Abstract:The combination of BLADE-DWI and ADC mapping offers a useful imaging tool for accurate detection of middle ear cholesteatoma. Use of SIR can numerically differentiate between cholesteatoma and noncholesteatoma.
“…In the light of previously described results on smaller samples of patients [ 13 , 30 , 32 , 34 ], we found two different groups of values not overlapping one another: patients with cholesteatoma were found to have lower ADC values (Group 1; ch+ median 822 × 10 −6 mm 2 /s) compared to patients without cholesteatoma (Group 2; ch− median 2233 × 10 −6 mm 2 /s) ( Figure 2 ). The difference in intensity signal is mainly due to the significant amount of granulation tissue and/or fibrosis of noncholesteatomatous inflammatory lesions.…”
Section: Discussionsupporting
confidence: 62%
“…As the hyperintensity of cholesteatoma on DWI is a combination of T2 shine-through effect and restricted water diffusion, to confirm the diagnostic suspicion it is always desirable to compare the DWI image to the ADC maps [ 23 ]. In case of true restricted diffusion, as happens with cholesteatoma, the area of increased DWI intensity will coincide with the low signal area on ADC map [ 13 , 30 ]. This appearance on DWI and on relative ADC map makes it possible to distinguish cholesteatoma from noncholesteatomatous inflammatory lesions, especially in case of doubt before second-look surgery [ 1 , 24 , 25 , 31 ].…”
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.
“…In the light of previously described results on smaller samples of patients [ 13 , 30 , 32 , 34 ], we found two different groups of values not overlapping one another: patients with cholesteatoma were found to have lower ADC values (Group 1; ch+ median 822 × 10 −6 mm 2 /s) compared to patients without cholesteatoma (Group 2; ch− median 2233 × 10 −6 mm 2 /s) ( Figure 2 ). The difference in intensity signal is mainly due to the significant amount of granulation tissue and/or fibrosis of noncholesteatomatous inflammatory lesions.…”
Section: Discussionsupporting
confidence: 62%
“…As the hyperintensity of cholesteatoma on DWI is a combination of T2 shine-through effect and restricted water diffusion, to confirm the diagnostic suspicion it is always desirable to compare the DWI image to the ADC maps [ 23 ]. In case of true restricted diffusion, as happens with cholesteatoma, the area of increased DWI intensity will coincide with the low signal area on ADC map [ 13 , 30 ]. This appearance on DWI and on relative ADC map makes it possible to distinguish cholesteatoma from noncholesteatomatous inflammatory lesions, especially in case of doubt before second-look surgery [ 1 , 24 , 25 , 31 ].…”
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.
“…In this study, we aimed to assess whether the quantitative analysis with SI/SIR and ADC values could be used to increase the sensitivity of the TSE-DWI method (12,14,31). A previous study with numerical assessment of SI on BLADE-DWI reported significant differences between the mean SIR of 3.28-3.75 in CS compared with a mean SIR of NCS lesions of 2.38; however, the sensitivity of this SIR measurement and the cutoff value was not reported in that study (31). The current study confirms these prior observations using a larger patient population, as well as evaluating the accuracy of these parameters with specific cutoff values (92.5 for SI and 0.9 for SIR measurements).…”
“…8 ) /cysts and non-specific inflammation (Figs. 9 and 10 ) can return high signal on the b1000 images [ 3 , 12 , 22 , 23 , 32 , 35 , 38 ]. They can also be a result of operative materials such as silastic sheet, bone dust/powder [ 2 , 20 , 35 ], and (calcified) cartilage [ 38 ].…”
Section: Pitfalls In Specificitymentioning
confidence: 99%
“…They can also be a result of operative materials such as silastic sheet, bone dust/powder [ 2 , 20 , 35 ], and (calcified) cartilage [ 38 ]. There are reports of false positive cases from dental braces artefacts [ 17 ], tympanosclerosis [ 38 ], cholesterol granuloma [ 22 , 38 ], and squamous cell carcinoma of the external auditory canal [ 35 ]. Fig.…”
Non-echoplanar diffusion weighted magnetic resonance imaging (DWI) has established itself as the modality of choice in detecting and localising post-operative middle ear cleft cholesteatoma. Despite its good diagnostic performance, there are recognised pitfalls in its radiological interpretation which both the radiologist and otologist should be aware of. Our article highlights the various pitfalls and provides guidance for improving radiological interpretation and navigating beyond many of the pitfalls. It is recommended radiological practice to interpret the diffusion weighted images together with the ADC map and supplement with the corresponding T1 weighted and T2 weighted images, all of which can contribute to and enhance lesion localisation and characterisation. ADC values are also helpful in improving specificity and confidence levels. Given the limitation in sensitivity in detecting small cholesteatoma less than 3 mm, serial monitoring with DWI over time is recommended to allow any small residual cholesteatoma pearls to grow and become large enough to be detected on DWI. Optimising image acquisition and discussing at a joint clinico-radiological meeting both foster good radiological interpretation to navigate beyond the pitfalls and ultimately good patient care.Teaching Points• Non-echoplanar DWI is the imaging of choice in detecting post-operative cholesteatoma.• There are recognised pitfalls which may hinder accurate radiological interpretation.• Interpret with the ADC map /values and T1W and T2W images.• Serial DWI monitoring is of value in detection and characterisation.• Optimising image acquisition and discussing at clinico-radiological meetings enhance radiological interpretation.
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