Detection of postoperative residual cholesteatoma with non-echo-planar diffusion-weighted magnetic resonance imaging.

Abstract

OBJECTIVE:

The aim of this study was to analyze the role of non-echo-planar imaging (non-EPI)-based diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of residual cholesteatoma after canal wall-up mastoidectomy before eventual second-look surgery.

STUDY DESIGN:

Prospective and blinded study.

SETTING:

Tertiary referral center.

PATIENTS:

The study group included the surgical, clinical, and imaging follow-up of 32 consecutive patients after primary cholesteatoma surgery.

INTERVENTIONS:

All patients were investigated with MRI, including late postgadolinium T1-weighted sequence and non-EPI-DW sequence, 10 to 18 months after first-stage cholesteatoma surgery by experienced surgeons using a canal wall-up mastoidectomy. The non-EPI-DW images were evaluated for the presence of a high-signal intensity lesion consistent with residual cholesteatoma. Imaging findings were correlated with findings from second-stage surgery in 19 patients, clinical follow-up examination in 11 patients, and, in 2 patients, clinical and MRI follow-up examination.

RESULTS:

Non-EPI-DW sequences depicted 9 of 10 residual cholesteatomas. The only lesion missed was a 2-mm cholesteatoma in an examination degraded by motion artifacts in a child. All other diagnosed cholesteatomas measured between 2 and 6 mm. Sensitivity, specificity, positive predictive value, and negative predictive value were 90, 100, 100, and 96%, respectively.

CONCLUSION:

Except for motion artifact-degraded examinations, non-EPI-DW MRI is able to detect even very small residual cholesteatoma after first-stage surgery by showing a high-signal intensity lesion. It has the capability of selecting patients for second-look surgery, avoiding unnecessary second-look surgery.

• Authors: Bert De Foer, Jean-Philippe Vercruysse, Anja Bernaerts, Filip Deckers, Marc Pouillon, Thomas Somers, Jan Casselman, Erwin Offeciers
• Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Otol Neurotol) Vol. 29 Issue 4 Pg. 513-7 (Jun 2008) ISSN: 1531-7129 [Print] United States
• PMID: 18520587 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Adolescent
• Adult
• Aged
• Artifacts
• Child
• Child, Preschool
• Cholesteatoma, Middle Ear (diagnosis, surgery)
• Diffusion Magnetic Resonance Imaging
• Double-Blind Method
• Female
• Humans
• Image Processing, Computer-Assisted
• Male
• Mastoid (surgery)
• Middle Aged
• Otologic Surgical Procedures
• Prospective Studies