Non-EPI versus Multishot EPI DWI in Cholesteatoma Detection: Correlation with Operative Findings

Abstract

BACKGROUND AND PURPOSE: Although multishot EPI (readout-segmented EPI) has been touted as a robust DWI sequence for cholesteatoma evaluation, its efficacy in disease detection compared with a non-EPI (eg, HASTE) technique is unknown. This study sought to compare the accuracy of readout-segmented EPI with that of HASTE DWI in cholesteatoma detection. MATERIALS AND METHODS:A retrospective review was completed of consecutive patients who underwent MR imaging for the evaluation of suspected primary or recurrent/residual cholesteatomas. Included patients had MR imaging examinations that included both HASTE and readout-segmented EPI sequences and confirmed cholesteatomas on a subsequent operation. Two neuroradiologist reviewers assessed all images, with discrepancies resolved by consensus. The ratio of signal intensity between the cerebellum and any observed lesion was noted.RESULTS: Of 23 included patients, 12 (52.2%) were women (average age, 47.8 [SD, 25.2] years). All patients had surgically confirmed cholesteatomas: Six (26.1%) were primary and 17 (73.9%) were recidivistic. HASTE images correctly identified cholesteatomas in 100.0% of patients. On readout-segmented EPI sequences, 16 (69.6%) were positive, 5 (21.7%) were equivocal, and 2 (8.7%) were falsely negative. Excellent interobserver agreement was noted between reviews on both HASTE (k ¼ 1.0) and readout-segmented EPI (k ¼ 0.9) sequences. The average signal intensity ratio was significantly higher on HASTE than in readout-segmented EPI, facilitating enhanced detection (mean difference 0.5; 95% CI, 0.3-0.8; P ¼ .003).CONCLUSIONS: HASTE outperforms readout-segmented EPI in the detection of primary cholesteatoma and disease recidivism.

Comparison of Diagnostic Performance and Image Quality between Topup-Corrected and Standard Readout-Segmented Echo-Planar Diffusion-Weighted Imaging for Cholesteatoma Diagnostics

“…In our opinion, uncorrected rsDWI should not be considered equal to tseDWI in terms of diagnostic accuracy and confidence. This statement is confirmed by our results in this study, which are in accordance with a study by Benson et al [ 20 ]. In contrast, topupDWI showed an enhanced diagnostic performance and almost caught up with tseDWI.…”

“…Unfortunately, comparisons between rsDWI and tseDWI in cholesteatoma diagnostics led to contradictory results in recent studies. Dudau et al found a comparable diagnostic performance between both sequences [ 19 ], whereas Benson et al and Wiesmueller et al found superior diagnostic accuracy and image quality for tseDWI [ 20 , 21 ]. Although in the last-mentioned study, rsDWI showed superior subjective image quality; its diagnostic performance was significantly degraded by higher susceptibility-induced distortions leading to both lower sensitivity and specificity.…”

MRI of middle ear cholesteatoma: The importance of observer reliance from diffusion sequences

“…The presented data elaborated a higher degree of diagnostic reliability in HASTE DWI than in RESOLVE DWI (ie, non‐EPI vs. EPI DWI) sequences. This result corresponds to the findings observed in the study of Benson et al., in which they compared HASTE with readout‐segmented EPI sequences in 23 patients 21 . HASTE DWI has a long acquisition time of approximately 5 minutes.…”

Magnetic Resonance Imaging Artifact Associated With Transcutaneous Bone Conduction Implants: Cholesteatoma and Vestibular Schwannoma Surveillance

“…These patients are currently surveilled postoperatively with a non-EPI DWI, which offers the most reliable imaging option for the surveillance of recidivistic or recurrent disease. 20 Given that the temporal bone is completely obstructed on non-EPI DWI in all but the Osia without magnet condition, evaluation of future imaging requirements for patients should be taken into consideration prior to implantation. Importantly, each episode of magnet removal requires 2 procedures, typically performed in the operating room under local anesthesia.…”