Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl

Lingam, Ravi Kumar; Nash, Robert; Majithia, Anooj; Kalan, A.; Singh, Arvind

doi:10.1007/s13244-016-0516-3

Cited by 57 publications

(39 citation statements)

References 44 publications

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“…23 Nevertheless, the acquisition time for non-EPI-DWI and EPI-DWI can be quite different. We found acquisition times between 3 and 6 minutes for 1 b-value with non-EPI-DWI in the literature, 21 and some studies did not indicate the acquisition time. 12,[24][25][26] Therefore, comparison between different sequences is always difficult.…”

Section: Discussionmentioning

confidence: 73%

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Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation

Fischer¹,

Schartinger²,

Dejaco³

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: MR imaging has become an important tool for the detection of cholesteatomas of the middle ear. Various diffusion-weighted imaging sequences are available and have shown promising results. This study aimed to evaluate readoutsegmented echo-planar DWI for the detection of cholesteatoma and compare the results with surgical validation. MATERIALS AND METHODS: Fifty patients with chronic otitis media (24 females and 26 males; range, 12-76 years of age; mean age, 41 years) who underwent MR imaging before an operation of the middle ear (1-169 days) were included. The MR imaging protocol consisted of axial and coronal readout-segmented echo-planar DWI with b-values of 0 and 1000 s/mm 2 and 3-mm slice thickness. The readoutsegmented echo-planar diffusion-weighted images were fused with standard T2-weighted sequences for better anatomic assignment. The results of the MR imaging evaluation were correlated with the results from the operation. RESULTS: Readout-segmented echo-planar DWI detected 22 of the 25 cases of surgically proved cholesteatoma. It has an accuracy of 92% (95% confidence interval, 80.8%-97.8%), a sensitivity of 88%, a specificity of 96%, a positive predictive value of 96%, and a negative predictive value of 89%. In 1 case, a positive finding for cholesteatoma with readout-segmented echo-planar DWI could not be proved by histology, and in 3 cases, histology yielded a cholesteatoma that was not detected with MR imaging. CONCLUSIONS: Readout-segmented echo-planar DWI is a promising and reliable MR imaging sequence for the detection and exclusion of cholesteatoma.

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Section: Discussionmentioning

confidence: 73%

“…Lingam et al also mentioned wax as a reason for false-positive cases: It can produce high signal changes on the bϭ1000 images and low signal and values on the ADC map. 21 Thus, it is important that the open mastoid cavity be cleaned before imaging and the surgeon be aware that wax can lead to a false-positive result.…”

Section: Discussionmentioning

confidence: 99%

Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation

Fischer¹,

Schartinger²,

Dejaco³

et al. 2019

AJNR Am J Neuroradiol

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“…In both cases, these findings are probably attributable to a small residual/recurrent cholesteatoma surrounded by a large amount of granulation tissue. In fact, DWI and ADC ability to detect small cholesteatomas is limited to lesions bigger than 2-3 mm [ 35 ]; therefore, small residual/recurrent pearls within granulation tissue resulting from first-time surgery can be easily missed.…”

Section: Discussionmentioning

confidence: 99%

ADC Benchmark Range for Correct Diagnosis of Primary and Recurrent Middle Ear Cholesteatoma

Russo

Elefante

Lullo

et al. 2018

BioMed Research International

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Objectives Magnetic resonance imaging (MRI) and in particular diffusion-weighted imaging (DWI) have been broadly proven to be the reference imaging method to discriminate between cholesteatoma and noncholesteatomatous middle ear lesions, especially when high tissue specificity is required. The aim of this study is to define a range of apparent diffusion coefficient (ADC) values within which the diagnosis of cholesteatoma is almost certain. Methods The study was retrospectively conducted on a cohort of 124 patients. All patients underwent first- or second-look surgery because primary or secondary acquired cholesteatoma was clinically suspected; they all had preoperative MRI examination 15 days before surgery, including DWI from which the ADC maps were calculated. Results Average ADC value for cholesteatomas was 859,4 × 10−6 mm2/s (range 1545 × 10−6 mm2/s; IQR = 362 × 10−6 mm2/s; σ = 276,3 × 10−6 mm2/s), while for noncholesteatomatous inflammatory lesions, it was 2216,3 × 10−6 mm2/s (range 1015 × 10−6 mm2/s; IQR = 372,75 × 10−6 mm2/s; σ = 225,6 × 10−6 mm2/s). Interobserver agreement with Fleiss' Kappa statistics was 0,96. No overlap between two groups' range of values was found and the difference was statistically significant for p < 0.0001. Conclusions We propose an interval of ADC values that should represent an appropriate benchmark range for a correct differentiation between cholesteatoma and granulation tissue or fibrosis of noncholesteatomatous inflammatory lesions.

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“…As a result, this technique is more susceptible to both motion artifacts and to slice position misregistration errors in post-acquisition ADC map calculations. However, PROPELLER can acquire two b values in a single scan, thus reducing the acquisition time and therefore removing the problems inherent to the HASTE sequence [21]. Studies comparing these two techniques have not yet been performed [6].…”

Section: Resultsmentioning

confidence: 99%

Diffusion-weighted magnetic resonance imaging with echo-planar and non-echo-planar (PROPELLER) techniques in the clinical evaluation of cholesteatoma

Moreno-Ramos¹,

Pérez²,

Rodríguez³

et al. 2019

Arch Otolaryngol Rhinold

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https://www.peertechz.com because of the high keratin content. Thus, whereas, echoplanar imaging (EPI-DWI) has the disadvantages of lower spatial resolution and the presence of artefacts due to the proximity of bone [8,18], the introduction of non-echo-planar AbstractBackground: Diffusion-weighted magnetic resonance imaging (DWI) is an alternative to second-look surgery for the detection of cholesteatoma.Purpose: To assess the utility of DWI with echo-planar (EPI-DWI) and non-echo-planar (PROPELLER) sequences for the diagnosis of primary and recurrent cholesteatoma. Materials and methods:A prospective study of 33 ears, 21 with previous cholesteatoma surgery. Twelve patients were asymptomatic, with 4 showing signs suggestive of cholesteatoma in previous CT scans. The MRI protocol was: axial and coronal T1-weighted and T2-weighted imaging, and diffusionweighted sequences by both EPI-DWI and PROPELLER techniques. The results were correlated with the clinical examination and subsequent surgical fi ndings. Ten patients undergoing ear surgery for other reasons were included as negative controls. Results:The diagnostic accuracy was calculated with the 22 patients who underwent surgery and the negative controls. Both diffusion-weighted sequences showed a specifi city of 100%. The sensitivity of PROPELLER was 95%, compared to 20% for EPI-DWI. The latter showed non-specifi c imaging with bone artefacts, thus making impossible to confi rm or exclude the diagnosis. The PROPELLER technique yielded one false negative, compared with 16 by EPI-DWI. Both techniques gave a false negative in one case of a primary cholesteatoma. A positive result was obtained in two patients with no clinical suspicion of recurrence. Conclusions:In contrast to EPI-DWI, PROPELLER is a reliable technique for diagnosing cholesteatoma. As positive results were found in asymptomatic patients, we recommend regular monitoring by PROPELLER, even in the absence of clinical fi ndings.

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Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl

Cited by 57 publications

References 44 publications

Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation

Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation

ADC Benchmark Range for Correct Diagnosis of Primary and Recurrent Middle Ear Cholesteatoma

Diffusion-weighted magnetic resonance imaging with echo-planar and non-echo-planar (PROPELLER) techniques in the clinical evaluation of cholesteatoma

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