Apparent Diffusion Coefficient Values of Middle Ear Cholesteatoma Differ from Abscess and Cholesteatoma Admixed Infection

Abstract

SUMMARY:A retrospective study was conducted on a cohort of 15 patients who underwent surgery because cholesteatoma or abscess was suspected. All patients had MR imaging prior to surgery with diffusion-weighted images (DWI) from which the apparent diffusion coefficient (ADC) value was calculated. Using this technique, we were able to determine 3 distinct ADC value ranges corresponding to the 3 groups of lesions found at surgery (pure cholesteatoma, cholesteatoma with infection, and abscess or infection). This needs to be confirmed by further studies with a wider range of patients.

Detection of cholesteatoma: High-resolution DWI using RS-EPI and parallel imaging at 3 tesla

“…Similarly, a certain cut-off value could not be indicated in our study as well. However, our findings are compatible with the literature data [3,16,18,[22][23][24].…”

“…According to the literature, the ADC values of cholesteatomas (700-1100 m 2 /s) have been reported to be equal or less than the brain parenchyma while those values of abscess (400-570 m 2 /s) have been reported to be significantly lower than the brain parenchyma [22,23]. However there is not a reported cut-off value related to ADC values in the literature.…”

Accuracy of turbo spin-echo diffusion-weighted imaging signal intensity measurements for the diagnosis of cholesteatoma

“…Although the qualitative non-echoplanar methods have high diagnostic accuracy (as seen above), there are still instances where the high signal of diffusion-weighted images does not unequivocally represent CS. The false positive cases reported in the literature include cholesterol granuloma, abscess, inserted fat graft, bony cement as well as chronic inflammatory tissue (7,(10)(11)(12)(13)(14)30). The cholesterol granuloma can be differentiated by its T1 hyperintensity, while the abscess can be differentiated by its acute clinical presentation as well as its very low ADC value (10,12,18).…”

The Diagnostic Accuracy of Non-Echo-Planar Diffusion-Weighted Imaging in the Detection of Residual and/or Recurrent Cholesteatoma of the Temporal Bone

“…22,23 The increased signal intensity of an empyema on non-EPI DWI is primarily caused by restricted diffusion and results less from T2 shine through effect. 23 However, the calculated ADC value of the lesion of the abovementioned patient (0.932 ϫ 10 Ϫ3 mm 2 /s) was not typical for an empyema (reported mean ADC value of 0.650 ϫ 10 Ϫ3 mm 2 /s) 23 ; therefore, in this case, the precision of the diagnosis could not be improved by measuring the ADC value of the lesion. The second patient with hyperintense signal intensity on DWI showed this increased DW signal intensity located very anteriorly in the middle ear cavity.…”