双能CT在中耳及外耳道胆脂瘤诊断和精准定位中的应用价值

The value of dual-energy CT in the diagnosis and localization of middle ear and external acoustic meatus cholesteatoma

目的:探讨双能CT(DECT)在中耳及外耳道胆脂瘤诊断及精准定位中的应用价值。方法:选取临床初步怀疑胆脂瘤并接受术前DECT检查的患者40例(44耳)。以术后结果为参考标准评估DECT对胆脂瘤的诊断效能,寻找鉴别胆脂瘤组与非胆脂瘤组差异有统计学意义的客观定量参数,采用受试者工作特征(ROC)曲线分析诊断效能最好的定量参数,评估DECT对胆脂瘤病变组织的定位准确性。结果:胆脂瘤组24耳,非胆脂瘤组20耳。DECT诊断胆脂瘤的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)分别为95.8%、80.0%、85.2%、94.1%,DECT与手术结果的一致性Kappa值为0.768。Water(Hap)浓度值为诊断胆脂瘤效能最高的参数,当Water(Hap)浓度值取最佳截断值1040.8 mg/cm3时,对应的曲线下面积为0.898,敏感度、特异度、PPV和NPV分别为91.67%、80%、84.6%和88.9%。DECT对胆脂瘤病变的精准定位总体准确率为91.7%。结论:DECT新技术可用于胆脂瘤定性、定量诊断和精准定位评估,有助于临床医师合理选择手术方案。

Objective:To evaluate the diagnostic efficiency and localization accuracy of dual-energy CT(DECT)for cholesteatoma.Methods:A total of 40 patients(44 ears)with a clinical suspicion of cholesteatoma received preoperative DECT and surgery.The diagnosis of cholesteatoma was evaluated randomly and independently on DECT,and quantitative parameters were measured and analyzed between choleliatoma and non-choleliatoma groups,with surgical results as the standard.The receiver operating characteristic curves(ROCs)were used to find out the parameters with the best diagnostic performance.The localization accuracy of DECT for cholesteatoma was also evaluated.Results:The sensitivity,specificity,PPV and NPV of visual evaluation on DECT for cholesteatoma were 95.8%,80.0%,85.2%and 94.1%respectively,with a Kappa value of 0.768.The Water(Hap)concentration was the best parameter for diagnosis of cholesteatoma with an area under the curve(AUC)of 0.898.The corresponding sensitivity and specificity,PPV and NPV were 91.67%,80%,84.6%,and 88.9%respectively when the Water(Hap)concentration was more than 1040.82mg/cm 3.The overall accuracy of DECT in evaluating cholesteatoma localization was 91.7%.Conclusions:DECT can diagnose cholesteatoma qualitatively and quantitatively and evaluate localization accurately,which can aid clinicians in selecting a suitable surgical plan.