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Muacevic A, Adler JR, Fatani NH, Alhatem H, Zabidi A, Ibrahim M. Non-echo Planar Diffusion-Weighted Imaging in the Detection of Recurrent or Residual Cholesteatoma: A Systematic Review and Meta-Analysis of Diagnostic Studies. Cureus 2022; 14:e32127. [PMID: 36601207 PMCID: PMC9805695 DOI: 10.7759/cureus.32127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/03/2022] Open
Abstract
We performed a systematic review and meta-analysis of patients with suspected recurrent cholesteatoma who underwent non-echo planar imaging (non-EPI) using diffusion-weighted magnetic resonance imaging (MRI), with surgery as the reference standard. We searched Medline, Google Scholar, and the Cochrane database for diagnostic test accuracy studies. The following prespecified subgroup analyses were performed: patient age, number of radiologists interpreting MRI, study design, and risk of bias. We used a bivariate model using a generalized linear mixed model to pool accuracies. Of the 460 records identified, 32 studies were included, of which 50% (16/32) were low risk of bias. The overall pooled sensitivity was 92.2% (95% CI 87.3-95.3%), and specificity was 91.7% (85.2-95.5%). The positive likelihood ratio was 11.1 (4.5-17.8), and the negative likelihood ratio was 0.09 (0.04-0.13). The pooled diagnostic odds ratio was 130.3 (20.5-240). Heterogeneity was moderate on visual inspection of the hierarchical summary receiver operating characteristic curve. Subgroup analyses showed prospective studies reporting higher accuracies (p=0.027), which were driven by higher specificity (prospective 93.1% (88.4-96.0%) versus retrospective 81.2% (81.0-81.4%)). There was no difference in subgroups comparing patient age (p=0.693), number of radiologists interpreting MRI (p=0.503), or risk of bias (p=0.074). No publication bias was detected (p=0.98). In conclusion, non-EPI is a highly sensitive and specific diagnostic test able to identify recurrent cholesteatomas of moderate to large sizes. This test can be considered a non-invasive alternative to second-look surgery.
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Sharma SD, Hariri A, Lingam RK, Singh A. Survey of the Use of Diffusion-Weighted Imaging for Cholesteatoma in the United Kingdom. ORL J Otorhinolaryngol Relat Spec 2021; 84:167-173. [PMID: 34455409 DOI: 10.1159/000516242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Non-echoplanar diffusion-weighted MRI (DWMRI) has a role in the surgical planning for cholesteatoma. AIMS/OBJECTIVES The aim of the study was to assess the use of DWMRI in the management of cholesteatoma across the UK, and measure clinicians' confidence in the use of DWMRI. MATERIALS AND METHODS Telephone survey in 139 Otolaryngology Departments in the United Kingdom between March 2017 and July 2017, and asking radiology delegates at the British Society of Head and Neck Imaging 2017 meeting. RESULTS The response rate was 101 out of 139 Trusts (73%). Of those respondents who did have DWMRI available, 68/88 respondents (77%) use it for cholesteatoma. The mean confidence (±standard deviation) of the respondents with DWMRI in identifying cholesteatoma presence was 7.3 ± 2.1, in identifying volume of cholesteatoma was 6.8 ± 1.8, and in identifying subsites of cholesteatoma was 4.6 ± 2.1. CONCLUSIONS AND SIGNIFICANCE DWMRI has a well-defined role in the follow-up of patients after cholesteatoma surgery, and those primary cases of cholesteatoma where the diagnosis is in question. The use of DWMRI for cholesteatoma is variable across the UK, but there are certain clinical scenarios where there is not enough awareness regarding the benefits of imaging (such as petrous apex cases of cholesteatoma).
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Affiliation(s)
- Sunil Dutt Sharma
- Department of Otorhinolaryngology, Northwick Park Hospital, London, United Kingdom
| | - Ahmad Hariri
- Department of Otorhinolaryngology, Northwick Park Hospital, London, United Kingdom
| | - Ravi Kumar Lingam
- Department of Otorhinolaryngology, Northwick Park Hospital, London, United Kingdom
| | - Arvind Singh
- Department of Otorhinolaryngology, Northwick Park Hospital, London, United Kingdom
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Importance of signal intensity on T1-weighted spin-echo sequence for the diagnosis of chronic cholesteatomatous otitis. Eur Arch Otorhinolaryngol 2020; 277:1601-1608. [DOI: 10.1007/s00405-020-05854-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
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Fan X, Liu Z, Ding C, Chang Z, Ma Q. The value of turbo spin-echo diffusion-weighted imaging apparent diffusion coefficient in the diagnosis of temporal bone cholesteatoma. Clin Radiol 2019; 74:977.e1-977.e7. [DOI: 10.1016/j.crad.2019.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/21/2019] [Indexed: 01/04/2023]
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Role of non-echo-planar diffusion-weighted images in the identification of recurrent cholesteatoma of the temporal bone. Radiol Med 2019; 125:75-79. [DOI: 10.1007/s11547-019-01085-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/12/2019] [Indexed: 01/10/2023]
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Ide S, Ganaha A, Tono T, Goto T, Nagai N, Matsuda K, Azuma M, Hirai T. Value of DW-MRI in the preoperative evaluation of congenital cholesteatoma. Int J Pediatr Otorhinolaryngol 2019; 124:34-38. [PMID: 31158569 DOI: 10.1016/j.ijporl.2019.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/19/2019] [Accepted: 05/16/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study evaluated the clinical value of diffusion-weighted magnetic resonance imaging (DW-MRI) in the diagnosis and staging of congenital cholesteatoma (CC). PATIENTS AND METHODS We retrospectively reviewed 24 patients with CC. All the patients underwent computed tomography (CT) and DW-MRI preoperatively; thereafter, surgery was performed. DW-MRI examination was performed with a 3 T MRI system using three-dimensional reversed fast imaging with steady-state precession and diffusion-weighted magnetic resonance sequence. The preoperative and operative CT and DW-MRI findings were compared. RESULTS Using DW-MRI, cholesteatoma was successfully detected in 17 (71%) of the 24 patients with CC. Among the seven patients with false-negative results, the cholesteatoma mass diameter was <5 mm in six patients and ≥5 mm in one patient. One of these patients had open type congenital cholesteatoma (OTCC). The detection rates for closed type cholesteatoma and OTCC were 85% (17/20) and 0% (0/4), respectively, using DW-MRI. Using CT and DW-MRI, the correct stage was identified in 88% (15/17) and 59% (10/17) of the patients with aeration around the CC and in 0% (0/7) and 100% (7/7) of those without aeration around the CC, respectively. CONCLUSION CT is the primary imaging tool for evaluating suspected CC in patients with aeration around the CC. However, CT is unreliable for the detection of the extension and staging of CC when the middle ear is filled with nonspecific imaging. DW-MRI is useful for the preoperative diagnosis and staging of CC > 5 mm in diameter with or without surrounding granulation tissue. Thus, we recommend using DW- MRI at least when CT fails to localize CC as a soft tissue mass because of non-specific tissue filling the middle ear and the mastoid.
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Affiliation(s)
- Shinsuke Ide
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Akira Ganaha
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Tetsuya Tono
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Takashi Goto
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Noriaki Nagai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Keiji Matsuda
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Minako Azuma
- Department of Radiology, University of Miyazaki, Miyazaki, Japan.
| | - Toshinori Hirai
- Department of Radiology, University of Miyazaki, Miyazaki, Japan.
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Fischer N, Schartinger VH, Dejaco D, Schmutzhard J, Riechelmann H, Plaikner M, Henninger B. Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation. AJNR Am J Neuroradiol 2019; 40:1055-1059. [PMID: 31122917 DOI: 10.3174/ajnr.a6079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/21/2019] [Indexed: 12/12/2022]
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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Affiliation(s)
- N Fischer
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - V H Schartinger
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - D Dejaco
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - J Schmutzhard
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - H Riechelmann
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - M Plaikner
- Radiology (M.P., B.H.), Medical University of Innsbruck, Innsbruck, Austria
| | - B Henninger
- Radiology (M.P., B.H.), Medical University of Innsbruck, Innsbruck, Austria
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Lips LMJ, Nelemans PJ, Theunissen FMD, Roele E, van Tongeren J, Hof JR, Postma AA. The diagnostic accuracy of 1.5 T versus 3 T non-echo-planar diffusion-weighted imaging in the detection of residual or recurrent cholesteatoma in the middle ear and mastoid. J Neuroradiol 2019; 47:433-440. [PMID: 30951771 DOI: 10.1016/j.neurad.2019.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE AND BACKGROUND This study retrospectively compares diagnostic performance of 1.5 T versus 3 T non-echo planar diffusion weighted imaging with or without additional T1 and T2 sequences in the detection of residual and/or recurrent cholesteatoma. METHODS Patients with clinically suspected recurrent cholesteatoma or postoperative routine survey MR who subsequently underwent surgical procedure were retrospectively included (135 patients, 164 operated ears) from a large database. Patients underwent 1.5 T (128 ears) or 3 T MRI (36 ears), with non-echo planar DWI, T1 and T2 acquisitions. Two radiologists independently reassessed the images. Definitive surgical diagnosis was used as gold standard. Sensitivity, specificity and diagnostic odds ratio were evaluated. RESULTS According to surgical diagnosis a cholesteatoma was present in 124 of 164 ears, corresponding with a prevalence of 75%. Sensitivity and specificity were lower for 3 T compared to 1.5 T, irrespective of whether additional T1 and T2-weighted sequences were used or not. Diagnostic odds ratios were higher for 1.5 T (34 and 12 for reader 1 and 2, respectively) compared to 3 T (3 and 4 for reader 1 and 2, respectively). Adding T1 and T2 sequences lowers sensitivity but increases specificity. CONCLUSION Non-epi DWI for the detection of residual/recurrent cholesteatoma is preferably performed on 1.5 T scanners over 3 T. The use of additional sequences regarding detection of cholesteatoma is debatable as it lowers sensitivity but increases specificity. However, these sequences may also be of use in diagnosing complications and planning surgical procedures in some hospitals.
