Detection of postoperative residual cholesteatoma with non-echo-planar diffusion-weighted magnetic resonance imaging.
OBJECTIVE
The aim of this study was to analyze the role of non-echo-planar imaging (non-EPI)-based diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of residual cholesteatoma after canal wall-up mastoidectomy before eventual second-look surgery.


METHODS
Prospective and blinded study.


METHODS
Tertiary referral center.


METHODS
The study group included the surgical, clinical, and imaging follow-up of 32 consecutive patients after primary cholesteatoma surgery.


METHODS
All patients were investigated with MRI, including late postgadolinium T1-weighted sequence and non-EPI-DW sequence, 10 to 18 months after first-stage cholesteatoma surgery by experienced surgeons using a canal wall-up mastoidectomy. The non-EPI-DW images were evaluated for the presence of a high-signal intensity lesion consistent with residual cholesteatoma. Imaging findings were correlated with findings from second-stage surgery in 19 patients, clinical follow-up examination in 11 patients, and, in 2 patients, clinical and MRI follow-up examination.


RESULTS
Non-EPI-DW sequences depicted 9 of 10 residual cholesteatomas. The only lesion missed was a 2-mm cholesteatoma in an examination degraded by motion artifacts in a child. All other diagnosed cholesteatomas measured between 2 and 6 mm. Sensitivity, specificity, positive predictive value, and negative predictive value were 90, 100, 100, and 96%, respectively.


CONCLUSIONS
Except for motion artifact-degraded examinations, non-EPI-DW MRI is able to detect even very small residual cholesteatoma after first-stage surgery by showing a high-signal intensity lesion. It has the capability of selecting patients for second-look surgery, avoiding unnecessary second-look surgery.
Department of Radiology, Augustinus Hospital, Wilrijk, Belgium. bert.defoer@GZA.be
Bert
B
De Foer
Jean-Philippe
JP
Vercruysse
Anja
A
Bernaerts
Filip
F
Deckers
Marc
M
Pouillon
Thomas
T
Somers
Jan
J
Casselman
Erwin
E
Offeciers
D000293:Adolescent; D000328:Adult; D000368:Aged; D016477:Artifacts; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D013506:Otologic Surgical Procedures; D011446:Prospective Studies