Diagnostic accuracy of non‐echo‐planar diffusion‐weighted MRI versus other MRI sequences in cholesteatoma

Abstract

The non-EPI MRI technique is a more accurate method in detecting middle ear cholesteatoma in comparison to other conventional sequences.

Diffusion-Weighted Intensity Magnetic Resonance in the Preoperative Diagnosis of Cholesteatoma

“…However, as reported in other studies [1,18,23,24], the main limitation of CT is the low specificity for cholesteatoma when tissue is present in the tympanic and mastoid air cavity because it cannot differentiate between cholesteatoma, cholesterol granuloma, brain parenchyma, granulation and scar tissue, just as in our experience (with a sensitivity of only 56%). It is typically the case of an FN patient whose CT scan showed no erosion signs, while both EPI and not-EPI DWI-MR revealed the presence of cholesteatoma confirmed also during surgery (fig.…”

“…Such hyperintensity can also be quantified using an objective parameter called ADC (apparent diffusion coefficient), calculated for each pixel of the image until obtaining a map of the lesion [6]. A specific sequence of DWI-MR, the multi-shot turbo spin-echo (MSh-TSE) not-echo planar imaging (EPI), has been reported recently [18,19] to be more reliable in the differential diagnosis of cholesteatoma, since it offers an improved spatial resolution (>3 mm) and reduces potential artifacts due to the air-bone interface. However, the latter involves longer acquisition times than traditional EPI sequences.…”

Use of Non-Echo-Planar Diffusion-Weighted MR Imaging for the Detection of Cholesteatomas in High-Risk Tympanic Retraction Pockets

“…10,12,15,30 Other advantages to DWI are its short acquisition times (2-5 minutes) and avoidance of intravenous contrast. 22,31 One of the most studied uses for non-EP DWI in middle ear disease is as an alternative to second-look surgery in canal wall-up mastoidectomies, 32 in which the posterior wall of the external ear canal is preserved. This makes postoperative care easier but impedes direct observation of the mastoidectomy during otomicroscopy, making it impossible to clinically detect residual and recurrent cholesteatomas.…”

“Dazed and diffused”: making sense of diffusion abnormalities in neurologic pathologies

“…In either case, diffusion-weighted hyperintensity is a useful feature for both the initial detection of cholesteatoma and the detection of residual or recurrent disease in post-surgical patients [35][36][37][38]. Post-surgical granulation tissue, in particular, can be distinguished in part from a recurrent or residual cholesteatoma by its lack of diffusion-weighted hyperintensity [35,36,39]. Indeed, newer DWI techniques have shown promise for identifying cholesteatomas ,5 mm and may obviate the need for second-look surgeries altogether [35,39,40].…”

“…Post-surgical granulation tissue, in particular, can be distinguished in part from a recurrent or residual cholesteatoma by its lack of diffusion-weighted hyperintensity [35,36,39]. Indeed, newer DWI techniques have shown promise for identifying cholesteatomas ,5 mm and may obviate the need for second-look surgeries altogether [35,39,40].…”