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Affiliation(s)
- L M J Lips
- Department of radiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands.
| | - P J Nelemans
- Department of Epidemiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - F M D Theunissen
- Department of radiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - E Roele
- Department of radiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - J van Tongeren
- Department of Otorhinolaryngology. Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - J R Hof
- Department of Otorhinolaryngology. Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - A A Postma
- Department of radiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
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Garcia-Iza L, Guisasola A, Ugarte A, Navarro JJ, Goiburu M, Altuna X. Utility of diffusion-weighted magnetic resonance imaging in the diagnosis of cholesteatoma and the influence of the learning curve. Eur Arch Otorhinolaryngol 2018; 275:2227-2235. [DOI: 10.1007/s00405-018-5074-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023]
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Hacettepe cartilage slicer: a novel cartilage slicer and its performance test results. The Journal of Laryngology & Otology 2017; 131:671-675. [PMID: 28446264 DOI: 10.1017/s0022215117000846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigated the performance of a cartilage slicer device referred to as the 'Hacettepe cartilage slicer'. METHODS Forty-one cartilage pieces were harvested from eight fresh frozen human ears and measured in thickness with a digital micrometer. These pieces were randomly sliced using four different thickness settings and two different types of blades. The thicknesses of the slices and remaining pieces were measured also. Scanning electron microscopy was utilised to determine the surface smoothness of the slices. RESULTS Thickness results showed a proportional increase with the increasing thickness setting, with a ±0.1 mm margin of error. The measurements showed that over 95 per cent of the slices' structural integrity was preserved. Although both blades provided satisfactory results, scanning electron microscopy revealed that the slices cut with a single bevel blade had superior surface smoothness. CONCLUSION To our knowledge, the current study is the first to evaluate the performance of a cartilage slicer device. Based on the thickness results, the Hacettepe cartilage slicer fulfilled its design goals: to consistently produce slices at the intended thickness with a ±0.1 mm tolerance, and to preserve over 95.3 per cent of cartilage thickness thereby ensuring undamaged, strong cartilage slices.
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A Meta-Analysis on the Diagnostic Performance of Non-Echoplanar Diffusion-Weighted Imaging in Detecting Middle Ear Cholesteatoma: 10 Years On. Otol Neurotol 2017; 38:521-528. [DOI: 10.1097/mao.0000000000001353] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Lingam RK, Nash R, Majithia A, Kalan A, Singh A. Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl. Insights Imaging 2016; 7:669-78. [PMID: 27558789 PMCID: PMC5028345 DOI: 10.1007/s13244-016-0516-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Abstract Non-echoplanar diffusion weighted magnetic resonance imaging (DWI) has established itself as the modality of choice in detecting and localising post-operative middle ear cleft cholesteatoma. Despite its good diagnostic performance, there are recognised pitfalls in its radiological interpretation which both the radiologist and otologist should be aware of. Our article highlights the various pitfalls and provides guidance for improving radiological interpretation and navigating beyond many of the pitfalls. It is recommended radiological practice to interpret the diffusion weighted images together with the ADC map and supplement with the corresponding T1 weighted and T2 weighted images, all of which can contribute to and enhance lesion localisation and characterisation. ADC values are also helpful in improving specificity and confidence levels. Given the limitation in sensitivity in detecting small cholesteatoma less than 3 mm, serial monitoring with DWI over time is recommended to allow any small residual cholesteatoma pearls to grow and become large enough to be detected on DWI. Optimising image acquisition and discussing at a joint clinico-radiological meeting both foster good radiological interpretation to navigate beyond the pitfalls and ultimately good patient care. Teaching Points • Non-echoplanar DWI is the imaging of choice in detecting post-operative cholesteatoma. • There are recognised pitfalls which may hinder accurate radiological interpretation. • Interpret with the ADC map /values and T1W and T2W images. • Serial DWI monitoring is of value in detection and characterisation. • Optimising image acquisition and discussing at clinico-radiological meetings enhance radiological interpretation.
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Affiliation(s)
- Ravi K Lingam
- Department of Radiology, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK.
| | - Robert Nash
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| | - Anooj Majithia
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| | - Ali Kalan
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| | - Arvind Singh
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
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