Fusion of MRIs and CT Scans for Surgical Treatment of Cholesteatoma of the Middle Ear in Children

Abstract

Recent developments in imaging techniques have made diffusion-weighted MRI more effective for detecting recurrent cholesteatoma. The major drawback of this technique, however, has been its poor anatomical and spatial discrimination. Fusion imaging using high-resolution CT and diffusion-weighted MRI appears to be a promising technique for both the diagnosis and precise localization of cholesteatomas. It provides useful information for surgical planning and, furthermore, is easy to use in pediatric cases.

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

“…Furthermore, they were the first to fuse non echo planar diffusion-weighted images and high resolution computed tomography (CT) images in order to precisely localise cholesteatomas. 7 Huins All the above-mentioned papers used and/or discussed extensively the half-Fourier acquired single-shot turbo spin-echo diffusion sequence, and, in our opinion, reported similar results and findings to our group, confirming our reported findings. …”

“…Furthermore, they were the first to fuse non echo planar diffusion-weighted images and high resolution computed tomography (CT) images in order to precisely localise cholesteatomas. 7 Huins All the above-mentioned papers used and/or discussed extensively the half-Fourier acquired single-shot turbo spin-echo diffusion sequence, and, in our opinion, reported similar results and findings to our group, confirming our reported findings. Authors' reply Dear Sirs, In reply to De Foer, the primary aim of our study 1 was to attempt to replicate the success obtained by Lehmann et al, 2 in France, obtained with the periodically rotated overlapping parallel lines with enhanced reconstruction sequence.…”

Improved Assessment of Middle Ear Recurrent Cholesteatomas Using a Fusion of Conventional CT and Non-EPI-DWI MRI

“…10,17,19 This result has been further confirmed from a comparative analysis between DWI alone and FD. [17][18][19] The superiority of the FD-based rMEC assess- ment that we describe in the present study could partly be due to a careful patient selection based on the DWI results, the number of patients, and the number of locations. DWI is an imaging technique that can clearly distinguish cholesteatoma from postsurgical abnormalities such as scars.…”

Magnetic resonance imaging at one year for detection of postoperative residual cholesteatoma in children: Is it too early?

“…In small dedicated pediatric series as well, Rajan or Plouin found impressive results with 100% PPV, NPV, sensibility 11 and specificity using non-EP DW MRI only or fused EP DW MR and CT. [6,9] In our study, detection rate was much lower but we have also more patients included. We tried to identify the reasons by reviewing all cases with the surgeon and pathologist : first of all, residual cholesteatoma size was mainly small (median, 2 mm).…”

“…Too few residual cholesteatoma were found, with only 2 residual in some series [6], and residual size ranged from 3 mm to 26 mm with a mean size of 1cm in some others. [8,9] (Table C) Therefore, excellent results found in literature should be interpreted with high caution.…”