title: Diffusion-weighted MR imaging sequence in the detection of postoperative recurrent cholesteatoma.
abstract: OBJECTIVE
  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.
  
  
  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/mm(2), 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 kappa 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/mm(2), 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/mm(2) 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 (kappa = 0.92). The smallest recurrent cholesteatoma was 5 mm in diameter, and this was correctly detected with the diffusion-weighted fast SE sequence.
  
  
  CONCLUSIONS
  Diffusion-weighted fast SE imaging enables the depiction of recurrent cholesteatoma in patients who have undergone middle ear surgery.
authors.affiliation: Department of Radiology, Centre Hospitalier Universitaire, Lille, France. f-dubrulle@chru-lille.fr
authors.forename: Frederique
authors.initials: F
authors.lastname: Dubrulle
authors.forename: Raphaelle
authors.initials: R
authors.lastname: Souillard
authors.forename: David
authors.initials: D
authors.lastname: Chechin
authors.forename: François M
authors.initials: FM
authors.lastname: Vaneecloo
authors.forename: Alain
authors.initials: A
authors.lastname: Desaulty
authors.forename: Christophe
authors.initials: C
authors.lastname: Vincent
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence