title: Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings.
abstract: Our objective was to assess the value of delayed contrast-enhanced T1-weighted spin-echo MR imaging in the detection of residual cholesteatoma in patients who have undergone canal wall-up tympanoplasty procedure. The MR imaging was obtained prior to revision surgery in 18 patients with opacity of the post-operative cavity at CT examination 12-18 months after canal wall-up tympanoplasty. In each patient the following was performed: precontrast T1- and T2-weighted images; and early and delayed contrast-enhanced axial and coronal T1-weighted imaging. Early and delayed MR imaging results were separately compared with surgical second-look findings. Sensitivity, specificity, and predictive values were evaluated for early and delayed post-contrast MR imaging, compared with second-look surgery findings. A residual cholesteatoma was correctly identified in 8 of 9 cases with delayed contrast-enhanced T1-weighted MR imaging. Mean sensitivity, specificity, positive predictive value, and interobserver agreement (evaluated by kappa statistics) were, respectively, 85.2, 92.6, 92.6%, and kappa=0.78 for the delayed contrast-enhanced MR imaging technique. The same parameters were, respectively, 96.3, 33.3, 60.6, and 0.30 for the early contrast-enhanced T1-weighted MR images. We conclude that delayed contrast-enhanced T1-weighted MR imaging is reliable for the detection of residual cholesteatomas of the middle ear in patients who have undergone canal wall-up tympanoplasty.
authors.affiliation: Department of Medical Imaging, Fondation Ophthalmologique Adolphe de Rothschild, 25, rue Manin, 75940 Paris, France. mwilliams@fo-rothschild.fr
authors.forename: Marc T
authors.initials: MT
authors.lastname: Williams
authors.forename: Denis
authors.initials: D
authors.lastname: Ayache
authors.forename: Corinne
authors.initials: C
authors.lastname: Alberti
authors.forename: Françoise
authors.initials: F
authors.lastname: Héran
authors.forename: François
authors.initials: F
authors.lastname: Lafitte
authors.forename: Monique
authors.initials: M
authors.lastname: Elmaleh-Bergès
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Piekarski
mesh_terms: D000293:Adolescent; D000328:Adult; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA