Contribution of magnetic resonance imaging to the diagnosis of middle ear cholesteatoma: analysis of a series of 97 cases.
OBJECTIVE
To evaluate the reliability of magnetic resonance imaging (MRI) for the diagnosis of middle ear cholesteatoma and to determine the contribution of each MRI sequence.


METHODS
A series of 97 cases was reviewed, corresponding to 89 patients (43 women, 46 men). Each patient was assessed by the following MRI protocol: T1-weighted, T2-weighted, early contrast-enhanced T1-weighted, delayed contrast-enhanced T1-weighted, and diffusion-weighted sequences. All patients were operated, for the first time in 16 cases and for second-look surgery in 81 cases. Radiological findings were compared to surgical and histological findings. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each sequence.


RESULTS
Seventy-four cholesteatomas were diagnosed at surgery. These lesions had a mean diameter of 8.29±5.46mm. The smallest cholesteatoma in this series was 2mm in diameter. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences had a sensitivity of 84.9% and 90.4%, a specificity of 87.5% and 75%, a positive predictive value of 95.4% and 91.7%, and a negative predictive value of 65.6% and 72%, respectively. T1-weighted, T2-weighted, and early contrast-enhanced T1-weighted sequences had a low specificity.


CONCLUSIONS
MRI is a reliable imaging modality for the diagnosis of middle ear cholesteatoma. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences were discriminant. In the context of postoperative follow-up of cholesteatoma, these sequences allow better selection of cases requiring second-look surgery.
Service d'ORL et chirurgie cervico faciale, université Clermont 1, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France. Electronic address: mohamed.akkari.orl@gmail.com.
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M
Akkari
Service de neuroradiologie, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France.
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J
Gabrillargues
Service d'ORL et chirurgie cervico faciale, université Clermont 1, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France.
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N
Saroul
Délégation à la recherche clinique et à l'innovation (DRCI), CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France.
B
B
Pereira
Service d'ORL et chirurgie cervico faciale, université Clermont 1, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France.
M
M
Russier
Service d'ORL et chirurgie cervico faciale, université Clermont 1, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France.
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T
Mom
Service d'ORL et chirurgie cervico faciale, université Clermont 1, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France.
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L
Gilain
D000328:Adult; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D003287:Contrast Media
Delayed contrast-enhanced T1-weighted; Diffusion-weighted imaging; MRI; Middle ear cholesteatoma