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Choi DL, Gupta MK, Rebello R, Archibald JD. Cost-comparison analysis of diffusion weighted magnetic resonance imaging (DWMRI) versus second look surgery for the detection of residual and recurrent cholesteatoma. J Otolaryngol Head Neck Surg 2019; 48:58. [PMID: 31699154 PMCID: PMC6836394 DOI: 10.1186/s40463-019-0384-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/22/2019] [Indexed: 02/10/2023] Open
Abstract
Background Cholesteatoma is a destructive, erosive growth of keratinizing squamous epithelium in the middle ear cleft. Following treatment with a canal wall-up (CWU) tympanomastoidectomy, surveillance of residual and recurrent disease has traditionally been achieved through a second look tympanotomy following the initial procedure. Historically, MRI sequences have been inadequate at differentiating between granulation tissue, inflammation, and cholesteatoma. Recent literature has shown diffusion-weighted magnetic resonance imaging (DWMRI) to be a viable alternative to second look surgery for the detection of residual or recurrent disease. The goal of the present study was to perform a cost analysis of DWIMRI versus second look surgery in the detection of residual or recurrent cholesteatoma following combined approach tympanomastoidectomy. Methods A probabilistic decision tree model was generated from a literature review to compare traditional second look surgery with DWMRI. Cost inputs were obtained from the Ontario Case Costing Initiative, the Ontario Health Insurance Plan (OHIP) schedule of benefits. Costs were reported in Canadian dollars and a payer perspective was adopted. A probabilistic sensitivity analysis was performed. Results According to the probabilistic sensitivity analysis, mean cost difference of traditional second look tympanotomy versus echo planar imaging (EPI) DWMRI was $180.27CAD, 95%CI [$177.32, $188,32] in favour of second-look tympanotomy. However, mean cost difference of traditional second look tympanotomy versus non-EPI DWMRI was $390.66CAD, 95%CI [$381.52, $399.80] in favour of non-EPI DWMRI. Conclusions Diffusion-weighted MRI, specifically non-EPI sequences, are a viable cost-saving alternative to second-look tympanotomy in the setting of detecting residual or recurrent cholesteatoma.
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Affiliation(s)
- David L Choi
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Michael K Gupta
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Rebello
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Jason D Archibald
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Gouda M, Nasr WF, Abd Elbary MES, Razek MMA. MRI as an Alternative to Second Look Mastoid Surgery. Indian J Otolaryngol Head Neck Surg 2018; 70:410-414. [PMID: 30211099 DOI: 10.1007/s12070-018-1407-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022] Open
Abstract
The main goal of surgery of cholesteatoma is eradication of the disease and revision surgery is indicated when a dry and safe ear has not been achieved. Residual cholesteatoma usually occurs at the sites that are difficult to reach with an operating microscope, such as posterior tympanum and anterior epitympanic recess. Computed tomography can be performed to delineate the extent of disease. High-resolution computed tomography scanning is important for planning for surgery and is indicated for all revision mastoid operations. Magnetic resonance imaging is superior to computed tomography in tissue characterization for diagnosis of recurrent cholesteatoma. To evaluate the cases of recurrent cholesteatoma comparing the intraoperative surgical findings with the preoperative MRI radiological findings and if the preoperative MRI can replace the second look surgery for cholesteatoma. This study was applied on 60 patients that have a recurrent cholesteatoma after previous mastoid surgery. A preoperative radiological evaluation was done by Magnetic resonance, surgical management was done by canal wall up or canal wall down mastoidectomy to exclude residual disease. Then, radiological, and surgical findings correlation was done. Diffusion-weighted MRI successfully detected 42 cases out of the 45 cases of surgically proved cholesteatoma, it has accuracy 95%, sensitivity 93.33%, specificity 100%, PPV 100% and NPV 83.33%. MRI is better than CT in tissue characterization for diagnosis of recurrent cholesteatoma, and can replace the unnecessary second look surgery of cholesteatoma.
