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Master Thesis

Cholestéatomes récurrents de l'oreille moyenne : valeur ajoutée de la fusion entre la séquence de diffusion non EPI en IRM et le TDM en pré opératoire

Abstract : Background and Purpose: Recurrence of middle ear cholesteatoma (rMEC) are treated by surgery. MRI and CT (computed tomography) are performed respectively for lesion detection and pre-surgical planning to assess bone damage in ossicules, tegmen, facial nerve canal, otic capsule or carotid canal. However CT interpretation can be challenging due to postoperative scar and fluid in the vicinity of rMEC. The aim of this study is to assess the added value of a co-registrated DWI (diffusion weighted imaging)-MRI/CT fusion in pre-surgical planning. Materials and Methods: 20 consecutives patients prospectively included prior to rMEC surgery. Multidetector-CT and 1.5T MRI were performed preoperatively including 3D-T1 and a non-EPI-TSE-b1000-DWI clinically available sequences. Fused images were manually created with a multistep process using a freeware. Two radiologists analyzed in double blind unfused and fused data in regard to lesion extension, volume measurement and contouring. Extensions were compared to operative finding. Intra and inter-observer variability were assessed for lesion volumes and contouring overlap similarity (Jaccard index) in a voxel-by-voxel method. Results: 2 lesions were DWI-. For the 18 DWI+ lesions, agreement with surgical finding was significant for unfused data (κ=0.72) and almost perfect (κ=0.99) for b1000/CT (p<0.001). Volume calculation agreements were almost perfect for both, and greater contour similarity was seen for fused (60%) compared to unfused data (52%, p<0.001). Conclusion: nonEPI-b1000/CT fusion is routinely available reliable tool to assess recurrent cholesteatoma extension prior to surgery and to define the best surgical technique.
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https://dumas.ccsd.cnrs.fr/dumas-02766854
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Submitted on : Thursday, June 4, 2020 - 9:21:37 AM
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Florence Félici. Cholestéatomes récurrents de l'oreille moyenne : valeur ajoutée de la fusion entre la séquence de diffusion non EPI en IRM et le TDM en pré opératoire. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02766854⟩

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