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Hosoya M, Kurihara S, Koyama H, Komune N. Recent advances in Otology: Current landscape and future direction. Auris Nasus Larynx 2024; 51:605-616. [PMID: 38552424 DOI: 10.1016/j.anl.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/24/2023] [Accepted: 02/21/2024] [Indexed: 05/12/2024]
Abstract
Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi Minato-ku, Tokyo, 105-8471, Japan
| | - Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8654, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1Maidashi Higashi-ku, Fukuoka 812-8582, Japan
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Uğurlu BN, Aktar Uğurlu G. Exploring trends and developments in cholesteatoma research: a bibliometric analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08749-z. [PMID: 38809268 DOI: 10.1007/s00405-024-08749-z] [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: 02/26/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Examination of the scientific literature on cholesteatoma from past to present using bibliometric methods. METHODS A total of 2353 articles on cholesteatoma between 1980 and 2023 were obtained from the Web of Science database and statistically analysed using bibliometric techniques. RESULTS The journals with the highest number of contributions to the literature were Otology & Neurotology (n = 192), Acta Oto-Laryngologica (156) and Laryngoscope (149). The most impactful journals based on h-index and total citation (TC) counts were Laryngoscope (h:36, TC: 4241), Otology & Neurotology (29, 3141), and American Journal of Otology (26, 2071) respectively. The most prolific author was Kojima H. (n = 49). According to the findings of the Reference Publication Year Spectroscopy (RPYS) analysis, there has been a significant increase in academic interest in Cholesteatoma since its first description in 1959, particularly following the expansion of its definition in 1977. Subsequently, the trend of increased interest has risen rapidly in later years, with notable peaks in research intensity observed in 1989, 2006, and 2011. The highest academic trend occurred in 2006. In recent years, trending topics have included innovative approaches such as diagnostic and imaging methods particularly alongside technological developments, endoscopic surgery, recurrence and complications, prognosis and quality of life, artificial intelligence, and obliteration. CONCLUSION In conclusion, the evolution of cholesteatoma and its research priorities reveal temporal shifts and emerging areas of interest over time. Primarily, diagnosis, treatment, and surgical approaches remain central. Additionally, research has expanded to encompass developments in surgical techniques, imaging modalities, cellular biology, pathology, and molecular mechanisms.
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Affiliation(s)
- Burak Numan Uğurlu
- Private Practitioner, Otolaryngology, Çorum, Turkey.
- Department of Otorhinolaryngology, Faculty of Medicine , Hitit University, Çorum, Turkey.
| | - Gülay Aktar Uğurlu
- Department of Otorhinolaryngology, Faculty of Medicine , Hitit University, Çorum, Turkey
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Adams JK, Marinelli JP, De Jong R, Spear SA, Erbele ID. Modern Trends in Otologic Surgery and Implications for Residency Training. Otolaryngol Head Neck Surg 2024; 170:1404-1410. [PMID: 38251771 DOI: 10.1002/ohn.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Placing a middle ear prosthesis is considered a key competency for the general otolaryngologist, but surgeons struggle to obtain and maintain this skill. The current study aims to characterize pre-coronavirus disease 2019 trends in stapedectomy and ossiculoplasty. STUDY DESIGN Database review. SETTING Tricare beneficiaries are treated at civilian and military facilities. METHODS The Department of Defense beneficiary population of more than nine million persons per year was reviewed for patients undergoing either stapedectomy or ossiculoplasty between 2010 and 2019, identified by the current procedural terminology code. RESULTS A total of 3052 stapedectomies and 7197 ossiculoplasties were performed. Over the 10-year study period, stapedectomy decreased by 23%, with an average annual rate of -2.7% per year (Pearson r = -.91, P = .0003). Ossiculoplasties declined by 18%, an average annual rate of -1.9% (r = -.8, P = .006). In combination, cases declined by 20%, an average annual rate of -2.2% (r = -.87, P = .001). CONCLUSION While declines in stapedectomy surgery have been well reported, here we show steady declines in ossiculoplasty as well. If these trends continue, more cochlear implantations may be performed annually than stapedectomy and ossiculoplasty combined, with cochlear implantation likely to overtake ossicular chain surgery in the near future. These changes in surgical volume have a direct implication on resident education and general otolaryngology expectations after graduation. Strong consideration should be made to replace "Stapedectomy/Ossiculoplasty" as resident key indicator with "Cochlear Implantation," a more professionally meaningful skill.
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Affiliation(s)
- Jason K Adams
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Russell De Jong
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Samuel A Spear
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
- Department of Defense Hearing Center of Excellence, San Antonio, Texas, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Isaac D Erbele
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Koro E, Ögren E, Olofsson K, Werner M. Evaluation of magnetic resonance imaging to detect cholesteatoma in clinical healthcare. Acta Otolaryngol 2024; 144:193-197. [PMID: 38662877 DOI: 10.1080/00016489.2024.2344820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/13/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Non-Echo-Planar Diffusion Weighed Magnetic Resonance Imaging (non-EPI DW MRI) plays a role in the planning of cholesteatoma surgery. OBJECTIVES To outline the usage of Non-EPI DW MRI in cholesteatoma diagnostics and to determine its accuracy, using otosurgery diagnostics as reference standard. MATERIAL AND METHODS A retrospective descriptive study. All subjects operated, with suspicion of cholesteatoma as indication, that had a preceding examination with non-EPI DW MRI, between October 2010 and March 2019. Calculating sensitivity, specificity, predicative values, and likelihood ratios, using non-EPI DW MRI as index test and diagnosis from otosurgery as reference standard. RESULTS Fifty-two subject episodes were included. Non-EPI DW MRI had a sensitivity of 0.50, specificity of 0.75, positive and negative predictive values of 0.74 and 0.52 and, positive and negative likelihood ratios of 2.0 and 0.67 respectively. CONCLUSIONS AND SIGNIFICANCE There is a clear annual trend with increased numbers of executed examinations during the study period. The diagnostic accuracy of non-EPI DW MRI does not reach acceptable levels in the existing everyday routine practice conditions. The accuracy of the examination increases when interpreted by an experienced radiologist and when using the definition of cholesteatoma recommended by EAONO/JOS.
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Affiliation(s)
- Eleonor Koro
- Department of Clinical Sciences, Otorhinolaryngology/Västernorrland research unit, University of Umeå, Umeå, Sweden
| | - Emely Ögren
- Department of Clinical Sciences, Otorhinolaryngology, University of Umeå, Umeå, Sweden
| | - Katarina Olofsson
- Department of Clinical Sciences, Otorhinolaryngology, University of Umeå, Umeå, Sweden
| | - Mimmi Werner
- Department of Clinical Sciences, Otorhinolaryngology, University of Umeå, Umeå, Sweden
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Bu DD, Schwam ZG, Wanna GB, Perez E, Cosetti MK. Cost-Effectiveness of Diffusion-Weighted Magnetic Resonance Imaging Versus Second-Look Surgery in Treating Cholesteatoma: A Modeling Study. Otol Neurotol 2024; 45:163-168. [PMID: 38206064 DOI: 10.1097/mao.0000000000004076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To evaluate whether canal wall-up (CWU) tympanomastoidectomy with diffusion-weighted magnetic resonance imaging (DW-MRI) is a cost-effective method of treating cholesteatoma compared with CWU with second-look surgery. DESIGN AND SETTING Cost-effectiveness analysis was conducted using a Markov state transition model. The simulation model adhered to the Panel Recommendations on Cost-Effectiveness in Health and Medicine established by the US Public Health Service. One-way and Monte Carlo probability sensitivity analyses were conducted for validation. INTERVENTIONS Tympanomastoidectomy with DW-MRI versus tympanomastoidectomy with second-look surgery. MAIN OUTCOME MEASURES Effectiveness and health utility were measured using quality-adjusted life years (QALYs). Costs were derived from Medicare reimbursement using the perspective of the payer. Probabilities for outcomes and complications were taken from existing literature. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio. RESULTS With base case analysis, the total cost was $15,069 when treated with CWU and second-look surgery versus $13,126 when treated with CWU and DW-MRI. The second-look treatment pathway yielded 17.05 QALYs, whereas the DW-MRI pathway yielded 16.91 QALYs in terms of health benefit accrued across the lifetime of the patient. The cost-effectiveness incremental cost-effectiveness ratio was $21,800/QALY. Using the conventional $50,000 willingness-to-pay threshold, second-look surgery was the more cost-effective approach 63.7% of the time by simulation. CONCLUSIONS Both treatment pathways were found to be cost-effective, with second-look surgery incrementally cost-effective 63.7% of the time. Assumptions were validated by one-way and Monte Carlo probability sensitivity analysis. PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED There is ample variation in treatment pathways regarding usage of DW-MRI and second-look surgery for cholesteatoma. LEARNING OBJECTIVE To evaluate the cost-effectiveness of DW-MRI and second-look surgery approaches, accounting for health-related quality-of-life outcomes and costs for the duration of the patient lifetimes. DESIRED RESULT To inform the discussion on the treatment for cholesteatoma given emergent noninvasive technologies.Level of Evidence: Level III.Indicate IRB or IACUC: Exempt.