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Affiliation(s)
- Magdy Gouda
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Wail Fayez Nasr
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Mohammad El-Sayed Abd Elbary
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Magdy M A Razek
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
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Bassiouni MAK, Atalla MB, Omran AA, Ibrahim ME, Talaat IM, Abdel Kader ANI. Evaluation of diffusion weighted MRI sequence as a predictor of middle ear cleft cholesteatoma: Imaging, operative and histopathological study. EGYPTIAN JOURNAL OF EAR, NOSE, THROAT AND ALLIED SCIENCES 2017. [DOI: 10.1016/j.ejenta.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Osman NMM, Rahman AA, Ali MTAH. The accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with Apparent Diffusion Coefficients in diagnosis of recurrent cholesteatoma. Eur J Radiol Open 2017; 4:27-39. [PMID: 28377947 PMCID: PMC5369335 DOI: 10.1016/j.ejro.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/24/2017] [Accepted: 03/10/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with ADC value combined with MDCT in evaluating recurrent cholesteatoma. PATIENTS Thirty patients (20 females and 10 males), their age ranged from 10 to 40years, had undergone a tympanomastoid surgery for a cholesteatoma of the middle ear underwent MDCT and MR DWI examination before second- or third-look surgery from May 2015 to October 2016. RESULTS CT showed partial opacification of the tympanomastoid cavity in 10 ears and complete opacification in 21 ears. CT detects 10 cases out of 20 cases of recurrent cholesteatoma with sensitivity 47.6%, specificity 100%, and NPP 47.6%. DWI depicted 21 out of 20 cases proved cholesteatoma patients (sensitivity 100%, specificity 90%, PPV 95.2% and P value is 0.001). All MRI of patients without cholesteatoma were correctly interpreted as showing negative findings for cholesteatoma (specificity = 100%). The ADC of cholesteatoma group (21 ears) were ranged from 553 to 759 × 10-3 mm2/s and the ADCs of non cholesteatoma group (10 ears) was ranged from 1495.8 to 1766.8 × 10-3 mm2/s. Cut off value of cholesteatoma is ≤759 × 10-3 mm2/s. CONCLUSION MR DWI with ADC combined with MDCT has high sensitivity, specificity, accuracy in detecting recurrent cholesteatoma.
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Muzaffar J, Metcalfe C, Colley S, Coulson C. Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis. Clin Otolaryngol 2016; 42:536-543. [DOI: 10.1111/coa.12762] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2016] [Indexed: 12/16/2022]
Affiliation(s)
- J. Muzaffar
- Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - C. Metcalfe
- Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - S. Colley
- Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - C. Coulson
- Queen Elizabeth Hospital Birmingham; Birmingham UK
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Cavaliere M, Di Lullo AM, Caruso A, Caliendo G, Elefante A, Brunetti A, Iengo M. Diffusion-Weighted Intensity Magnetic Resonance in the Preoperative Diagnosis of Cholesteatoma. ORL J Otorhinolaryngol Relat Spec 2014; 76:212-21. [DOI: 10.1159/000365931] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 07/11/2014] [Indexed: 11/19/2022]
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Alvo A, Garrido C, Salas Á, Miranda G, Stott CE, Delano PH. Use of non-echo-planar diffusion-weighted MR imaging for the detection of cholesteatomas in high-risk tympanic retraction pockets. AJNR Am J Neuroradiol 2014; 35:1820-4. [PMID: 24812017 DOI: 10.3174/ajnr.a3952] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Non-echo-planar DWI MR imaging (including the HASTE sequence) has been shown to be highly sensitive and specific for large cholesteatomas. The purpose of this study was to determine the diagnostic accuracy of HASTE DWI for the detection of incipient cholesteatoma in high-risk retraction pockets. MATERIALS AND METHODS This was a prospective study of 16 patients who underwent MR imaging with HASTE DWI before surgery. Surgeons were not informed of the results, and intraoperative findings were compared against the radiologic diagnosis. Sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS Among the 16 retraction pockets, 10 cholesteatomas were diagnosed intraoperatively (62.5%). HASTE showed 90% sensitivity, 100% specificity, 100% positive predictive value, and 85.7% negative predictive value in this group of patients. We found only 1 false-negative finding in an infected cholesteatoma. CONCLUSIONS We demonstrate a high correlation between HASTE and surgical findings, suggesting that this technique could be useful for the early detection of primary acquired cholesteatomas arising from retraction pockets and could help to avoid unnecessary surgery.
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Affiliation(s)
- A Alvo
- From the Departments of Otorhinolaryngology (A.A., C.E.S., P.H.D.)
| | - C Garrido
- Radiology (C.G., A.S., G.M.), Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Á Salas
- Radiology (C.G., A.S., G.M.), Hospital Clínico Universidad de Chile, Santiago, Chile
| | - G Miranda
- Radiology (C.G., A.S., G.M.), Hospital Clínico Universidad de Chile, Santiago, Chile
| | - C E Stott
- From the Departments of Otorhinolaryngology (A.A., C.E.S., P.H.D.)
| | - P H Delano
- From the Departments of Otorhinolaryngology (A.A., C.E.S., P.H.D.)
