中耳胆脂瘤的HRCT诊断

目的 :探讨中耳胆脂瘤HRCT特征、诊断及鉴别诊断。材料和方法 :回顾性分析 66例中耳胆脂瘤患者术前临床和HRCT检查资料 ,并与手术病理结果对照。结果 :66例中耳胆脂瘤HRCT表现为鼓室 /鼓窦内团块状软组织影和骨质改变 ,包括听骨硬化、移位、破坏 ,盾板破坏及中耳腔扩大 ,有的还伴有乙状窦、天盖、面神经管及水平半规管的破坏。结论 :依据中耳腔内软组织影的分布、形态及骨质改变等特点 ,中耳胆脂瘤可通过HRCT做出诊断和鉴别诊断。     

慢性中耳炎HRCT与X线平片对照分析

目的：探讨HRCT与X线平片对慢性中耳炎的诊断价值，评价HRCT在诊断中的作用。材料与方法：回顾性分析28例（30耳）慢性中耳炎患者HRCT及X线检查资料，其中18例与手术病理结果对照，10例定期随访。结果：HRCT显示中耳乳突骨质破坏14耳，听骨链破坏、移位16耳，软组织块影13耳，鼓室傲窦粘膜增厚8耳，伴面神经管破坏4耳，半规管瘘及鼓室盖破坏2耳。X线平片显示中耳乳突骨质破坏6耳，鼓室盖破坏1耳。结论：X线平片不能显示耳部细微骨质结构，HRCT在慢性中耳炎的诊断及分型中具有重要作用，对确定手术治疗方案具有一定价值。     

慢性中耳炎的HRCT诊断

目的探讨慢性中耳炎的HRCT特征、诊断及鉴别诊断.方法回顾性分析105例慢性中耳炎患者术前临床和HRCT检查资料,并与手术病理结果对照.结果36例胆脂瘤型中耳炎HRCT表现为鼓室或/及鼓窦内团块状软组织影和骨质改变,包括听骨硬化、移位、破坏,盾板破坏及中耳腔扩大,有的还伴有乙状窦、天盖、水平半规管的破坏.69例渗出肉芽型中耳炎HRCT表现多呈斑片状、条索状或网状软组织影,部分可见液平,听骨移位及破坏较轻.结论依据中耳腔内软组织影的分布、形态及骨质改变等特点,大多数慢性中耳炎可籍HRCT做出诊断或鉴别诊断.     

中耳胆脂瘤--一个特征性CT征象

目的 :研究中耳胆脂瘤的 CT特征 ,提高对其 CT征象的认识。方法 :对手术证实的 14例慢性中耳炎和 14例中耳胆脂瘤的病人进行 HRCT扫描 ,着重观察盾板和上鼓室外侧壁骨质改变。对软组织病灶分布、形态 ,听骨破坏等也进行了分析、比较。结果 :胆脂瘤中 ,盾板破坏 12例 ,同时合并上鼓室外侧壁破坏 8例 ;慢性中耳炎肉芽肿型盾板侵蚀 1例 ,无上鼓室外侧壁破坏。结论 :盾板骨质破坏和上鼓室外侧壁破坏是松弛部胆脂瘤较特征性的 CT征象。软组织分布和形态、听骨破坏有辅助诊断价值。     

胆脂瘤型中耳炎高分辨率CT诊断价值

目的探讨HRCT在胆脂瘤型中耳炎诊断中的应用价值。方法回顾性研究经手术病理证实胆脂瘤型中耳炎27例的HRCT表现,并与手术结果对照分析。结果高分辨率CT清楚的显示起源部位不同和大小不等的中耳胆脂瘤的软组织影以及其引起的中耳系统细微的骨质破坏征象。上鼓室?鼓窦及乳突区软组织肿块(27/27),骨质破坏包括听骨(23/27)、盾板(16/27)、面神经管(10/27)及乙状窦壁(4/27)。术前CT正确诊断率达90%以上。结论HRCT对胆脂瘤型中耳炎有肯定诊断价值,对临床有重要指导意义。     

胆脂瘤型中耳炎的CT诊断

本文回顾性分析了经手术病理证实的４９耳胆脂瘤型中耳炎和８耳胆固醇性肉芽肿的临床和ＨＲＣＴ检查资料。中耳胆脂瘤的ＣＴ表现为：（１）鼓室、鼓窦内软组织影和骨质破坏；（２）听骨移位及破坏；（３）鼓膜增厚、内陷、穿孔；（４）严重者可破坏乙状窦板、天装置、半规管和面神经管等。笔者对后天性胆脂瘤的组织密度、颞骨各部位胆脂瘤的ＣＴ诊断，胆固醇肉芽肿的病理机制、临床和ＣＴ表现、与胆脂瘤的鉴别诊断等进行了探讨。     

