Value of T1-weighted Magnetic Resonance Imaging in Cholesteatoma Detection

Fukuda, Atsushi; Morita, Shinya; Harada, Taisuke; Fujiwara, Kazutoshi; Hoshino, Kimiko; Nakamaru, Yuji; Homma, Akihiro

doi:10.1097/mao.0000000000001558

Cited by 21 publications

(18 citation statements)

References 15 publications

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“…11 Further analysis included reviewing T1-weighted images with fat saturation and T2weighted images considering known pitfalls (Fig 1). 16 The colorencoded images were not included in the evaluation procedure.…”

Section: Imaging Techniquementioning

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: Imaging Techniquementioning

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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“…17,18 Furthermore, T1-w images with fat saturation and T2-w sequences were reviewed to avoid known pitfalls. 19 Every hyperintense signal in T1-w fat-saturated images with DWI-suspicious lesions was further analyzed. The simple yes/no decision for cholesteatoma diagnosis was further divided into a reliance score based on a Likert-type scale: from 1 = very insecure to 5 = very secure (refer to Figure 1 for an example).…”

Section: Evaluation Of the Mr Imagesmentioning

confidence: 99%

MRI of middle ear cholesteatoma: The importance of observer reliance from diffusion sequences

Fischer

Plaikner

Schartinger

et al. 2021

Journal of Neuroimaging

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Background and Purpose: Diffusion-weighted imaging(DWI) in MRI has been developed as an important tool for the detection of cholesteatoma. Various DWI sequences are available. This study aims to evaluate the importance of the observer's reliance level for the detection of cholesteatoma. Methods: Forty patients meeting the following criteria were included in the study: (1) chronic otitis media, (2) preoperative MRI including various DWI sequences, and (3) middle-ear surgery. The MRI protocol contained the following sequences: (1) axial and (2) coronal echoplanar imaging (EPI) readout-segmented (RESOLVE) DWI with Trace acquisition and (3) coronal non-EPI half-Fourier acquired single-shot turbo spin-echo (HASTE) DWI. Cholesteatoma diagnosis was based on standard diagnostic criteria for cholesteatoma with DWI. Additionally, the radiologists were asked to grade personal reliance on their diagnosis using a Likert-type scale from 1 = very insecure to 5 = very secure.Results: Axial and coronal RESOLVE DWI showed a sensitivity of 77.3% and a specificity of 72.2%, respectively. The mean reliance was 3.9 for axial and 3.8 for coronal images. HASTE DWI had a sensitivity/specificity of 81.8%/66.7% with the highest reliance of all evaluated sequences (4.4). Cases with a reliance level of 5 showed a sensitivity/specificity of 100% in all sequences. A reliance level of 5 was given in the axial and coronal RESOLVE DWI in 32.5% of cases and in the HASTE DWI in 57.5%. Conclusion:The evaluated DWI sequences showed comparable results. The reliance level significantly improved the predictor of cholesteatoma disease with MRI techniques.

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“…4,7 A current radiological dilemma for the diagnosis of cholesteatoma on non-echo planar diffusion-weighted imaging is the indeterminate high signal at the site of concern, with various suggestions in the literature to help with making a diagnosis, such as using apparent diffusion coefficient map images and T1-weighted images. 5,6,8…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance non-echo planar diffusion-weighted imaging accuracy in detecting cholesteatoma in comparison with clinical and surgical findings

et al. 2021

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Objective Magnetic resonance imaging utilising non-echo planar diffusion-weighted imaging is known to have high sensitivity and specificity in detecting cholesteatoma. Method Data was retrospectively collected from patients who had undergone non-echo planar diffusion-weighted imaging from 1 January 2010 to 31 December 2016. The ratio of average pixel grey-scale values between the middle-ear lesion, pons and temporal lobe was used to quantify the degree of restricted diffusion and assess the statistical significance to detect cholesteatoma. Results A total of 107 patients had non-echo planar diffusion-weighted imaging during the study period. Non-echo planar diffusion-weighted imaging shows good specificity and sensitivity with an excellent positive predictive value and accuracy. Analysis of the grey-scale pixel ratio for cholesteatoma detection showed statistically significant results. Conclusion Non-echo planar diffusion-weighted magnetic resonance imaging is accurate for cholesteatoma assessment. When the middle-ear lesion non-echo planar diffusion-weighted imaging intensity is higher than the ipsilateral temporal lobe, it is highly suggestive of a cholesteatoma formation.

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Value of T1-weighted Magnetic Resonance Imaging in Cholesteatoma Detection

Abstract: Our results suggest that T1W imaging may aid in the exclusion of false-positive cases on diagnostic non-EP DW MR imaging for cholesteatomas. A combination of non-EP DW and T1W imaging may improve the specificity and accuracy compared with non-EP DW imaging alone.

Cited by 21 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

MRI of middle ear cholesteatoma: The importance of observer reliance from diffusion sequences

Magnetic resonance non-echo planar diffusion-weighted imaging accuracy in detecting cholesteatoma in comparison with clinical and surgical findings

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