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Affiliation(s)
- Daniel D Bu
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Kumar J. Diffusion-Weighted Magnetic Resonance Imaging of Cholesteatoma: Navigating the Multifarious Techniques. Indian J Radiol Imaging 2024; 34:3-5. [PMID: 38106863 PMCID: PMC10723951 DOI: 10.1055/s-0043-1777292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Affiliation(s)
- Jyoti Kumar
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
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Zaman SU, Rangankar VP, Krishnarjun M, Kalekar TM, Shah VP, Pawar R, Kulothungan G. Readout-Segmented Echoplanar (RESOLVE) Diffusion-Weighted Imaging on 3T MRI in Detection of Cholesteatoma-Our Experience. Indian J Radiol Imaging 2024; 34:16-24. [PMID: 38106850 PMCID: PMC10723965 DOI: 10.1055/s-0043-1776054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background Several research studies have demonstrated the utility of diffusion-weighted imaging (DWI) in detecting middle ear cholesteatomas, especially with the non-echoplanar imaging (non-EPI) DWI technique. REadout Segmentation Of Long Variable Echo trains (RESOLVE), a multishot-EPI DWI, has better spatial resolution at a thinner section acquisition with reduced image distortion compared to the single-shot-EPI DWI technique. Purpose In this study, we evaluated the diagnostic ability of RESOLVE -DWI in middle ear cholesteatomas with surgical and histopathological support. Patients and Methods Fifty patients with clinical suspicion of primary cholesteatoma or postoperative recurrence were subjected to routine sequences and RESOLVE-DWI on magnetic resonance imaging (MRI). Thirty-eight patients had unilateral disease, while 12 patients had bilateral disease. The bilateral temporal bones of 50 patients were evaluated on MRI. The results attained by RESOLVE-DWI were correlated with intraoperative and histopathological findings. Results RESOLVE-DWI truly detected 55 of the 58 surgically proven cholesteatomas. RESOLVE-DWI could not detect three cholesteatoma lesions due to their small size and falsely diagnosed one case each of impacted wax and non-cholesteatomatous otitis media as cholesteatoma. With a 95% confidence interval, RESOLVE-DWI showed 94.8% sensitivity, 95.2% specificity, 96% positive predictive value, 93% negative predictive value, and 95% diagnostic accuracy in cholesteatoma detection. Conclusion RESOLVE-DWI is a sensitive and specific DWI technique for detecting middle ear cholesteatoma. However, RESOLVE-DWI has limitations in the diagnosis of small (<3 mm) cholesteatomas.
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Affiliation(s)
- Sameeh Uz Zaman
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
| | - Varsha P. Rangankar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Muralinath Krishnarjun
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Tushar M. Kalekar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Viraj Pankaj Shah
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Rishikesh Pawar
- Seth A.J.B ENT Municipal Hospital, Mumbai, Maharashtra, India
| | - Gowtham Kulothungan
- Shri Sathya Sai Medical College and Hospital, Chengalpattu, Tamil Nadu, India
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Daoudi H, Levy R, Baudouin R, Couloigner V, Leboulanger N, Garabédian EN, Belhous K, Boddaert N, Denoyelle F, Simon F. Performance of Non-EPI DW MRI for Pediatric Cholesteatoma Follow-Up. Otolaryngol Head Neck Surg 2024; 170:221-229. [PMID: 37313857 DOI: 10.1002/ohn.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the accuracy, sensitivity, and specificity of nonecho planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) to detect residual cholesteatoma in children. STUDY DESIGN Retrospective study. SETTING Tertiary comprehensive hospital. METHODS Children operated on for a first-stage cholesteatoma procedure from 2010 to 2019 were included. MRIs were performed with non-EPI DW sequences. Initial reports were collected, indicating the presence or absence of hyperintensity suggestive of cholesteatoma. Three hundred twenty-three MRIs were correlated with the subsequent surgery (66%) or year-later MRI (21%), or were considered accurate if performed 5 years or more after the last surgery (13%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging procedure for the detection of cholesteatoma were calculated. RESULTS Two hundred twenty-four children with mean age of 9 ± 4 years old presented with cholesteatoma. MRIs were performed 27 ± 24 months after surgery. Residual cholesteatoma was diagnosed in 35%. The sensitivity, specificity, PPV, and NPV of MRI were 62%, 86%, 74%, and 78%, respectively. Accuracy, sensitivity, and specificity increased significantly over time (multivariate analysis). The mean delay after last surgery was of 30 ± 2.0 months for accurate MRI (true positive or negative) versus 17 ± 2.0 months for nonaccurate (false positive or negative) MRIs (p < .001). CONCLUSION However, long the delay after the last surgery, the sensitivity of non-EPI diffusion sequence MRI in children has limitations for the detection of residual cholesteatoma. Surveillance for residual cholesteatoma should incorporate findings at primary surgery, surgeon experience, a low threshold for second-look procedures, and routine imaging.
