Abstract
BACKGROUND AND PURPOSE
MR imaging has become an important tool for the detection of cholesteatomas of the middle ear. Various diffusion-weighted imaging sequences are available and have shown promising results. This study aimed to evaluate readout-segmented echo-planar DWI for the detection of cholesteatoma and compare the results with surgical validation.
MATERIALS AND METHODS
Fifty patients with chronic otitis media (24 females and 26 males; range, 12–76 years of age; mean age, 41 years) who underwent MR imaging before an operation of the middle ear (1–169 days) were included. The MR imaging protocol consisted of axial and coronal readout-segmented echo-planar DWI with b-values of 0 and 1000 s/mm2 and 3-mm slice thickness. The readout-segmented echo-planar diffusion-weighted images were fused with standard T2-weighted sequences for better anatomic assignment. The results of the MR imaging evaluation were correlated with the results from the operation.
RESULTS
Readout-segmented echo-planar DWI detected 22 of the 25 cases of surgically proved cholesteatoma. It has an accuracy of 92% (95% confidence interval, 80.8%–97.8%), a sensitivity of 88%, a specificity of 96%, a positive predictive value of 96%, and a negative predictive value of 89%. In 1 case, a positive finding for cholesteatoma with readout-segmented echo-planar DWI could not be proved by histology, and in 3 cases, histology yielded a cholesteatoma that was not detected with MR imaging.
CONCLUSIONS
Readout-segmented echo-planar DWI is a promising and reliable MR imaging sequence for the detection and exclusion of cholesteatoma.
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Fellows’ Journal Club
Readout-segmented echo-planar (RESOLVE)-DWI is a new alternative technique for obtaining DWI with high quality, delivering sharp images at high spatial resolution and reduced slice thickness. Fifty patients with chronic otitis media who underwent MR imaging before an operation of the middle ear were included. The MR imaging protocol consisted of axial and coronal readout-segmented echo-planar DWI with b-values of 0 and 1000 s/mm2 and 3-mm slice thickness. The readout segmented echo-planar diffusion-weighted images were fused with standard T2-weighted sequences for better anatomic assignment. Readout-segmented echo-planar DWI detected 22 of the 25 cases of surgically proved cholesteatoma. It has an accuracy of 92%, a sensitivity of 88%, a specificity of 96%, a positive predictive value of 96%, and a negative predictive value of 89%. Readout-segmented echo-planar DWI is a promising and reliable MR imaging sequence for the detection and exclusion of cholesteatoma.