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

Abstract

ObjectiveTo assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy.MethodsA prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients.ResultsCholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ = 0.72, p = 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ = 0.57, p = 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ = 0.994, p = 0.001).ConclusionDiffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.

Correlation of pre-operative computed tomography, intra-operative findings and surgical outcomes in revision tympanomastoidectomy

“…• Recurrence after initial surgery for chronic otitis media may be difficult to identify in the tympanic cavity and mastoid prior to revision surgery Male sex was linked to a higher risk of cholesteatoma recurrence, which has been described earlier, and indicates that our sample is representative of the larger patient population. 21 The most common localisations of recurrent disease visible on pre-operative CT were tympanic perforation, ossicular chain involvement, posterior canal wall destruction, attic disease and antrum involvement. This correlated well with intra-operative findings (Table 3).…”

“…Male sex was linked to a higher risk of cholesteatoma recurrence, which has been described earlier, and indicates that our sample is representative of the larger patient population. 21…”

“…These findings correspond to well-known disease recurrence patterns in published literature, confirming that failure to address these areas during initial or previous surgery may be a principal factor in disease recurrence. 21…”

“…12 The correlations between CT scans and intra-operative findings identified in this study may be useful in follow up as well, as indicators of early recurrence, and for prompt timely surgical intervention in patients with otherwise occult disease. 21…”

Prediction of skull base osteomyelitis in necrotising otitis externa with diffusion-weighted imaging

“…Further studies with larger numbers of patients are recommended. Second, this study applied diffusion-weighted imaging; further studies using diffusion tensor imaging combined with dynamic contrast-enhanced MRI and proton magnetic resonance spectroscopy, on a 3 Tesla scanner, 39–46 will improve the results. Third, this study employed echo-planar imaging diffusion-weighted imaging of the skull base, which is associated with susceptibility changes at air–tissue interfaces that lead to image distortion and artefacts.…”