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Affiliation(s)
- Hannah Daoudi
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Raphaël Levy
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Robin Baudouin
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Vincent Couloigner
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Leboulanger
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eréa-Noel Garabédian
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kahina Belhous
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Nathalie Boddaert
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Simon
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
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Baudouin R, Simon F, Levy R, Breton S, Alciato L, Talab E, Leboulanger N, Couloigner V, Garabedian EN, Denoyelle F. Early Magnetic Resonance Imaging to Diagnose Residual Cholesteatoma in Children and Benefit of Radiological Rereview. Otolaryngol Head Neck Surg 2023; 169:1631-1638. [PMID: 37264987 DOI: 10.1002/ohn.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Non-echo-planar diffusion-weighted (DW) magnetic resonance imaging (non-EPI MRI) is the appropriate sequence to detect residual cholesteatoma. In the child, MRI may be clinically useful to determine the timing of the second-look procedure. The aim of this paper was to retrospectively evaluate the performance of early MRI (before the 18th postoperative month) in detecting residual cholesteatoma in children after review by experienced specialized neuroradiologists. STUDY DESIGN Retrospective study. SETTING One university center comparative cohort. METHODS All patients who had a 2-staged procedure for cholesteatoma with an MRI before the second stage from 2010 to 2020 were included and analyzed. Three pediatric neuroradiologists reviewed all the images blinded to the surgical result. RESULTS N = 141 cholesteatoma events (140 children) were included with a mean age at MRI of 10 (±4) years old. Non-EPI MRIs were performed 10.7 (±3.8) months after the first-stage surgery and 2.2 (±2.6) months before the second-stage procedure. Non-EPI MRI had a 0.57 sensitivity (SE) and 0.83 specificity (SP). MRI was reviewed in 112 cases. The diagnosis was corrected in 17 cases (15.1%) (3 true positives, 7 false negatives, and 7 false positives). SE = 0.63 (p = 0.1) and SP = 0.92 (p = 0.08) after rereading. CONCLUSION Early MRI's SE is poor but SP is excellent after rereading. Evidence does not support the use of early non-EPI MRI to modify the surgical strategy or to postpone the second look. If performed, early non-EPI MRI should be read by specialized experienced radiologists with all 3 sequences (T1, T2, and non-EPI DW) and apparent diffusion coefficient calculation, especially in cases of otitis media with effusion.
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Affiliation(s)
- Robin Baudouin
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - François Simon
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Raphaël Levy
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sylvain Breton
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Department of Radiology, Paris Imagerie 114, Paris, France
| | - Lauranne Alciato
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Elsa Talab
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Erea-Noël Garabedian
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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Beckmann S, Hool SL, Yacoub A, Hakim A, Caversaccio M, Wagner F, Anschuetz L. Accuracy of High-Resolution Computed Tomography Compared to High-Definition Ear Endoscopy to Assess Cholesteatoma Extension. Otolaryngol Head Neck Surg 2023; 169:1276-1281. [PMID: 37418100 DOI: 10.1002/ohn.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/10/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To correlate radiographic evidence of cholesteatoma in the retrotympanum with intraoperative endoscopic findings in cholesteatoma patients and to evaluate the clinical relevance of radiographic evidence of cholesteatoma in the retrotympanum. STUDY DESIGN Case series with chart review. SETTING Tertiary referral center. METHODS Seventy-six consecutive cases undergoing surgical cholesteatoma removal with preoperative high-resolution computed tomography (HRCT) were enrolled in this study. A retrospective analysis of the medical records was conducted. The extension of cholesteatoma regarding different middle ear subspaces, into the antrum and mastoid were reviewed radiologically in preoperative HRCT and endoscopically from surgical videos. Additionally, facial nerve canal dehiscence, infiltration of the middle cranial fossa, and inner ear involvement were documented. RESULTS Comparison of radiological and endoscopic cholesteatoma extension revealed statistically highly significant overestimation of radiological cholesteatoma extension for all retrotympanic regions (sinus tympani 61.8% vs 19.7%, facial recess 69.7% vs 43.4%, subtympanic sinus 59.2% vs 7.9%, and posterior sinus 72.4% vs 4.0%) and statistically significant overestimation for mesotympanum (82.9% vs 56.6%), hypotympanum (39.5% vs 9.2%), and protympanum (23.7% vs 6.6%). No statistically significant differences were found for epitympanum (98.7% vs 90.8%), antrum (64.5% vs 52.6%), and mastoid (26.3% vs 32.9%). Statistically significant radiological overestimation of facial nerve canal dehiscence (54.0% vs 25.0%) and invasion of tegmen tympani (39.5% vs 19.7%) is reported. CONCLUSION Radiologic cholesteatoma extension in different middle ear subspaces is overestimated compared to the intraoperative extension. The preoperative relevance of radiological retrotympanic extension might be limited in the choice of approach and transcanal endoscopic approach is always recommended first.