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Geoffray A, Guesmi M, Nebbia JF, Leloutre B, Bailleux S, Maschi C. MRI for the diagnosis of recurrent middle ear cholesteatoma in children--can we optimize the technique? Preliminary study. Pediatr Radiol 2013; 43:464-73. [PMID: 23160645 DOI: 10.1007/s00247-012-2502-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 07/16/2012] [Accepted: 08/27/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recurrent cholesteatoma after surgical excision occurs frequently in children. Until recently, a surgical second look was mandatory and considered as standard reference. MRI including a delayed T1 sequence after gadolinium injection and diffusion-weighted imaging (DWI) has proved its efficiency but has been evaluated mainly in adults. OBJECTIVE Our purpose was to evaluate the accuracy of DWI to diagnose recurrence of cholesteatoma in children. MATERIALS AND METHODS We evaluated prospectively with MRI 20 ears in 18 children who had had surgery for cholesteatoma. We compared DWI and delayed T1-weighted images following gadolinium administration with intraoperative or follow-up findings. We calculated the sensitivity and specificity of each sequence for the diagnosis of recurrent cholesteatoma. RESULTS Sensitivity to diagnose recurrent cholesteatoma was 87% for both DWI and delayed post-gadolinium sequences, specificity was 71% and 83%, respectively. Adding both sequences, the sensitivity was 87%, the specificity 100%. There was one false negative probably due to small size recurrence. CONCLUSION In our series, DWI was reliable to diagnose recurrent cholesteatoma in children and allows avoiding surgery when negative. However, because small recurrences less than 5 mm may be missed, follow-up must be prolonged (5 years).
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Affiliation(s)
- Anne Geoffray
- Fondation Lenval, 57 avenue de la Californie, 06200, Nice, France.
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Sharifian H, Taheri E, Borghei P, Shakiba M, Jalali AH, Roshanfekr M, Firouznia K. Diagnostic accuracy of non-echo-planar diffusion-weighted MRI versus other MRI sequences in cholesteatoma. J Med Imaging Radiat Oncol 2012; 56:398-408. [PMID: 22883647 DOI: 10.1111/j.1754-9485.2012.02377.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Non-echo-planar imaging (EPI) MRI has been recently introduced to improve the detection of small-sized cholesteatoma and decrease different artefacts occurring in the EPI-diffusion-weighted (DW) technique. This technique is also time saving in comparison to delayed post-contrast imaging. We prospectively assessed the diagnostic accuracy of MRI including delayed post-contrast standard MRI, EPI and non-EPI-DW sequences in the detection of middle ear cholesteatoma. METHODS We evaluated 35 patients suspected of having cholesteatoma who underwent MRI including delayed post-contrast MRI, EPI and non-EPI-DW sequences prior to their planned surgery, and the MR findings were compared with surgical findings. Two experienced radiologists reported the images. Sensitivity, specificity and predictive values of MRI were estimated. RESULTS We detected 26 cases of cholesteatoma at surgery. Sensitivity and specificity of delayed post-contrast MRI, EPI DW and non-EPI DW were 73.1 and 77.8%, 61.5 and 88.9%, and 96.2 and 100%, respectively, as interpreted by the first radiologist. Sensitivity and specificity of delayed post-contrast MRI, EPI-DW sequence and non-EPI-DW sequence were 84.6 and 88.9%, 50 and 88.9%, and 92.3 and 100%, respectively, as interpreted by the second radiologist. CONCLUSION The non-EPI MRI technique is a more accurate method in detecting middle ear cholesteatoma in comparison to other conventional sequences.
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Affiliation(s)
- Hashem Sharifian
- Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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A systematic review of diffusion-weighted magnetic resonance imaging in the assessment of postoperative cholesteatoma. Otol Neurotol 2012; 32:1243-9. [PMID: 21921855 DOI: 10.1097/mao.0b013e31822e938d] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE A systematic review to determine whether the diffusion-weighted (DW) magnetic resonance imaging scan can reliably detect residual or recurrent cholesteatoma after mastoid surgery. DESIGN A systematic review. DATA SOURCES Databases including EMBASE, MEDLINE, CINAHL, Web of Science, and Cochrane Review were searched for studies published without language restriction from the start of the databases. Additional studies were identified from cited references. SELECTION CRITERIA Initial search identified 402 publications, of which 16 studies met the inclusion criteria for the systematic review. The DW imaging (DWI) scan was used to detect residual or recurrent cholesteatoma and subsequent second-look surgery was performed to correlate the findings. REVIEW METHODS Studies were assessed for their selection of patients for radiologic investigations, imaging parameters, and subsequent surgery. Outcome measures included sensitivity, specificity, positive and negative predictive values of the DWI, and the incidence and size of residual or recurrent cholesteatoma. RESULTS Two different modalities of DWI sequences have been described. Eight studies with 225 patients analyzed echo-planar imaging (EPI) and 8 studies with 207 patients described the "non-EPI" scanning techniques. Non-EPI parameters are more reliable in identifying residual or recurrent cholesteatoma with sensitivity, specificity, and positive and negative predictive values of 91%, 96%, 97%, and 85%, respectively. CONCLUSION The available evidence suggests that non-EPI such as half-Fourier acquisition single-shot turbo spin echo sequences are more reliable in identifying residual or recurrent cholesteatoma. This is a promising radiologic investigation; however, we think further studies are required with more patients and long-term results to establish its place as an alternative to a second-stage surgery after canal wall up surgery.
