Diffusion-Weighted Intensity Magnetic Resonance in the Preoperative Diagnosis of Cholesteatoma

Abstract

We have analyzed the preoperative diagnosis of cholesteatoma through the use of diffusion-weighted intensity magnetic resonance (DWI-MR) in 16 consecutive patients suffering from chronic otitis media with clinical and radiological (by computed tomography) suspicion of cholesteatoma. In particular, we compared the radiological data with intraoperative ones, verifying the correspondence (in terms of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) between what is reported by DWI-MR and what is actually detectable at the time of surgery. Furthermore, we identified the most reliable DWI-MR sequence [single-shot (SSh) echo planar imaging (EPI) vs. multi-shot turbo spin-echo not-EPI] to detect cholesteatoma and reduce the time for examination. The obtained data on computed tomography scans revealed low diagnostic accuracy (56%); DWI-MR, instead, showed higher values, especially using not-EPI sequences (93.75 vs. 68.75% obtained by SSh-EPI sequences).

Accuracy of turbo spin-echo diffusion-weighted imaging signal intensity measurements for the diagnosis of cholesteatoma

“…These results are similar to previously published qualitative studies in the literature reporting 100% sensitivity and specificity (22)(23)(24)(25). However, most qualitative non-echoplanar DWI studies in the literature have reported slightly lower sensitivity (82%-92%) and specificity (86%-96%) values (5,6,14,19,(26)(27)(28). The false-negative cases and thus the relatively lower sensitivity levels for the non-echoplanar evaluation of CS are reported to be due to the insufficiency of the technique to demonstrate mural and very small lesions (17,19,22).…”

A Systematic Review of Non‐Echo Planar Diffusion‐Weighted Magnetic Resonance Imaging for Detection of Primary and Postoperative Cholesteatoma

“…17 The main reason of exclusion was that not all patients with positive and negative DW-MRI results underwent surgical intervention and/or missing data were not mentioned. This resulted in a total of 7 studies included for final quantitative analysis of primary and recurrent cases 4-10 and 4 studies for subgroup analysis of primary cases only. 13-16…”

Cross-cultural adaptation and Italian validation of chronic otitis media outcome test 15 (COMOT-15)

“…Otitis media (OM) includes various subtypes of pathologies characterised by middle ear mucosa inflammation such as acute otitis media (AOM), otitis media with effusion (OME), chronic suppurative otitis media (CSOM), mastoiditis and cholesteatoma. CSOM (with or without cholesteatoma) affects approximately 2-4% of the general population and is defined as a chronic inflammation of the middle ear and mastoid cavity with or without tympanic membrane perforation [1][2][3] . It is characterised by recurrent ear discharge and hearing loss, and, less frequently, otalgia, fever, vertigo and tinnitus 1 .…”