胆脂瘤型中耳炎对面神经管破坏的高分辨率CT评价

目的 探讨HRCT及图像后处理技术对胆脂瘤型中耳炎继发面神经管破坏的诊断价值.方法 对80例胆脂瘤型中耳炎患者进行颞骨轴位HRCT扫描,利用多平面重建(MPR)、双斜位MPR及曲面重建(CPR)技术进行面神经管重建.结果 71例患者为单侧胆脂瘤,9例为双侧胆脂瘤(共89耳).64耳发现面神经管骨质破坏,表现面神经管壁骨质模糊、缺损,以鼓室段最多见,占73.44%(47/64),Austin Ⅲ～Ⅳ度胆脂瘤累及面神经管的比例占87.5%(56/64),其中13耳为多节段破坏.手术发现39耳面神经管骨质缺损,破坏范围>5 mm占82.05%(32/39).结论 HRCT扫描及图像后处理技术能准确诊断中耳胆脂瘤继发的面神经管破坏,对临床手术有重要指导意义.     

中耳先天性胆脂瘤的影像学分析

目的结合手术所见,探讨中耳先天性胆脂瘤的影像学特征。方法回顾性分析15例(15耳)中耳先天性胆脂瘤患者的HRCT和MRI表现及术中所见。结果病例分为2组,第1组胆脂瘤局限于鼓室;第2组胆脂瘤受累范围较广,可以由鼓室向后累及鼓窦或乳突,或向前累及颞下颌关节。第1组11例(11耳),颞骨CT见鼓室内砧镫关节周围软组织影,呈球状或片状,11耳盾板均正常,7例合并听骨链畸形;其中3例进行了MRI扫描,由于病灶较小,2例MRI未发现病灶,1例虽然可以发现病灶,但是DWI未见高信号。第2组4例(4耳),3例颞骨CT示鼓室、和/或鼓窦内软组织影,1例示鼓室内病变向前累及颞下颌关节,3例合并听小骨畸形,其中2例进行了MRI扫描,均发现病灶并可见DWI高信号。结论中耳先天性胆脂瘤CT主要表现为鼓室内砧镫关节周围软组织影,可合并听骨链畸形,当病灶较小时MRI不能发现。     

胆脂瘤型慢性中耳炎的HRCT应用

目的 :探讨胆脂瘤型慢性中耳炎 (CMC)的HRCT特征 ,提高对该病的诊断及鉴别诊断水平。方法 :回顾性分析 3 8例CMC患者的临床和HRCT检查资料 ,并与手术病理结果对照。结果 :CMC患者HRCT表现 :①中耳腔内团块状影、周围有低密度环包绕。②骨质改变 ,包括盾板、上鼓室外侧壁破坏 ,中耳腔扩大、周缘骨质硬化 ,听小骨移位、破坏 ,严重者可伴有乙状窦壁、鼓室盖、面神经管及半规管的破坏。③大多数为硬化型乳突。结论 :HRCT对大多数CMC可作出准确诊断和鉴别诊断 ,是目前该疾病的首选检查方法     

慢性胆脂瘤型中耳炎HRCT诊断

目的 探讨胆脂瘤型中耳炎的高分辨率CT表现,提高对本病诊断的准确性.方法 搜集经手术病理证实43 例胆脂瘤型中耳炎的HRCT表现.结果 胆脂瘤型中耳炎HRCT表现：a）鼓室、鼓窦内团块状、片状软组织影;b）不同程度的骨质破坏,其中包括鼓室、鼓窦入口及鼓窦破坏扩大以及听小骨破坏移位.结论 高分辨率CT对于胆脂瘤型中耳炎能做出准确诊断并具有很高的诊断价值.     

Cholesteatoma of the Prussak's space. Diagnosis with computerized tomography]

Prussak's space localization represents the early stage of the cholesteatoma arising from the pars flaccida of the tympanic membrane. From Prussak's space the mass spreads to the antrum and to mastoid air cells. Its demonstration is infrequent probably due to the limited use of CT in inflammatory diseases of the middle ear. On CT scans, cholesteatomas present as small soft-tissue masses, and their growth is responsible for scutum and ossicular chain erosion. The mass may also spread posteriorly to the aditus and antrum, and involve tendons and ligaments, which is a different behavior than that of fluid collections or granulation tissue. The authors report 9 cases of Prussak's cholesteatoma evaluated by means of HRCT.     

