title: High-resolution three-dimensional diffusion-weighted imaging of middle ear cholesteatoma at 3.0 T MRI: usefulness of 3D turbo field-echo with diffusion-sensitized driven-equilibrium preparation (TFE-DSDE) compared to single-shot echo-planar imaging.
abstract: OBJECTIVE
  To prospectively evaluate the usefulness of a newly developed high-resolution three-dimensional diffusion-weighted imaging method, turbo field-echo with diffusion-sensitized driven-equilibrium (TFE-DSDE) in diagnosing middle-ear cholesteatoma by comparing it to conventional single-shot echo-planar diffusion-weighted imaging (SS-EP DWI).
  
  
  METHODS
  Institutional review board approval and informed consent from all participants were obtained. We studied 30 patients with preoperatively suspected acquired cholesteatoma. Each patient underwent an MR examination including both SS-EP DWI and DSDE-TFE using a 3.0 T MR scanner. Images of the 30 patients (60 temporal bones including 30 with and 30 without cholesteatoma) were reviewed by two independent neuroradiologists. The confidence level for the presence of cholesteatoma was graded on a scale of 0-2 (0=definite absence, 1=equivocal, 2=definite presence). Interobserver agreement as well as sensitivity, specificity, and accuracy for detection were assessed for the two reviewers.
  
  
  RESULTS
  Excellent interobserver agreement was shown for TFE-DSDE (κ=0.821) whereas fair agreement was obtained for SS-EP DWI (κ=0.416). TFE-DSDE was associated with significantly higher sensitivity (83.3%) and accuracy (90.0%) compared to SS-EP DWI (sensitivity=35.0%, accuracy=66.7%; p<0.05). No significant difference was found in specificity (96.7% for TFE-DSDE, 98.3% for SS-EP DWI) CONCLUSION: With increased spatial resolution and reduced susceptibility artifacts, TFE-DSDE improves the accuracy in diagnosing acquired middle ear cholesteatomas compared to SS-EP DWI.
authors.affiliation: Department of Clinical Radiology, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yamashita
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshiura
authors.forename: Akio
authors.initials: A
authors.lastname: Hiwatashi
authors.forename: Makoto
authors.initials: M
authors.lastname: Obara
authors.forename: Osamu
authors.initials: O
authors.lastname: Togao
authors.forename: Nozomu
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D018424:Cholesteatoma, Middle Ear / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Cholesteatoma; DWI; Head and neck