Diffusion weighted MR imaging of primary and recurrent middle ear cholesteatoma: an assessment by readers with different expertise.
OBJECTIVE
Diffusion weighted imaging (DWI) has been proven to be valuable in the diagnosis of middle ear cholesteatoma. The aims of our study were to evaluate the advantage of multi-shot turbo spin echo (MSh TSE) DWI compared to single-shot echo-planar (SSh EPI) DWI for the diagnosis of cholesteatoma.


METHODS
Thirty-two patients with clinical suspicion of unilateral cholesteatoma underwent preoperative MRI (1.5T) with SSh EPI and MSh TSE. Images were separately analyzed by 4 readers with different expertise to confirm the presence of cholesteatoma. Sensitivity, specificity, diagnostic accuracy, and positive (PPV) and negative predictive values (NPV) were assessed for each observer and interrater agreement was assessed using kappa statistics. Diagnosis was obtained at surgery.


RESULTS
Overall MSh TSE showed higher diagnostic accuracy and lower negative predictive value (NPV) compared to conventional SSh EPI. Interreader agreement between the observers revealed the superiority of MSh TSE compared to SSh EPI. Interrater agreement among all the four observers was higher by using MSh TSE compared to SSh EPI.


CONCLUSIONS
Our findings suggest that MSh TSE DWI has higher sensitivity for detection of cholesteatoma and lower probability of misdiagnosis. MSh TSE DWI is useful in guiding less experienced observers to the diagnosis.
Dipartimento di Scienze Biomediche Avanzate-Neuroradiologia, Università Federico II, 80131 Napoli, Italy.
A
A
Elefante
Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Federico II, 80131 Napoli, Italy.
M
M
Cavaliere
Dipartimento di Scienze Biomediche Avanzate-Neuroradiologia, Università Federico II, 80131 Napoli, Italy.
C
C
Russo
Dipartimento di Scienze Biomediche Avanzate-Neuroradiologia, Università Federico II, 80131 Napoli, Italy.
G
G
Caliendo
Dipartimento di Scienze Biomediche Avanzate-Neuroradiologia, Università Federico II, 80131 Napoli, Italy.
M
M
Marseglia
Dipartimento di Scienze Biomediche Avanzate-Neuroradiologia, Università Federico II, 80131 Napoli, Italy.
D
D
Cicala
Dipartimento di Scienze Biomediche Avanzate-Neuroradiologia, Università Federico II, 80131 Napoli, Italy.
D
D
Piccolo
Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Federico II, 80131 Napoli, Italy.
A
A
Di Lullo
Dipartimento di Scienze Biomediche Avanzate-Neuroradiologia, Università Federico II, 80131 Napoli, Italy.
L
L
Brunetti
Dipartimento di Scienze Biomediche Avanzate-Neuroradiologia, Università Federico II, 80131 Napoli, Italy.
A
A
Palma
Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Federico II, 80131 Napoli, Italy.
M
M
Iengo
Dipartimento di Scienze Biomediche Avanzate-Neuroradiologia, Università Federico II, 80131 Napoli, Italy.
A
A
Brunetti
D000293:Adolescent; D000328:Adult; D000368:Aged; D018424:Cholesteatoma, Middle Ear / Q000000981:diagnostic imaging* / Q000473:pathology; D003951:Diagnostic Errors; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012680:Sensitivity and Specificity