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Khemani S, Singh A, Lingam RK, Kalan A. Imaging of postoperative middle ear cholesteatoma. Clin Radiol 2011; 66:760-7. [PMID: 21524417 DOI: 10.1016/j.crad.2010.12.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 12/12/2010] [Accepted: 12/14/2010] [Indexed: 01/01/2023]
Abstract
Cholesteatoma is often treated surgically using canal wall-preserving techniques. Clinical and otoscopic diagnosis of residual or recurrent disease after this form of surgery is unreliable and thus radiological imaging is often used prior to mandatory "second-look" surgery. Imaging needs to be able to differentiate residual or recurrent disease from granulation tissue, inflammatory tissue or fluid within the middle ear cavity and mastoid cavity. High-resolution computed tomography (HRCT), conventional magnetic resonance imaging (MRI), and delayed contrast MRI have all been used in detecting postoperative cholesteatoma. Although delayed contrast MRI performs better than HRCT and conventional MRI, the sensitivities and specificities of these different imaging methods are relatively poor. Diffusion-weighted MRI (DWI and, in particular, non-echo planar DWI) has been shown to have a high sensitivity and specificity for detecting recurrent cholesteatoma. In this review we provide examples of postoperative imaging appearances following cholesteatoma surgery and we review the relevant literature with an emphasis on studies evaluating the diagnostic accuracy of DWI.
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Affiliation(s)
- S Khemani
- Department of Otolaryngology, Northwick Park & Central Middlesex Hospitals, London, UK
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Evaluation of acquired cholesteatoma with PROPELLER diffusion imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Aarts MCJ, Rovers MM, van der Veen EL, Schilder AGM, van der Heijden GJM, Grolman W. The diagnostic value of diffusion-weighted magnetic resonance imaging in detecting a residual cholesteatoma. Otolaryngol Head Neck Surg 2010; 143:12-6. [PMID: 20620613 DOI: 10.1016/j.otohns.2010.03.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 03/17/2010] [Accepted: 03/22/2010] [Indexed: 11/16/2022]
Abstract
In this evidence-based case report, we address the following clinical question: What is the predictive value of diffusion-weighted magnetic resonance imaging (DW MRI) for detecting a residual cholesteatoma in patients with chronic otitis media with cholesteatoma who have previously undergone a canal-wall-up procedure? We searched for relevant synonyms for the determinant, MRI, and for the outcome, cholesteatoma, and retrieved relevant publications in Embase, PubMed, Cinahl, and Web of Science by using search terms in the title and abstract fields. The search yielded 683 records, of which 11 were relevant and valid for our clinical question. We pooled the data of the MRI findings of the included studies by adding the two-by-two tables of the individual studies. For the eight echo planar imaging (EPI) DW MRI studies, this resulted in a pooled sensitivity, specificity, positive predictive value, and negative predictive value of 68 percent, 87 percent, 81 percent, and 78 percent, respectively. For the three non-echo planar (non-EPI) DW MRI studies, the sensitivity, specificity, positive predictive value, and negative predictive value were 97 percent, 97 percent, 97 percent, and 97 percent, respectively. DW MRI, especially the non-EPI DW MRI, appears to be a rather accurate method, as opposed to a standard second-look operation, for the follow-up of patients who have undergone a canal-wall-up procedure for a chronic otitis media with cholesteatoma and who have no clinical signs of recurrent cholesteatoma.
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Affiliation(s)
- Mark C J Aarts
- Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Schwartz KM, Lane JI, Bolster BD, Neff BA. The utility of diffusion-weighted imaging for cholesteatoma evaluation. AJNR Am J Neuroradiol 2010; 32:430-6. [PMID: 20488909 DOI: 10.3174/ajnr.a2129] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
DWI is a useful technique for the evaluation of cholesteatomas. It can be used to detect them when the physical examination is difficult and CT findings are equivocal, and it is especially useful in the evaluation of recurrent cholesteatoma. Initial DWI techniques only detected larger cholesteatomas, >5 mm, due to limitations of section thickness and prominent skull base artifacts. Newer techniques allow detection of smaller lesions and may be sufficient to replace second-look surgery in patients with prior cholesteatoma resection.
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Affiliation(s)
- K M Schwartz
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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