Detection of Postoperative Residual Cholesteatoma With Non-Echo-Planar Diffusion-Weighted Magnetic Resonance Imaging

Abstract

Except for motion artifact-degraded examinations, non-EPI-DW MRI is able to detect even very small residual cholesteatoma after first-stage surgery by showing a high-signal intensity lesion. It has the capability of selecting patients for second-look surgery, avoiding unnecessary second-look surgery.

Non echo planar, diffusion-weighted magnetic resonance imaging (periodically rotated overlapping parallel lines with enhanced reconstruction sequence) compared with echo planar imaging for the detection of middle-ear cholesteatoma

“…Our work essentially served to highlight to the UK otolaryngological community the fact that simply using any non echo planar imaging sequence to detect cholesteatoma is unlikely to yield success. We agree that the half-Fourier acquired single-shot turbo spin-echo sequence, used by De Foer et al 3 to detect middle-ear cholesteatoma, shows the most promise in the literature to date, but not in a UK setting at the time when our paper was originally written. In our view, the art of accurately detecting middle-ear cholesteatoma on imaging is very operator-dependent, hence the need for local departments to trial the method themselves.…”

“…Our group was the first to describe, in 2006, the halfFourier acquired single-shot turbo spin-echo diffusionweighted magnetic resonance imaging (MRI) sequence, and to compare it to the routinely used echo planar diffusion-weighted sequences, 2 both in patients prior to first stage surgery 3 and in patients prior to 'second-look' surgery for residual cholesteatoma. 4 In this last, 2008 paper, we concluded that second-look surgery could be replaced by the use of half-Fourier acquired single-shot turbo spin-echo diffusion-weighted sequences.…”

The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty

“…CT scanning to look for residual cholesteatoma has been superseded by new magnetic resonance imaging (MRI) techniques utilising non-echo planar sequences to detect cholesteatoma, thereby reducing patient radiation exposure [21], although at present there seems to be a learning curve with the use of these newer MRI techniques [22]. Without the newer diagnostic MRI techniques, Dornhoffer states that patients should undergo second look surgery if there is major disruption of the cholesteatoma sac during initial surgery.…”

HASTE diffusion-weighted mri: reliability for detection of cholesteatoma

“…Delayed postcontrast T1 spin-echo sequences improve the diagnosis of recurrent cholesteatoma and allow differentiation between scar tissue, which shows delayed enhancement, and cholesteatoma, which does not show delayed enhancement; conversely, inflammatory tissue displays early enhancement (7). However, these sequences do not provide the diagnostic performance necessary to eliminate the need for second-look surgery (7)(8)(9)(10)(11). Growing data suggest that DWI, particularly Half-Fourier acquisition single-shot turbo spin-echo (HASTE) DWI, yields better diagnostic performance for the detection of cholesteatomas (8,11).…”