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Affiliation(s)
- Sven Beckmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sara-Lynn Hool
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Abraam Yacoub
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Arsany Hakim
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Xun M, Liu X, Sha Y, Zhang X, Liu JP. The diagnostic utility of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography for cholesteatoma: A meta-analysis. Laryngoscope Investig Otolaryngol 2023; 8:627-635. [PMID: 37342121 PMCID: PMC10278117 DOI: 10.1002/lio2.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 06/22/2023] Open
Abstract
Objective The purpose of this meta-analysis was to compare the efficiency of high-resolution computed tomography (HRCT) and diffusion-weighted magnetic resonance imaging (DWI) in guiding the diagnosis of middle ear cholesteatoma in clinical practice. Materials and methods Cochrane Library, Medline, Embase, PubMed, and Web of Science were searched for studies that evaluated the sensitivity and specificity of HRCT or DWI in detecting middle ear cholesteatoma. A random-effects model was used to calculate and summarize the pooled estimates of sensitivity, specificity, and diagnostic odds ratios. Postoperative pathological results were considered as the diagnostic gold standard for middle ear cholesteatoma. Results Fourteen published articles (860 patients) met the inclusion criteria. The sensitivity and specificity of DWI when diagnosing cholesteatoma (regardless of type) were 0.88 (95% confidence interval [CI], 0.80-0.93) and 0.93 (95% CI, 0.86-0.97), respectively, while those of HRCT were 0.68 (95% CI, 0.57-0.77) and 0.78 (95% CI, 0.60-0.90), respectively. Notably, the sensitivity and specificity levels of DWI were similar to those of HRCT (p = .1178 for sensitivity, p = .2144 for specificity; pair-sampled t tests). The sensitivity and specificity of DWI or HRCT for the diagnosis of primary cholesteatoma were 0.78 (95% CI, 0.65-0.88) and 0.84 (95% CI, 0.69-0.93), respectively, while that for recurrent cholesteatoma were 0.93 (95% CI, 0.61-0.99) and 0.94 (95% CI, 0.82-0.98), respectively. Conclusion DWI and HRCT have similar levels of high sensitivity and specificity in detecting various cholesteatomas. Also, the diagnostic efficiency of HRCT or DWI for recurrent cholesteatoma is identical to that of primary cholesteatoma. Therefore, HRCT may be used in clinical settings to reduce the use of DWI and save clinical resources. Lay summary Data on the use of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography in the diagnosis of cholesteatoma were obtained through a literature search. They were analyzed to guide the clinical diagnosis and treatment of cholesteatoma. Level of evidence NA.
