Temporal bone dual-layer detector dual-energy computed tomography for identifying cholesteatoma.

objectivesCholesteatomas (CSs) are locally aggressive and can infiltrate adjacent structures as they expand. This study aimed to establish a straightforward scoring system using dual-layer detector dual-energy CT (DL-DECT) to improve the identification of cholesteatomas in patients. MATERIALS AND

methodsBetween August 2023 and July 2024, 871 patients with soft tissue density shadows in the ear region who underwent DL-DECT examination were retrospectively enrolled at our institute. Surgical treatments followed by pathological examinations were performed. Based on pathological findings, the lesions were classified into cholesteatoma (CS) and non-cholesteatoma (non-CS) groups. The diagnostic performance of anatomical and quantitative parameters derived from DL-DECT was evaluated using receiver operating characteristic (ROC) curve analysis. Logistic regression was applied to develop a diagnostic scoring system.

resultsA total of 87 patients (median age, 51 years; 45 men and 42 women) with suspected temporal bone CS were included, comprising 44 CS cases and 43 non-CS cases. The effective atomic number (Zeff) demonstrated the highest diagnostic accuracy (area under the curve [AUC] = 0.786), followed by the slope of the energy spectral curve (AUC = 0.784), scutum destruction (AUC = 0.759), and CT40 keV (AUC = 0.724). Logistic regression identified two significant predictors, which were incorporated into the scoring system. When the system score reached 2 points (Zeff ≤ 7.12 accompanied by scutum destruction), the AUC in the ROC analysis reached 0.868 (95% confidence interval: 0.778-0.931), significantly outperforming each individual parameter (all p < 0.05).

conclusionThe DL-DECT-derived scoring system serves as an innovative imaging marker for detecting CSs. KEY POINTS: Question Accurate differentiation between CSs and non-CSs is critical for selecting surgical approaches. However, high-resolution CT demonstrates limited discriminatory power. Findings A straightforward diagnostic scoring system incorporating Zeff ≤ 7.12 and scutum destruction was developed to efficiently identify patients with CS. Clinical relevance This scoring system may facilitate the early identification of CS, potentially improving patient outcomes through timely intervention.