The Efficacy of DW and T1-W MRI Combined with CT in the Preoperative Evaluation of Cholesteatoma

Abstract

Objective: This study aims to assess the efficacy of diffusion-weighted (DW) and T1-weighted (T1W) magnetic resonance imaging (MRI) combined with high-resolution computed tomography (HRCT) (together as DW-T1W-CT) in the preoperative evaluation of the presence and extent of cholesteatoma, which helps determine whether a patient is suitable for transcanal endoscopic ear surgery (TEES). Methods: This retrospective study included 35 patients (18 male and 17 female) aged from 2 to 81 years diagnosed with chronic otitis media with or without cholesteatoma, who had received surgical treatment and a preoperative MRI and HRCT during the period of December 2015 to December 2020 at Cathay General Hospital. We compared the preoperative DW-T1W-CT findings with the intraoperative findings and final pathologic diagnosis. The accurate predictive value was evaluated using the presence of cholesteatoma and its extent. Results: Regarding the efficacy of detecting cholesteatoma, we found a sensitivity of 92% (23/25 cases with cholesteatoma), a specificity of 90% (9/10 cases without cholesteatoma), and an overall accurate predictive value of 91.4% (32/35) by using combined DW-T1W-CT imaging. With regard to evaluating the extent of cholesteatoma, the combined DW-T1W-CT images obtained an accurate predictive value of 84% (21/25 cases of cholesteatoma). Conclusion: Combined DW-T1W-CT has been proven to be a reliable tool in detecting the presence of cholesteatoma. It is also useful in preoperatively depicting the extent of cholesteatoma, which is crucial for determining whether a patient is suitable for TEES, aiding in surgical planning and patient consultation.

Clinical Analysis of 85 Cases of External Auditory Canal Cholesteatoma Surgery under Specialized Endoscopy

“…Only one 91-year-old female patient complained of intolerable ear pain. For such patients, in addition to local block anesthesia of the external auditory canal, local block anesthesia of the posterior auricular sulcus and temporomandibular joint fossa can be added, and attention should be paid to the direction and depth of needle insertion to implement injection to avoid causing transient facial paralysis [ 20 ]. During the operation, the patient's mood can be soothed by communicating with the patient, encouraging positively, and playing music.…”

Optimizing Cholesteatoma Assessment: Utilizing of Diffusion-Weighted Magnetic Resonance Imaging and Computed Tomography Imaging for Diagnostic Precision and Surgical Excellence

“…In the current study, the smallest size of cholesteatoma detected was 4.5 mm. This is slightly better than van der Toom et al [8] , Sun et al [13] and Cavaliere et al [14] . In those studies, the smallest size was 5 mm.…”

Fusion computed tomography–magnetic resonance imaging scans for pre-operative staging of congenital middle-ear cholesteatoma

“…Pre-operative combined CT-MRI images have been described to have an accurate predictive value of 84-87 per cent in determining the extent of cholesteatoma. [7][8][9] We considered using the advantages of fusion CT-MRI images in patients with congenital cholesteatoma because, by definition, such patients have an intact tympanic membrane, which deprives the ear surgeon of important information on disease extent derived from otoscopic examination.…”