title: The efficacy of color mapped fusion images in the diagnosis and treatment of cholesteatoma using transcanal endoscopic ear surgery.
abstract: OBJECTIVE
  To assess the efficacy of color mapped fusion images (CMFIs) in preoperatively evaluating the anatomic location of cholesteatomas and determining whether a patient is indicated for transcanal endoscopic ear surgery.
  
  
  METHODS
  Prospective case study.
  
  
  METHODS
  A single university hospital.
  
  
  METHODS
  Ninety-two patients scheduled for middle ear cholesteatoma surgery.
  
  
  METHODS
  Imaging analysis was first performed using echo planar diffusion-weighted imaging (EPI) for the first patient group with mixed results. Imaging analysis was then performed using 1-mm thin-slice non-EPI combined with magnetic resonance cisternography in a second group. The resulting image was then processed using color mapping to create a CMFI that enhanced cholesteatoma visualization. A second non-EPI was also performed on the third group, incorporating a T1-weighted image (T1WI) to reduce false-positives.
  
  
  METHODS
  Preoperative findings from EPI, non-EPI/CMFIs, and non-EPI/T1WI-enhanced CMFIs were compared with intraoperative findings. The positive predictive value and negative predictive value were also evaluated for each group.
  
  
  RESULTS
  Both the positive predictive value and negative predictive value obtained from the CMFIs were high in all areas of the middle ear, and CMFI facilitated accurate detection of the anatomic location of cholesteatomas of 3 mm or larger. The incidence of false-positives was further reduced in the final 18 patients by performing T1WI to distinguish between cholesteatomas and cholesterin granulomas.
  
  
  CONCLUSIONS
  CMFI combined with T1WI is a reliable diagnostic modality for evaluating the anatomic location of cholesteatomas 3 mm or larger and determining whether transcanal endoscopic ear surgery is indicated for treatment in such cases.
authors.affiliation: *Departments of Otolaryngology, Head and Neck Surgery, and †Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Watanabe
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ito
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Furukawa
authors.forename: Kazunori
authors.initials: K
authors.lastname: Futai
authors.forename: Toshinori
authors.initials: T
authors.lastname: Kubota
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kanoto
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Toyoguchi
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hosoya
authors.forename: Seiji
authors.initials: S
authors.lastname: Kakehata
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery*; D003952:Diagnostic Imaging / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging; D004432:Ear, Middle / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*