The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas

The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas will be described in this paper. The pre- and postoperative imaging of the temporal bone was performed with HRCT and MRI.HRCT and MRI were performed in the axial and coronal plane. MRI was done with T2 weighted and T1 weighted sequences both before and after the intravenous application of contrast material. All imaging findings were confirmed clinically or surgically. The preoperative cholesteatoma-caused complications depicted by HRCT included bony erosions of the ossicles, scutum, facial canal in the middle ear, tympanic walls including the tegmen tympani, and of the labyrinth. The preoperative cholesteatoma-caused complications depicted by MRI included signs indicative for labyrinthitis, and brain abscess. Postoperative HRCT depicted bony erosions caused by recurrent cholesteatoma,bony defects of the facial nerve and of the labyrinth, and a defect of the tegmen tympani with a soft tissue mass in the middle ear. Postoperative MRI delineated neuritis of the facial nerve, labyrinthitis, and a meningo-encephalocele protruding into the middle ear. HRCT and MRI are excellent imaging tools to depict either bony or soft tissue complications or both if caused by acquired cholesteatomas. According to our findings and to the literature HRCT and MRI are complementary imaging methods to depict pre- or postoperative complications of acquired cholesteatomas if these are suspected by clinical examination.     

Use of Non-Echo-Planar Diffusion-Weighted MR Imaging for the Detection of Cholesteatomas in High-Risk Tympanic Retraction Pockets

BACKGROUND AND PURPOSE:Non-echo-planar DWI MR imaging (including the HASTE sequence) has been shown to be highly sensitive and specific for large cholesteatomas. The purpose of this study was to determine the diagnostic accuracy of HASTE DWI for the detection of incipient cholesteatoma in high-risk retraction pockets.MATERIALS AND METHODS:This was a prospective study of 16 patients who underwent MR imaging with HASTE DWI before surgery. Surgeons were not informed of the results, and intraoperative findings were compared against the radiologic diagnosis. Sensitivity, specificity, and positive and negative predictive values were calculated.RESULTS:Among the 16 retraction pockets, 10 cholesteatomas were diagnosed intraoperatively (62.5%). HASTE showed 90% sensitivity, 100% specificity, 100% positive predictive value, and 85.7% negative predictive value in this group of patients. We found only 1 false-negative finding in an infected cholesteatoma.CONCLUSIONS:We demonstrate a high correlation between HASTE and surgical findings, suggesting that this technique could be useful for the early detection of primary acquired cholesteatomas arising from retraction pockets and could help to avoid unnecessary surgery.

Middle ear cholesteatomas are benign but locally aggressive nonneoplastic lesions composed of a keratinizing stratified squamous epithelial matrix, an inflammatory perimatrix, and desquamated keratin content.¹ Pathophysiologically, cholesteatomas are divided into congenital (epithelium trapped within the middle ear during fetal development) and acquired. Acquired cholesteatomas are further divided into primary (arising from a tympanic membrane retraction) and secondary (epithelium reaching the middle ear through a tympanic perforation, fracture, or iatrogenic procedure).^2,3 Cholesteatomas progressively erode the bony structures surrounding the middle ear (ossicles, facial nerve canal, bony labyrinth, and skull base), predisposing to a wide range of complications, including potentially severe infections such as meningitis and intracranial abscesses.⁴ Surgery is the only known curative treatment and should be performed early because less destruction allows more conservative and hearing-preserving procedures with a reduced risk of complications.Tympanic retraction pockets are invaginations of the tympanic membrane into the middle ear cleft caused by Eustachian tube dysfunction, which interferes with proper middle ear ventilation.⁵ The diagnosis of a “dangerous” or high-risk retraction pocket is proposed when the bottom of the pocket becomes hidden to the otomicroscope and/or starts retaining skin, because this may lead to primary acquired cholesteatoma.¹ Given that there is a continuum from tympanic retraction pockets to small cholesteatomas, the distinction between retraction pockets that have already developed a cholesteatoma and those that have not remains a problem in otologic surgery because conventional clinical and radiologic methods are often insufficient. In addition, dangerous retraction pockets and small cholesteatomas share similar clinical signs and symptoms, and it is often impossible to differentiate them via otomicroscopy. A substantial number of such patients undergo surgical procedures such as mastoidectomies or atticotomies, but only a subset actually have cholesteatomas.CT is the most widely used imaging technique for the detection of a middle ear mass and assessing tympanomastoid anatomy and the extent of bone erosion.⁶ However, it is nonspecific for cholesteatoma and relies on indirect signs for its diagnosis.^7,8 More recently, MR imaging techniques have been used to differentiate cholesteatoma from other middle ear masses, especially T1-weighted delayed postcontrast imaging and DWI.^9,10DWI techniques are based on the restriction of movement of water molecules, such as that caused by keratin-filled cholesteatomas, producing a hyperintense signal.¹¹ Conventional EPI has been displaced by non-EPI techniques when the temporal bone is the focus, because these sequences have fewer artifacts and thinner sections, allowing the detection of cholesteatomas as small as 2 mm.¹² Several studies of non-echo-planar (EP) DWI have provided excellent sensitivity and specificity for the detection of cholesteatomas. Currently, MR imaging is suggested when the diagnosis of cholesteatoma cannot be established by other means, often in the setting of congenital and residual/recurrent disease.¹⁰The purpose of this study was to evaluate the sensitivity and specificity of non-EP DWI for the detection of cholesteatomas in skin-retaining and/or otomicroscopically inaccessible tympanic retraction pockets.     

