Repeated Postoperative Follow-up Diffusion-weighted Magnetic Resonance Imaging to Detect Residual or Recurrent Cholesteatoma

Steens, Stefan C. A.; Venderink, Wulphert; Kunst, Dirk; Meijer, Anton; Mylanus, E.A.M.

doi:10.1097/mao.0000000000000985

Cited by 32 publications

(26 citation statements)

References 15 publications

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“…We found acquisition times between 3 and 6 minutes for 1 b-value with non-EPI-DWI in the literature, 21 and some studies did not indicate the acquisition time. 12,[24][25][26] Therefore, comparison between different sequences is always difficult. As with sequences used in other studies, many parameters such as slice thickness, number of slices, and FOV must be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation

Fischer¹,

Schartinger²,

Dejaco³

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: MR imaging has become an important tool for the detection of cholesteatomas of the middle ear. Various diffusion-weighted imaging sequences are available and have shown promising results. This study aimed to evaluate readoutsegmented echo-planar DWI for the detection of cholesteatoma and compare the results with surgical validation. MATERIALS AND METHODS: Fifty patients with chronic otitis media (24 females and 26 males; range, 12-76 years of age; mean age, 41 years) who underwent MR imaging before an operation of the middle ear (1-169 days) were included. The MR imaging protocol consisted of axial and coronal readout-segmented echo-planar DWI with b-values of 0 and 1000 s/mm 2 and 3-mm slice thickness. The readoutsegmented echo-planar diffusion-weighted images were fused with standard T2-weighted sequences for better anatomic assignment. The results of the MR imaging evaluation were correlated with the results from the operation. RESULTS: Readout-segmented echo-planar DWI detected 22 of the 25 cases of surgically proved cholesteatoma. It has an accuracy of 92% (95% confidence interval, 80.8%-97.8%), a sensitivity of 88%, a specificity of 96%, a positive predictive value of 96%, and a negative predictive value of 89%. In 1 case, a positive finding for cholesteatoma with readout-segmented echo-planar DWI could not be proved by histology, and in 3 cases, histology yielded a cholesteatoma that was not detected with MR imaging. CONCLUSIONS: Readout-segmented echo-planar DWI is a promising and reliable MR imaging sequence for the detection and exclusion of cholesteatoma.

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Section: Discussionmentioning

confidence: 99%

Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation

Fischer¹,

Schartinger²,

Dejaco³

et al. 2019

AJNR Am J Neuroradiol

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“…If available, coloured image-fusion of DWI and anatomic sequences helps to better demonstrate the findings to patients or clinicians. On the basis of the findings by Steens et al[34] repeated follow-up DWI after surgery of cholesteatoma is recommended. Their study showed an evidence of cholesteatoma in 31% of the patients on repeated follow-up DWI.…”

Section: Dwi For the Daily Clinical Practisementioning

confidence: 99%

Diffusion weighted imaging for the detection and evaluation of cholesteatoma

Henninger

Kremser

2017

WJR

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Cholesteatoma is a collection of keratinous debris and stratified squamous epithelium. It is trapped in the middle ear and can lead to bony erosion. The disease is treated surgically often followed by a second-look procedure to check for residual tissue or recurrence. Cholesteatoma has specific signal-intensity characteristics on magnetic resonance imaging with very high signal intensity on diffusion weighted imaging (DWI). Various DWI techniques exist: Echo-planar imaging (EPI)-based and non-EPI-based techniques as well as new approaches like multi-shot EPI DWI. This article summarizes all techniques, discusses the significance in detecting cholesteatoma and mentions actual studies. Further recommendations for daily clinical practise are provided.

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“…6 ). A recent study demonstrated that in patients with a negative first post-operative follow-up DWI and no clinical signs of post-operative cholesteatoma, a repeat second-follow up scan (performed at least 6 months after first follow-up DWI) was positive or equivocal for disease in 14 out of 45 (31 %) ears, with five ears having cholesteatoma confirmed on surgical exploration [ 40 ]. In addition, 2 third-follow-up DWI scans, which were previously negative, turned positive for cholesteatoma and was confirmed on surgery.…”

Section: Navigating Past the Pitfalls In Sensitivitymentioning

confidence: 99%

Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl

et al. 2016

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Non-echoplanar diffusion weighted magnetic resonance imaging (DWI) has established itself as the modality of choice in detecting and localising post-operative middle ear cleft cholesteatoma. Despite its good diagnostic performance, there are recognised pitfalls in its radiological interpretation which both the radiologist and otologist should be aware of. Our article highlights the various pitfalls and provides guidance for improving radiological interpretation and navigating beyond many of the pitfalls. It is recommended radiological practice to interpret the diffusion weighted images together with the ADC map and supplement with the corresponding T1 weighted and T2 weighted images, all of which can contribute to and enhance lesion localisation and characterisation. ADC values are also helpful in improving specificity and confidence levels. Given the limitation in sensitivity in detecting small cholesteatoma less than 3 mm, serial monitoring with DWI over time is recommended to allow any small residual cholesteatoma pearls to grow and become large enough to be detected on DWI. Optimising image acquisition and discussing at a joint clinico-radiological meeting both foster good radiological interpretation to navigate beyond the pitfalls and ultimately good patient care.Teaching Points• Non-echoplanar DWI is the imaging of choice in detecting post-operative cholesteatoma.• There are recognised pitfalls which may hinder accurate radiological interpretation.• Interpret with the ADC map /values and T1W and T2W images.• Serial DWI monitoring is of value in detection and characterisation.• Optimising image acquisition and discussing at clinico-radiological meetings enhance radiological interpretation.

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Repeated Postoperative Follow-up Diffusion-weighted Magnetic Resonance Imaging to Detect Residual or Recurrent Cholesteatoma

Cited by 32 publications

References 15 publications

Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation

Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation

Diffusion weighted imaging for the detection and evaluation of cholesteatoma

Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl

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