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Affiliation(s)
- Mengzhao Xun
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Xu Liu
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Yongfang Sha
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Xin Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Jian Ping Liu
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
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12
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Cao C, Song J, Su R, Wu X, Wang Z, Hou M. Structure-constrained deep feature fusion for chronic otitis media and cholesteatoma identification. MULTIMEDIA TOOLS AND APPLICATIONS 2023:1-21. [PMID: 37362730 PMCID: PMC10157598 DOI: 10.1007/s11042-023-15425-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 06/28/2023]
Abstract
Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) were two most common chronic middle ear disease(MED) clinically. Accurate differential diagnosis between these two diseases is of high clinical importance given the difference in etiologies, lesion manifestations and treatments. The high-resolution computed tomography (CT) scanning of the temporal bone presents a better view of auditory structures, which is currently regarded as the first-line diagnostic imaging modality in the case of MED. In this paper, we first used a region-of-interest (ROI) network to find the area of the middle ear in the entire temporal bone CT image and segment it to a size of 100*100 pixels. Then, we used a structure-constrained deep feature fusion algorithm to convert different characteristic features of the middle ear in three groups as suppurative otitis media (CSOM), middle ear cholesteatoma (MEC) and normal patches. To fuse structure information, we introduced a graph isomorphism network that implements a feature vector from neighbourhoods and the coordinate distance between vertices. Finally, we construct a classifier named the "otitis media, cholesteatoma and normal identification classifier" (OMCNIC). The experimental results achieved by the graph isomorphism network revealed a 96.36% accuracy in all CSOM and MEC classifications. The experimental results indicate that our structure-constrained deep feature fusion algorithm can quickly and effectively classify CSOM and MEC. It will help otologist in the selection of the most appropriate treatment, and the complications can also be reduced.
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Affiliation(s)
- Cong Cao
- School of Mathematics and Statistics, Central South University, Changsha, 410083 China
| | - Jian Song
- Department of Otorhinolaryngology of Xiangya Hospital, Central South University, Changsha, 410008 China
- Key Laboratory of Otolaryngology Major Disease Research of Hunan Province, Changsha, 410008 China
- National Clinical Research Centre for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 410008 China
| | - Ri Su
- School of Mathematics and Statistics, Central South University, Changsha, 410083 China
| | - Xuewen Wu
- Department of Otorhinolaryngology of Xiangya Hospital, Central South University, Changsha, 410008 China
- Key Laboratory of Otolaryngology Major Disease Research of Hunan Province, Changsha, 410008 China
- National Clinical Research Centre for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 410008 China
| | - Zheng Wang
- School of Computer Science, Hunan First Normal University, Changsha, 410205 China
| | - Muzhou Hou
- School of Mathematics and Statistics, Central South University, Changsha, 410083 China
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13
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Kroon VJ, Mes SW, Borggreven PA, van de Langenberg R, Colnot DR, Quak JJ. Cholesteatoma surgery in the pediatric population: remaining challenges in the era of mastoid obliteration. Eur Arch Otorhinolaryngol 2023; 280:1713-1722. [PMID: 36208330 PMCID: PMC9988747 DOI: 10.1007/s00405-022-07669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To present the first pediatric study on the safety and efficacy of mastoid obliteration using S53P4 bioactive glass (BAG) for cholesteatoma surgery. METHODS A single-center retrospective cohort study was conducted. Inclusion criteria were pediatric cases (≤ 18 years) and at least at least one year of follow-up including non-echo planar diffusion-weighted MRI to assess cholesteatoma recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were evaluated. RESULTS A total of 61 cases (56 patients) were included. Most cases had an otologic history before the development of the cholesteatoma. CWU procedure was performed in 18 cases (30%) and CWD procedure in 43 cases (70%). The cholesteatoma recidivism rate was 33% after a mean follow-up period of 58 months. Kaplan-Meier curve estimated a 5-year recidivism rate of 40%. Few complications were seen that were all minor and resolved spontaneously or after local or systemic treatment. Control of the infection (merchant grade 0-1) was achieved in 98% of the cases. Closure of the air-bone gap within 20 dB was achieved in 22% of the cases with complete audiometric evaluation. CONCLUSION In this MRI-controlled study, we show the safety and efficacy of S53P4 BAG for mastoid obliteration in a pediatric cholesteatoma cohort. Postoperative complications were both rare and minor, and a dry ear was achieved in almost all patients. Nevertheless, persistent hearing loss and the apparent high recidivism rate reflect the challenging nature of pediatric cholesteatoma.
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Affiliation(s)
- Victor J Kroon
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
- Faculty of Medicine, University Utrecht, Utrecht, The Netherlands.
