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Original Research

Diffusion-weighted MR Imaging Sequence in the Detection of Postoperative Recurrent Cholesteatoma

Published Online:Feb 1 2006https://doi.org/10.1148/radiol.2381041649

Abstract

Purpose: To prospectively evaluate a fast spin-echo (SE) diffusion-weighted sequence for magnetic resonance (MR) imaging of recurrent cholesteatoma in patients who have undergone middle ear surgery.

Materials and Methods: The study was approved by the institutional review board, and informed consent was obtained from all patients. Twenty-four patients (10 female and 14 male patients; mean age, 44 years) who had undergone resection of cholesteatoma were referred for MR imaging. MR imaging was performed with a 1.5-T unit by using unenhanced diffusion-weighted fast SE imaging at b factors of 0 and 800 sec/mm2, unenhanced T2-weighted fast SE imaging, unenhanced T1-weighted SE imaging, and delayed contrast material–enhanced T1-weighted imaging. Two radiologists evaluated the diffusion-weighted fast SE images for the presence of a high-signal-intensity cholesteatoma. Results from MR imaging were compared with reports from second- or third-look surgery. Interobserver agreement was assessed with the κ statistic.

Results: A recurrent cholesteatoma was correctly identified in 13 of 14 patients with diffusion-weighted fast SE images obtained with a b factor of 800 sec/mm2, for a positive predictive value of 93%. In patients without recurrent cholesteatoma, all diffusion-weighted fast SE MR images obtained with a b factor of 800 sec/mm2 were correctly interpreted as showing no high signal intensity. Thus, the negative predictive value was 100%. Sensitivity and specificity were 100% (13 of 13 patients) and 91% (10 of 11 patients), respectively. Interobserver agreement was excellent (κ = 0.92). The smallest recurrent cholesteatoma was 5 mm in diameter, and this was correctly detected with the diffusion-weighted fast SE sequence.

Conclusion: Diffusion-weighted fast SE imaging enables the depiction of recurrent cholesteatoma in patients who have undergone middle ear surgery.

© RSNA, 2005

References

  • 1 Czerny C, Turetschek K, Duman M, Imhof H. Imaging of the middle ear: CT and MRI [in German]. Radiologe 1997; 37: 945–953.
    Medline Google Scholar
  • 2 Campbell JP, Pillsbury HC. The use of computerized tomographic imaging in revision mastoid surgery for chronic otitis media. Am J Otol 1990;11:387–394.
    Medline Google Scholar
  • 3 Blaney SP, Tierney P, Oyarazabal M, Bowdler DA. CT scanning in “second look” combined approach tympanoplasty. Rev Laryngol Otol Rhinol (Bord) 2000;121:79–81.
    Medline Google Scholar
  • 4 Wake M, Robinson JM, Witcombe JB, Bazerbachi S, Stansbie JM, Phelps PD. Detection of recurrent cholesteatoma by computerized tomography after “closed cavity” mastoid surgery. J Laryngol Otol 1992;106:393–395.
    Medline Google Scholar
  • 5 Tierney PA, Pracy P, Blaney SP, Bowdler DA. An assessment of the value of the preoperative computed tomography scans prior to otoendoscopic “second look” in intact canal wall mastoid surgery. Clin Otolaryngol Allied Sci 1999;24:274–276.
    Medline Google Scholar
  • 6 Sheehy JL, Robinson JV. Revision tympanoplasty: residual and recurrent cholesteatoma—a report on 272 intact canal wall revisions. In: Sade J, ed. Cholesteatoma and mastoid surgery: 2nd International Conference. Amsterdam, the Netherlands: Kugler, 1982; 443–448.
    Google Scholar
  • 7 Heran F, Williams M. MRI of the ear. J Neuroradiol 2003;30(3):131–145.
    Medline Google Scholar
  • 8 Kosling S, Bootz F. CT and MR imaging after middle ear surgery. Eur J Radiol 2001;40(2):113–118.
    Medline Google Scholar
  • 9 Vanden Abeele D, Coen E, Parizel PM, Van de Heyning P. Can MRI replace a second look operation in cholesteatoma surgery? Acta Otolaryngol 1999;119:555–561.
    Medline Google Scholar
  • 10 Kimitsuki T, Suda Y, Kawano H, Tono T, Komune S. Correlation between MRI findings and second-look operation in cholesteatoma surgery. ORL J Otorhinolaryngol Relat Spec 2001;63:291–293.
    Medline Google Scholar
  • 11 Williams MT, Ayache D, Alberti C, et al. Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings. Eur Radiol 2003;13:169–174.
    Medline Google Scholar
  • 12 Fitzek C, Mewes T, Fitzek S, Mentzel HJ, Hunsche S, Stoeter P. Diffusion-weighted MRI of cholesteatomas of the petrous bone. J Magn Reson Imaging 2002;15(6):636–641.
    Medline Google Scholar
  • 13 Fitzek CM, Fitzek S, Meves T, Mann W, Stoeter P. Ultrafast MRI examination of cholesteatomas of the petrous bone [abstr]. Eur Radiol 2000;10(suppl):295.
    Google Scholar
  • 14 Bergui M, Zhong J, Bradac GB, Sales S. Diffusion-weighted images of intracranial cyst-like lesions. Neuroradiology 2001;43:824–829.
    Medline Google Scholar
  • 15 Joel D, Swartz H, Haensberger R. Imaging of temporal bone. Stuttgart, Germany: Thieme, 1997; 78.
    Google Scholar
  • 16 Aikele P, Kittner T, Offergeld C, Kaftan H, Huttenbrink KB, Laniado M. Diffusion-weighted MR imaging in pediatric and adult patients who have undergone middle ear surgery. AJR Am J Roentgenol 2003;181:261–265.
    Medline Google Scholar
  • 17 Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging in intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 1986;161:401–407.
    Google Scholar
  • 18 Schaefer PW, Grant PE, Gonzalez RG. Diffusion-weighted MR imaging of the brain. Radiology 2000;217:331–345.
    Google Scholar
  • 19 Annet L, Duprez T, Grandin C, Dooms G, Collard A, Cosnard G. Apparent diffusion coefficient measurements within intracranial epidermoid cysts in six patients. Neuroradiology 2002;44:326–328.
    Medline Google Scholar
  • 20 Chen S, Ikawa F, Kurisu K, Takaba J, Kanou Y. Quantitative MR evaluation of intracranial epidermoid tumors by fast fluid-attenuated inversion recovery imaging and echo-planar diffusion-weighted imaging. AJNR Am J Neuroradiol 2001;22:1089–1096.
    Medline Google Scholar

Article History

Published in print: 2006