Role of Magnetic Resonance Imaging in Cholesteatoma: The Indian Experience

Abstract

The objectives are to evaluate role of magnetic resonance imaging (MRI) in diagnosis of cholesteatoma and correlate imaging findings with intraoperative findings, and to emphasize of role of imaging in the follow-up of postoperative patients for differentiating residual/recurrent cholesteatoma from granulation/inflammatory tissue. In this prospective study, 31 patients were evaluated with a specific MRI protocol and high resolution computed tomography of the temporal bones. These included patients with a strong suspicion of having a cholesteatoma on clinical examination and postoperative cases on clinical follow up. Based on specific MRI findings, presence of cholesteatoma was reported in 17 out of 31 patients. All 31 patients underwent surgery and 19 patients had confirmed intraoperative cholesteatoma. This study shows high sensitivity of a specific sequence based MRI examination in detection of cholesteatoma and in differentiating cholesteatoma from postoperative inflammatory/granulation tissue. To the best of the author's knowledge, this is the first such study performed in the Indian Asian population.

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

“…Thus, DWI images of middle ear cavity should be obtained in the axial plane. We think that performing T1 and T2 W images in addition to RS-EPI is necessary for accurate detection of localization & extension of the lesions and detection of other pathologic conditions of the ears and/or cranium (such as fistulas, masses or abscess) [14,17]. As we have experienced in our study, 3D isotropic (voxel sizes < 1 mm) acquisition of T1 W and T2 W sequences might be useful for evaluation of whole cranium simultaneously.…”

“…The possibility of missing small size cholesteatoma due to nonisotropic acquisition of DWI or relatively thick slices has been reported previously [14,24]. Usually, mural cholesteatomas are not visible on DWI [18].…”

“…HRCT is the most commonly used technique for scanning temporal bone. Although HRCT can be useful for the diagnosis of the patients without middle-ear surgery history, it is often insufficient for the diagnosis of small sized cholesteatoma lesions (especially in patients with middle-ear surgery history) [14]. HRCT and DWI are usually combined for the diagnosis of cholesteatoma in daily routine practice.…”

“…These conflicting results were believed to be related with the dimension of cholesteatoma [16]. Delayed phase post-contrast T1 W imaging (45 minutes after intravenous gadolinium administration) has some disadvantages including increased cost, the scanning time and risk of nephrogenic systemic fibrosis [14,17]. In addition, some false positive results could be seen at delayed phase post-contrast T1 W imaging such as retained inflammatory secretions, which may simulate a nonenhancing cholesteatoma [18].…”

Assessment of chronic suppurative otitis media patients with cholesteatoma on the basis of gadolinium enhanced T1-T2 weighted images of MRI

“…Due to it's locally aggressive nature and insidious clinical course cholesteatomas are potentially dangerous, surgery being the primary universally accepted treatment for this condition. 4 Partial or total destruction of ossicles is seen in approximately 80% of patients with cholesteatoma, whereas in chronic otitis media without cholesteatom, ossicular chain erosion can be seen in approximately 20% cases. 3 Imaging plays an important role, especially in complicated and recurrent conditions imaging findings may fundamentally influence the treatment.…”