Evaluation of diffusion weighted MRI sequence as a predictor of middle ear cleft cholesteatoma: Imaging, operative and histopathological study

Publication date: Available online 18 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Mokhtar Abdel Khalek Bassiouni, Mohamed Bassiouni Atalla, Ahmed Amin Omran, Mohamed Eid Ibrahim, Iman Mamdouh Talaat, Al Nagy Ibreak Abdel Kader
ObjectivesNon-echoplanar imaging (Non-EPI) MRI has been recently introduced to improve the detection of small sized cholesteatoma and decrease different artifacts occurring in the echo-planar diffusion weighted image (EPI DWI) technique. It is a time saving procedure in comparison to the delayed post-contrast imaging. We prospectively assessed the diagnostic accuracy of Non-EPI-DW sequences in the detection of middle ear cleft cholesteatoma.Material and methodsForty patients suspected to have cholesteatoma were collected from the ENT outpatient clinic of a tertiary referral center. Twenty patients underwent primary mastoid surgery, ten patients scheduled for revision mastoid surgery, while the remaining patients underwent second look operation after one year of their first surgery. All patients underwent Non-EPI-DW sequences prior to their planned surgery. Diagnosis of cholesteatoma was based on evidence of a hyperintense lesion on diffusion-weighted images that were correlated with the surgical findings and histopathological examination, which was used as the gold standard for diagnostic confirmation. Sensitivity, specificity and predictive values of MRI were estimated.ResultsDiffusion weighted imaging accurately predicted the presence of cholesteatoma in 88.2% of cases, and it correctly excluded it in 100% of cases. Sensitivity, specificity, positive and negative predictive values were 88.24%, 100%, 100% and 60%, respectively. Non-echo-planar DWI has been shown to have a high sensitivity and specificity for detecting recurrent cholesteatoma.ConclusionsNon-echoplanar DWI is an effective technique in cholesteatoma diagnosis. It is capable of detecting lesions larger than 2mm.



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