title: Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging--value in detection.
abstract: OBJECTIVE
  To retrospectively compare non-echo-planar (non-EP) diffusion-weighted (DW) imaging, delayed gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging, and the combination of both techniques in the evaluation of patients with cholesteatoma.
  
  
  METHODS
  This institutional review board-approved study, for which the need to obtain informed consent was waived, included 57 patients clinically suspected of having a middle ear cholesteatoma without a history of surgery and 63 patients imaged before "second-look" surgery. Four blinded radiologists evaluated three sets of MR images: a set of delayed gadolinium-enhanced T1-weighted images, a set of non-EP DW images, and a set of both kinds of images. Overall sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV), as well as intra- and interobserver agreement, were assessed and compared among methods. To correct for the correlation between different readings, a generalized estimating equations logistic regression model was fitted. Results were compared with surgical results, which were regarded as the standard of reference.
  
  
  RESULTS
  Sensitivity, specificity, NPV, and PPV were significantly different between the three methods (P < .005). Sensitivity and specificity, respectively, were 56.7% and 67.6% with the delayed gadolinium-enhanced T1-weighted images and 82.6% and 87.2% with the non-EP DW images. Sensitivity for the combination of both kinds of images was 84.2%, while specificity was 88.2%. The overall PPV was 88.0% for delayed gadolinium-enhanced T1-weighted images, 96.0% for non-EP DW images, and 96.3%for the combination of both kinds of images. The overall NPV was 27.0% for delayed gadolinium-enhanced T1-weighted images, 56.5% for non-EP DW images, and 59.6% for the combination of both kinds of images.
  
  
  CONCLUSIONS
  MR imaging for detection of middle ear cholesteatoma can be performed by using non-EP DW imaging sequences alone. Use of the non-EP DW imaging sequence combined with a delayed gadolinium-enhanced T1-weighted sequence yielded no significant increases in sensitivity, specificity, NPV, or PPV over the use of the non-EP DW imaging sequence alone.
authors.affiliation: Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: De Foer
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Vercruysse
authors.forename: Anja
authors.initials: A
authors.lastname: Bernaerts
authors.forename: Joke
authors.initials: J
authors.lastname: Meersschaert
authors.forename: Christoph
authors.initials: C
authors.lastname: Kenis
authors.forename: Marc
authors.initials: M
authors.lastname: Pouillon
authors.forename: Luc
authors.initials: L
authors.lastname: De Beuckeleer
authors.forename: Johan
authors.initials: J
authors.lastname: Michiels
authors.forename: Kris
authors.initials: K
authors.lastname: Bogaerts
authors.forename: Filip
authors.initials: F
authors.lastname: Deckers
authors.forename: Thomas
authors.initials: T
authors.lastname: Somers
authors.forename: Robert
authors.initials: R
authors.lastname: Hermans
authors.forename: Erwin
authors.initials: E
authors.lastname: Offeciers
authors.forename: Jan W
authors.initials: JW
authors.lastname: Casselman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; D019786:Gadolinium DTPA; C072417:gadoterate meglumine