| | - Steven W Mes
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
- Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Pepijn A Borggreven
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Rick van de Langenberg
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - David R Colnot
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Jasper J Quak
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
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14
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Baba A, Kurokawa R, Kurokawa M, Reifeiss S, Policeni BA, Ota Y, Srinivasan A. Advanced imaging of head and neck infections. J Neuroimaging 2023. [PMID: 36922159 DOI: 10.1111/jon.13099] [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: 12/29/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
When head and neck infection is suspected, appropriate imaging contributes to treatment decisions and prognosis. While contrast-enhanced CT is the standard imaging modality for evaluating head and neck infections, MRI can better characterize the skull base, intracranial involvement, and osteomyelitis, implying that these are complementary techniques for a comprehensive assessment. Both CT and MRI are useful in the evaluation of abscesses and thrombophlebitis, while MRI is especially useful in the evaluation of intracranial inflammatory spread/abscess formation, differentiation of abscess from other conditions, evaluation of the presence and activity of inflammation and osteomyelitis, evaluation of mastoid extension in middle ear cholesteatoma, and evaluation of facial neuritis and labyrinthitis. Apparent diffusion coefficient derived from diffusion-weighted imaging is useful for differential diagnosis and treatment response of head and neck infections in various anatomical sites. Dynamic contrast-enhanced MRI perfusion may be useful in assessing the activity of skull base osteomyelitis. MR bone imaging may be of additional value in evaluating bony structures of the skull base and jaw. Dual-energy CT is helpful in reducing metal artifacts, evaluating deep neck abscess, and detecting salivary stones. Subtraction CT techniques are used to detect progressive bone-destructive changes and to reduce dental amalgam artifacts. This article provides a region-based approach to the imaging evaluation of head and neck infections, using both conventional and advanced imaging techniques.
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Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott Reifeiss
- Department of Radiology, Roy Caver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Bruno A Policeni
- Department of Radiology, Roy Caver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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15
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Localization Evaluation of Primary Middle Ear Cholesteatoma With Fusion of Turbo Spin-Echo Diffusion-Weighted Imaging and High-Resolution Computed Tomography. J Comput Assist Tomogr 2023; 47:144-150. [PMID: 36395525 DOI: 10.1097/rct.0000000000001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the application of high-resolution computed tomography (HRCT) and turbo spin-echo diffusion-weighted imaging (TSE-DWI) fusion imaging for localization of middle ear cholesteatomas. METHODS Eighty-six patients with clinically suspected middle ear cholesteatomas were enrolled prospectively. Ear TSE-DWI and HRCT scans were performed using a postprocessing workstation to generate a TSE-DWI-CT fusion image. Subsequently, all the enrolled patients received surgical treatment. According to the STAM system (difficult access sites [S], the tympanic cavity [T], the attic [A], and the mastoid [M]), the agreement between the localization of lesions evaluated by HRCT, TSE-DWI, and TSE-DWI-CT fusion images and the intraoperatively recorded localization were computed using Cohen κ statistic. RESULTS Based on the pathological results, the enrolled patients were divided into a cholesteatoma (n = 50) and a noncholesteatoma group (n = 36). The area under the receiver operator characteristic curve for diagnosis of cholesteatoma with TSE-DWI-CT fusion imaging was identical to that using the TSE-DWI images (0.924 vs 0.924, P > 0.05), but was significantly higher than that with HRCT imaging (0.924 vs 0.767, P = 0.0005). Furthermore, the diagnostic sensitivity and specificity of TSE-DWI-CT fusion imaging for cholesteatomas were 96.0% and 88.9%, respectively. Depending on whether the cholesteatoma extended to the mastoid, TSE-DWI-CT fusion imaging demonstrated good agreement with the intraoperative record for localization of lesions (κ = 0.808) and had a high accuracy of localization by the STAM system. CONCLUSIONS Turbo spin-echo-DWI-CT fusion images have a very high diagnostic value for the preoperative localization of cholesteatomas.
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16
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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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17
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Kroon VJ, Mes SW, Borggreven PA, van de Langenberg R, Colnot DR, Quak JJ. Mastoid Obliteration Using S53P4 Bioactive Glass in Cholesteatoma Surgery: A 10-Year Single-Center Experience in 173 Adult Patients with Long-Term Magnetic Resonance Imaging Controlled Follow-up. Otol Neurotol 2022; 43:1181-1188. [PMID: 36099589 PMCID: PMC9671595 DOI: 10.1097/mao.0000000000003685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To present the long-term outcomes of mastoid obliteration in cholesteatoma surgery using S53P4 bioactive glass (BAG) in an adult population. STUDY DESIGN Retrospective cohort study. SETTING Single-center study. PATIENTS All 173 adult patients who underwent primary or revision surgery for cholesteatoma with mastoid obliteration using S53P4 BAG with at least 1 year of follow-up including nonecho planar diffusion-weighted magnetic resonance imaging (MRI) (non-EP DWI MRI) and/or second-look surgery to evaluate recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were included. INTERVENTIONS Patients underwent CWU or CWD mastoidectomy using S53P4 BAG. MAIN OUTCOME AND MEASURES Cholesteatoma recidivism, postoperative complications, Merchant grade, hearing outcome. RESULTS Cholesteatoma recidivism was assessed by MRI in 97% of all cases and second-look surgery look surgery in 3% of cases. After a mean follow-up period of 53 months, cholesteatoma recidivism was seen in 10% of the cases (n = 18). Using the Kaplan-Meier curve to extrapolate, a 5-year recidivism rate of 12% was estimated. Only minor complications occurred, all resolving spontaneously or after minor treatment. Merchant grade of 0 to 1 was achieved 95% of the patients, no persistently wet ears were observed. Closure of the air-bone gap within 20 dB was possible in 32%. CONCLUSION In this long-term (up to 10 yr) follow-up study, we demonstrated the safety of S53P4 BAG. Minimal and only minor postoperative complications were observed. The effectiveness of BAG was indicated by the low rate of recidivism, even when using non-EP DWI MRI, a sensitive and specific noninvasive technique to detect cholesteatoma recidivism.