胸内结节病的高分辨CT诊断与应用价值

目的:探讨胸内结节病的高分辨CT表现特点。方法:回顾性分析48例经临床和病理确诊的胸内结节病的高分辨CT表现。结果:48例中纵膈及肺门淋巴结均有肿大46例(95.8%);纵膈淋巴结肿大47例,无纵膈淋巴结肿大1例(2.1%);双侧肺门淋巴结肿大42例(87.5%),单侧肺门淋巴结肿大5例(10.4%),无肺门淋结肿大1例(2.1%)。内乳动脉旁淋巴结肿大2例(4.2%),心膈角淋巴结肿大2例(4.2%),两腋窝淋巴结肿大4例(8.3%),淋巴结钙化5例(10.4%)。增强的19例肿大的淋巴结均呈均匀强化。48例中既有淋巴结肿大又伴有肺内浸润改变的44例,支气管血管周围间质增厚17例,沿淋巴管周围间质分布的境界清楚的小结节38例,大结节或实变17例,磨玻璃影12例,纤维化表现18例,支气管狭窄2例,胸膜增厚及胸腔积液各2例。结论:胸内结节病临床表现及实验室检查无特异性,HRCT检查可发现淋巴结肿大,又可显示肺内特征性改变,可提高诊断准确率,并能评估临床疗效和预后,具有重要的指导意义。     

Computerized tomography in cholesteatoma of the middle ear with intact tympanic membrane

The growth of a middle ear cholesteatoma behind a normal tympanic membrane is a rare though possible event. In such cases, CT may provide useful information for diagnosis. The results are presented of a CT study carried out on 14 patients affected with unilateral conductive hearing loss and with normal tympanic membrane. CT allowed the diagnosis of middle ear cholesteatoma to be made in all cases. All patients were treated with surgery: 8 of them underwent tympanoplasty and 6 explorative tympanotomy. While the diagnosis of cholesteatoma was confirmed in 13 patients, in 1 case tympanosclerosis was diagnosed. CT diagnosis of middle ear cholesteatoma is based on the demonstration of a low-density soft-tissue mass, in association with bone erosion or ossicular dislocation. The author emphasizes the difficulty of a CT diagnosis of cholesteatoma in the patients with middle ear soft-tissue masses in the absence of bone alterations.     

CTVE对胆脂瘤型中耳炎听骨链病变的诊断价值

目的：探讨螺旋CT仿真内镜（CTVE）对胆脂瘤型中耳炎听骨链病变的诊断价值。方法：比较28耳胆脂瘤型慢性中耳炎听骨链的CTVE表现与临床手术所见。结果：CTVE显示的胆脂瘤型中耳炎听骨链破坏与手术所见基本相符，但对听骨链的细微病变价值有限，结论：CTVE是一种全新的多角度立体地观察听骨链结构的非侵入性影像手段。     

The value of single-shot turbo spin-echo diffusion-weighted MR imaging in the detection of middle ear cholesteatoma

Introduction Single-shot (SS) turbo spin-echo (TSE) diffusion-weighted (DW) magnetic resonance imaging (MRI) is a non echo-planar imaging (EPI) technique recently reported for the evaluation of middle ear cholesteatoma. We prospectively evaluated a SS TSE DW sequence in detecting congenital or acquired middle ear cholesteatoma and evaluated the size of middle ear cholesteatoma detectable with this sequence. The aim of this study was not to differentiate between inflammatory tissue and cholesteatoma using SS TSE DW imaging. Methods A group of 21 patients strongly suspected clinically and/or otoscopically of having a middle ear cholesteatoma without any history of prior surgery were evaluated with late post-gadolinium MRI including this SS TSE DW sequence. Results A total of 21 middle ear cholesteatomas (5 congenital and 16 acquired) were found at surgery with a size varying between 2 and 19 mm. Hyperintense signal on SS TSE DW imaging compatible with cholesteatoma was found in 19 patients. One patient showed no hyperintensity due to autoevacuation of the cholesteatoma sac into the external auditory canal. Another patient showed no hyperintensity because of motion artifacts. Conclusion This study shows the high sensitivity of this SS TSE DW sequence in detecting small middle ear cholesteatomas, with a size limit as small as 2 mm.