使用光子计数探测器CT改善对位置异常的中耳假体的可视化：一项尸体研究。
Improved visualization of malpositioned middle ear prostheses using photon-counting detector CT: a cadaver study.
文献信息
| PMID | 42829685 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Maryam Sadeghian |
| 作者单位 | Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States. |
| 期刊 | Radiology advances |
| SCI 分区 | Q3 |
| IF | 1.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 中耳假体的评估需要高分辨率成像来评估位置和结构完整性。
目的： 在尸体标本中评估光子计数探测器（PCD）-CT对中耳假体成像的诊断性能。
材料与方法： 将9种不同的中耳假体植入5个新鲜冷冻全头标本中，分别置于正确的解剖位置和移位以模拟位置异常。标本使用PCD-CT（NAEOTOM Alpha，Siemens）和能量积分探测器（EID）-CT（SOMATOM Force，Siemens）扫描，分别重建为0.2 mm和0.4 mm。每台扫描仪评估18个病例（9个假体，2种位置），由2名神经放射科医生评估（36次判读），他们对扫描仪和位置设盲，并对假体位置、判读者信心和整体图像质量进行评分。比较了与参考标准的一致性以及判读者之间的一致性。
结果： 与EID-CT相比，PCD-CT显示出更高的诊断信心，而准确性和判读者间一致性在扫描仪之间未显示出显著差异。正确判读，PCD-CT与EID-CT：外侧接触，31/36（86.1%；95% CI，58.3-94.4）对29/36（80.6%；95% CI，55.6-91.7），P = .500；内侧接触，30/36（83.3%；95% CI，55.6-94.4）对26/36（72.2%；95% CI，50.0-83.3），P = .250。PCD-CT识别出所有完全接触丧失（评分3）的病例，而EID-CT每次接触漏诊1次判读。PCD-CT的判读者间一致性可能高于EID-CT（外侧：κw：0.804 [95% CI，0.578-0.941] 对0.571 [95% CI，0.302-0.778]，P = .250；内侧：0.684 [95% CI，0.191-0.934] 对0.481 [95% CI，0.024-0.835]，P = .250）。PCD-CT的判读者信心显著更高；判读者1和2的平均配对差异分别为外侧接触9.4（95% CI，1.8-17.1；Holm校正P = .019）和23.1分（95% CI，13.4-32.7；P < .001），内侧接触16.4（95% CI，10.0-22.8；P < .001）和17.8分（95% CI，6.8-28.8；P = .007）。判读者分别在16/18（88.9%；95% CI，65.3-98.6）和17/18例（94.4%；95% CI，72.7-99.9）中偏好PCD-CT图像质量。
结论： PCD-CT与显著更高的判读者信心和更偏好的图像质量相关，而在诊断准确性或判读者间一致性方面无显著差异。这些发现表明PCD-CT是术后中耳评估的一种有前景的模态，值得进一步研究。
英文摘要
BACKGROUND: Evaluation of middle ear prostheses requires high-resolution imaging to assess position and structural integrity.
PURPOSE: To assess the diagnostic performance of photon-counting-detector (PCD)-CT for middle ear prosthesis imaging in cadaveric specimens.
MATERIALS AND METHODS: Nine different middle ear prostheses were implanted in 5 fresh-frozen whole-head specimens, both in correct anatomic position and displaced to mimic malposition. Specimens were scanned on PCD-CT (NAEOTOM Alpha, Siemens) and energy-integrating-detector (EID)-CT (SOMATOM Force, Siemens), reconstructed at 0.2 mm and 0.4 mm, respectively. Eighteen cases (9 prostheses, 2 positions) per scanner were evaluated by 2 neuroradiologists (36 readings), blinded to scanner and position, who scored prosthesis position, reader confidence, and overall image quality. Agreement with the reference standard and between readers was compared.
RESULTS: PCD-CT showed higher diagnostic confidence compared with EID-CT, while accuracy and inter-reader agreement did not demonstrate significant differences between scanners. Correct readings, PCD-CT versus EID-CT: lateral contact, 31/36 (86.1%; 95% CI, 58.3-94.4) vs 29/36 (80.6%; 95% CI, 55.6-91.7), P = .500; medial contact, 30/36 (83.3%; 95% CI, 55.6-94.4) vs 26/36 (72.2%; 95% CI, 50.0-83.3), P = .250. PCD-CT identified all cases of complete contact loss (score 3), while EID-CT missed 1 reading per contact. Inter-reader agreement may be higher with PCD-CT vs EID-CT (lateral: κw: 0.804 [95% CI, 0.578-0.941] vs 0.571 [95% CI, 0.302-0.778], P = .250; medial: 0.684 [95% CI, 0.191-0.934] vs 0.481 [95% CI, 0.024-0.835], P = .250). Reader confidence was significantly higher with PCD-CT; mean paired differences for Readers 1 and 2 were 9.4 (95% CI, 1.8-17.1; Holm-adjusted P = .019) and 23.1 points (95% CI, 13.4-32.7; P < .001) for lateral contact, and 16.4 (95% CI, 10.0-22.8; P < .001) and 17.8 points (95% CI, 6.8-28.8; P = .007) for medial contact. Readers preferred PCD-CT image quality in 16/18 (88.9%; 95% CI, 65.3-98.6) and 17/18 cases (94.4%; 95% CI, 72.7-99.9), respectively.
CONCLUSION: PCD-CT was associated with significantly higher reader confidence and preferred image quality, without significant differences in diagnostic accuracy or inter-reader agreement. These findings suggest that PCD-CT is a promising modality for postoperative middle ear evaluations and warrants further investigations.