紧张部内陷袋胆脂瘤高分辨率CT征象分析

doi:10.6040/j.issn.1671-7554.0.2022.0680

Abstract

Abstract: Objective To analyze the high resolution CT(HRCT)features of pars tensa cholesteatoma in order to provide reference for imaging diagnosis of the disease. Methods HRCT data of 36 patients(36 ears)with pars tensa cholesteatoma confirmed by clinic and pathology were retrospectively analyzed. MPR technique was used to reconstruct the standard axial and coronal images. The morphological characteristics of the lesions, lesion range, destruction of the auditory ossicles, changes in the periphery bone structure and degree of mastoid cells were analyzed by two chief physicians. Results All 36 cases presented soft-tissue originating from the tympanic cavity, 6 of which were limited masses, 15 patchy and 15 diffuse masses. All lesions were located in mesotympanum and hypotympanum, including 21 in attic, 9 in mastoid cavity, 7 in anterior epitympanic recess, 28 in tympanic sinus and 25 in facial recess. One case had normal ossicular chain, 6 disruptions of the head of malleus, 17 disruptions of the handle of malleus, 14 disruptions of the body of incus, 35 disruptions of the long limb of incus, 11 disruptions of the short limb of incus, 23 disruptions of the head of stapes, 21 disruptions of the anterior and posterior crus of stapes, and 30 cases of external displacement of ossicular chain. Two cases had horizontal semicircular canal destruction, 3 pyramid segment destruction of facial canal, 17 horizontal segment destruction of facial canal, 2 vertical segment destruction of facial canal, 5 obvious destruction of scutal shield, 13 rough scutal shield, 18 complete scutal shield, 5 drum sinus entrance enlargement, 5 sclerosis of the bony borders of the mastoid cavity. The development of the mastoid cells was classified as grade 0 in 17 cases, grade 1 in 10 cases, grade 2 in 9 cases, and grade 3 in 0 case. Conclusion Pars tensa cholesteatomas are located in the tympanic cavity, which cause ossicular chain to displace laterally. The destruction of ossicular chain is mainly observed in the long limb of incus and stapes superstructure.

Key words: Pars tensa, Retraction pocket, Cholesteatoma of middle ear, High resolution CT, Early diagnosis

CLC Number:

R764.2

DONG Yalin, GONG Wuxian, HU Jinzhuo, LI Yani, WANG Ximing. High resolution CT features of acquired primary pars tensa cholesteatoma[J].Journal of Shandong University (Health Sciences), 2022, 60(12): 82-87.

