprendizado , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Colesteatoma da Orelha Média/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVE: To evaluate the accuracy, sensitivity, and specificity of nonecho planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) to detect residual cholesteatoma in children. STUDY DESIGN: Retrospective study. SETTING: Tertiary comprehensive hospital. METHODS: Children operated on for a first-stage cholesteatoma procedure from 2010 to 2019 were included. MRIs were performed with non-EPI DW sequences. Initial reports were collected, indicating the presence or absence of hyperintensity suggestive of cholesteatoma. Three hundred twenty-three MRIs were correlated with the subsequent surgery (66%) or year-later MRI (21%), or were considered accurate if performed 5 years or more after the last surgery (13%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging procedure for the detection of cholesteatoma were calculated. RESULTS: Two hundred twenty-four children with mean age of 9 ± 4 years old presented with cholesteatoma. MRIs were performed 27 ± 24 months after surgery. Residual cholesteatoma was diagnosed in 35%. The sensitivity, specificity, PPV, and NPV of MRI were 62%, 86%, 74%, and 78%, respectively. Accuracy, sensitivity, and specificity increased significantly over time (multivariate analysis). The mean delay after last surgery was of 30 ± 2.0 months for accurate MRI (true positive or negative) versus 17 ± 2.0 months for nonaccurate (false positive or negative) MRIs (p < .001). CONCLUSION: However, long the delay after the last surgery, the sensitivity of non-EPI diffusion sequence MRI in children has limitations for the detection of residual cholesteatoma. Surveillance for residual cholesteatoma should incorporate findings at primary surgery, surgeon experience, a low threshold for second-look procedures, and routine imaging.
Assuntos
Colesteatoma da Orelha Média , Humanos , Criança , Pré-Escolar , Adolescente , Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/cirurgia , Seguimentos , Estudos Retrospectivos , Estudos Prospectivos , Imagem de Difusão por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/métodos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The fusion of computed tomography images with non-echo planner diffusion-weighted magnetic resonance images may overcome the limitations of each individual modality. OBJECTIVES: This study aimed to assess the ability of the 'fusion' technique to predict the location of middle ear cholesteatoma by evaluating Its impact on preoperative surgical planning and postoperative results. METHODOLOGY: Eighty-three adults with cholesteatoma underwent preoperative CT scans and non-EPI-DW-MRI with or without the 'fusion' technique. We evaluated cholesteatoma localization in both groups, selecting the most appropriate surgical technique, and correlating it with the intraoperative findings. Both groups were compared in terms of residual/recurrent cholesteatoma at one, six and twelve months after surgery. RESULTS: The 'fusion' technique's sensitivity, specificity, and accuracy in predicting the location of cholesteatoma were 97.5. 97.4, and 97.5%, respectively, versus 97.59, 57.69, and 73.21% of CT alone. There was a total operators agreement after the evaluation of the 'fusion' images with the adopted surgical technique. A statistically significant decrease in residual and recurrence cholesteatoma rates was found in group A. CONCLUSIONS: The 'fusion' technique provides the surgeon with the precise cholesteatoma location, guiding him in making the correct surgical decision, contributing to the decrease in postoperative residual and recurrence rates.