Assessment of Mass Effect Sign at High-Resolution Computed Tomography in Prediction of Cholesteatoma

Abstract

Objective The aim of this study was to assess the accuracy of mass effect sign in the diagnosis of cholesteatoma at high-resolution computed tomography (HRCT). Methods This prospective study included 32 ears in 24 patients with chronic otitis media who underwent HRCT of the temporal bone. Otoscopic and operative notes were recorded. Image analysis was done both qualitatively and quantitatively. In the qualitative analysis, mass effect was evaluated visually by comparing both ears together in 4 certain anatomical sites. Ossicular erosions, erosion of tegmen tympani, erosion of tympanic segment of facial nerve canal, and the presence of lobulated nondependent opacity were also evaluated. In the quantitative analysis, we calculated the difference between the distances of the described anatomical sites in both ears. Results Qualitative analysis of mass effect sign showed 97.1% accuracy in detecting cholesteatoma. Ossicular erosions showed 69.2% accuracy in the diagnosis of cholesteatoma. In the quantitative analysis, we found that the cutoff point of 0.45 mm in the difference of aditus measure between both ears showed 85.3% accuracy in differentiating cholesteatoma from otitis media. The cutoff point of 0.75 mm in the differences in supratubal measure showed 86.1% accuracy. The cutoff point of 0.45 mm in the medial to incus measure showed 100% accuracy. Conclusion High-resolution computed tomography is highly valuable for the detection of mass effect sign, which has great importance in diagnosing cholesteatoma.

The value of different diffusion-weighted magnetic resonance techniques in the diagnosis of middle ear cholesteatoma. Is there still an indication for echo-planar diffusion-weighted imaging?

“…Diagnosis of cholesteatomas is based on clinical, otoscopic, and imaging evaluation, including HRCT and MRI. Highresolution CT is a recommended method to localize and define cholesteatoma before surgery, especially in cases with bony erosions of the tegmen tympani, the ossicular chain, and walls of the middle ear/mastoid [4,16]. Nevertheless, HRCT demonstrates non-specific opacification in the petrous bone, leading to diagnostic difficulties and making this method insufficient to differentiate cholesteatoma from granulation, fibrous tissue, and fluid [4,16].…”

“…High-resolution computed tomography (HRCT) allows for recognition of bony destruction, precise localization of the opacity, and assessment of postsurgical or congenital additional temporal bone anomalies. However, it is not capable of differentiation between granulation, fibrous tissue, fluid, and cholesteatoma [4]. Magnetic resonance imaging (MRI) techniques have been introduced to distinguish different pathologies within the middle ear, with particular importance of diffusion-weighted imaging (DWI).…”

Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy

“…5,6 Non-contrast magnetic resonance imaging (MRI) and high-resolution computed tomography (CT) are unreliable, and are limited in their ability to distinguish recurrent or residual cholesteatoma from cholesterol granuloma and granulation tissue. 7–11…”