References

[1] Yung M, Tono T, Olszewska E, et al. EAONO/JOS joint consensus statements on the definitions, classification and staging of middle ear cholesteatoma [J]. J Int Adv Otol, 2017, 13(1): 1-8.
[2] Tono T, Sakagami M, Kojima H, et al. Staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society [J]. Auris Nasus Larynx, 2017, 44(2): 135-140.
[3] Louw L. Acquired cholesteatoma pathogenesis: stepwise explanations [J]. J Laryngol Otol, 2010, 124(6): 587-593.
[4] Urík M, Tedla M, Hurník P. Pathogenesis of retraction pocket of the tympanic membrane-a narrative review [J]. Medicina(Kaunas), 2021, 57(5): 425. doi:10.3390 /medicina57050425.
[5] 孔维丽, 吴君昊, 郑虹. 中耳胆脂瘤发病机制与治疗[J]. 国际耳鼻咽喉头颈外科杂志, 2019, 43(6):334-339. KONG Weili, WU Junhao, ZHENG Hong. Pathogenesis and treatment of middle ear cholesteatoma [J]. Journal of Shandong University(Health Sciences), 2019,43(6): 334-339.
[6] 刘凯, 牛学才, 程东风, 等. 早期获得性中耳小胆脂瘤的HRCT表现[J]. 中国中西医结合影像学杂志, 2009, 7(4):3. LIU Kai, NIU Xuecai, CHENG Dongfeng. HRCT findings of acquired small cholesteatoma in the middle ear of early stage [J]. Chinese Imaging Journal of Integrated Traditional and Western Medicine, 2009, 7(4): 3.
[7] 韩宇, 张昌明, 凤亚妮, 等. 紧张部内陷袋性胆脂瘤的临床特点及手术疗效[J]. 听力学及言语疾病杂志, 2019, 27(5):514-518. HAN Yu, ZHANG Changming, FENG Yani. Clinical characteristics and surgical effects of acquired primary pars tensa cholesteatoma [J]. Journal of Audiology and Speech Pathology, 2019, 27(5): 514-518.
[8] Matsuda K, Tono T, Kojima H, et al. Practicality analysis of the staging system proposed by the Japan Otological Society for acquired middle ear cholesteatoma: a multicenter study of 446 surgical cases in Japan [J]. Auris Nasus Larynx, 2018, 45(1): 45-50.
[9] Gamaleldin OA, Elsebaie NA, Khalifa MH, et al. Assessment of mass effect sign at high-resolution computed tomography in prediction of cholesteatoma [J]. J Comput Assist Tomogr, 2019, 43(2): 288-293.
[10] Hool SL, Beckmann S, Hakim A, et al. Variability of the retrotympanum and its association with mastoid pneumatization in cholesteatoma patients [J]. Eur Arch Otorhinolaryngol, 2022.doi:10.1007/s00405-022-07465-w.
[11] Silva MNL, Selaimen FA, Huve FDC, et al. Endoscopic-assisted canal wall-up tympanomastoidectomy for reduction of residual cholesteatoma [J]. Int Arch Otorhinolaryngol, 2021, 26(2): e260-e264.
[12] Volgger V, Lindeskog G, Krause E, et al. Identification of risk factors for residual cholesteatoma in children and adults: a retrospective study on 110 cases of revision surgery [J]. Braz J Otorhinolaryngol, 2018, 86(2): 201-208.
[13] Selwyn D, Howard J, Cuddihy P. Pre-operative prediction of cholesteatomas from radiology: retrospective cohort study of 106 cases [J]. J Laryngol Otol, 2019, 133(6): 477-481.
[14] 李必强, 王小铭, 黄显龙, 等. HRCT常规重建与后处理对CSOM及中耳胆脂瘤诊断价值[J]. 中华耳科学杂志, 2015, 13(2):304-308. LI Biqiang, WANG Xiaoming, HUANG Xianlong, et al. The diagnostic value of HRCT image reconstruction and post-processing technology in chronic suppurative otitis media and middle ear cholesteatoma [J]. Chinese Journal of Otology, 2015, 13(2): 304-308.
[15] Chiao W, Chieffe D, Fina M. Endoscopic management of primary acquired cholesteatoma [J]. Otolaryngol Clin North Am, 2021, 54(1): 129-145.
[16] Yu Y, See J, Ng JH, et al. Patterns of middle-ear cholesteatoma and implications for surgical approach [J]. J Laryngol Otol, 2020, 1-5. doi: 10.1017/S0022215120000109.
[17] 王方园, 吴南, 杨仕明, 等. 耳内镜中耳外科手术体系的建立[J]. 中华耳科学杂志, 2021, 19(2):186-191. WANG Fangyuan, WU Nan, YANG Shiming, et al. The diagnostic value of HRCT image reconstruction and post-processing technology in chronic suppurative otitis media and middle ear cholesteatoma [J]. Chinese Journal of Otology, 2021, 19(2):186-191.
[18] 孙建军, 刘阳. 中耳炎临床分类和手术分型指南(2012)解读[J]. 中华耳鼻咽喉头颈外科杂志, 2013(1):6-10.
[19] Parab SR, Khan MM. Endoscopic management of tympanic membrane retraction pockets: a two handed technique with endoscope holder [J]. Indian J Otolaryngol Head Neck Surg, 2019, 71(4): 504-511.
[20] Rutkowska J, Ozgirgin N, Olszewska E. Cholesteatoma definition and classification: a literature review [J]. J Int Adv Otol, 2017, 13(2): 266-271.
[21] Shinnabe A, Yamamoto H, Hara M, et al. Differences in clinical characteristics of fallopian canal dehiscence associated with pars flaccida and pars tensa cholesteatomas [J]. Eur Arch Otorhinolaryngol, 2014, 271(8): 2171-2175.
[22] Rosito LS, Netto LF, Teixeira AR, et al. Classification of cholesteatoma according to growth patterns [J]. JAMA Otolaryngol Head Neck Surg, 2016, 142(2): 168-172.
[23] Yoshida S, Seki S, Sugiyama T, Kikuchi S, Yoshida N, Iino Y. Comparative study on adhesive otitis media and pars tensa cholesteatoma in children [J]. Auris Nasus Larynx. 2022, 49(5): 790-796.
[24] Shinnabe A, Hara M, Hasegawa M, et al. Differences in middle ear ventilation disorders between pars flaccida and pars tensa cholesteatoma in sonotubometry and patterns of tympanic and mastoid pneumatization [J]. Otol Neurotol, 2012, 33(5): 765-768.

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High resolution CT features of acquired primary pars tensa cholesteatoma

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