The impact of fusion imaging technique on middle ear cholesteatoma surgery: a prospective comparative study

Abstract

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.

Chinese Abstract

背景：计算机断层扫描图像与非回波规划器扩散加权磁共振图像的融合可以克服单个模式的局限性。

目的：本研究旨在通过评估“融合”技术对术前手术计划和术后结果的影响, 来评估该技术预测中耳胆脂瘤位置的能力。

方法：83 名患有胆脂瘤的成人接受了术前 CT 扫描和非 EPIDW-MRI, 有或没有“融合”技术。 我们评估了两组的胆脂瘤定位, 选择最合适的手术技术, 并将其与术中发现相关联。 两组在手术后 1 、6 和 12个月时, 就残留/复发胆脂瘤进行了比较。

结果：“融合”技术预测胆脂瘤位置的敏感性、特异性和准确性为分别为 97.5%、97.4% 和 97.5%, 而单独使用 CT 时为 97.59%、57.69% 和 73.21%。在对采用的手术技术及“融合”图像进行评估后, 达成了总体操作者协议。 发现在A组胆脂瘤残留率和复发率呈统计学意义上的显著降低。

结论：“融合”技术为外科医生提供了精确的胆脂瘤位置, 指导他做出正确的手术决定, 有助于减少术后残留率和复发率。

Keywords:

• Cholesteatoma
• CT scan
• non-EPI DW MRI
• fusion technique
• surgical planning
• recurrence

Acknowledgement

The authors have no budget or financial relationships to disclose

Disclosure statement

No potential conflict of interest was reported by the author(s).