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Affiliation(s)
| | - Steven W Mes
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht
| | - Pepijn A Borggreven
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht
| | | | - David R Colnot
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht
| | - Jasper J Quak
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht
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18
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Takahashi M, Noda K, Yoshida K, Tsuchida K, Yui R, Nakazawa T, Kurihara S, Baba A, Motegi M, Yamamoto K, Yamamoto Y, Ojiri H, Kojima H. Preoperative prediction by artificial intelligence for mastoid extension in pars flaccida cholesteatoma using temporal bone high-resolution computed tomography: A retrospective study. PLoS One 2022; 17:e0273915. [PMID: 36190937 PMCID: PMC9529134 DOI: 10.1371/journal.pone.0273915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/16/2022] [Indexed: 11/07/2022] Open
Abstract
Cholesteatoma is a progressive middle ear disease that can only be treated surgically but with a high recurrence rate. Depending on the extent of the disease, a surgical approach, such as microsurgery with a retroarticular incision or transcanal endoscopic surgery, is performed. However, the current examination cannot sufficiently predict the progression before surgery, and changes in approach may be made during the surgery. Large amounts of data are typically required to train deep neural network models; however, the prevalence of cholesteatomas is low (1-in-25, 000). Developing analysis methods that improve the accuracy with such a small number of samples is an important issue for medical artificial intelligence (AI) research. This paper presents an AI-based system to automatically detect mastoid extensions using CT. This retrospective study included 164 patients (80 with mastoid extension and 84 without mastoid extension) who underwent surgery. This study adopted a relatively lightweight neural network model called MobileNetV2 to learn and predict the CT images of 164 patients. The training was performed with eight divided groups for cross-validation and was performed 24 times with each of the eight groups to verify accuracy fluctuations caused by randomly augmented learning. An evaluation was performed by each of the 24 single-trained models, and 24 sets of ensemble predictions with 23 models for 100% original size images and 400% zoomed images. Fifteen otolaryngologists diagnosed the images and compared the results. The average accuracy of predicting 400% zoomed images using ensemble prediction model was 81.14% (sensitivity = 84.95%, specificity = 77.33%). The average accuracy of the otolaryngologists was 73.41% (sensitivity, 83.17%; specificity, 64.13%), which was not affected by their clinical experiences. Noteworthily, despite the small number of cases, we were able to create a highly accurate AI. These findings represent an important first step in the automatic diagnosis of the cholesteatoma extension.
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Affiliation(s)
- Masahiro Takahashi
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
- * E-mail:
| | | | | | - Keisuke Tsuchida
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Ryosuke Yui
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Takara Nakazawa
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Sho Kurihara
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Akira Baba
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masaomi Motegi
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhisa Yamamoto
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Yamamoto
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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19
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Bako P, Kovacs M, Uzsaly J, Burian A, Bodzai G, Nemeth A, Toth A, Szanyi I, Gerlinger I. Subtotal Petrosectomy and Cochlear Implantation in Children With Chronic Suppurative Otitis Media: A Single Institutional Experience. J Audiol Otol 2022; 26:214-222. [PMID: 36285467 PMCID: PMC9597276 DOI: 10.7874/jao.2022.00220] [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: 05/12/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic suppurative otitis media (CSOM) with or without cholesteatoma is a frequent chronic inflammatory condition in children, which may lead to severe hearing loss that affects speech development. Treatment of recurrent CSOM associated with unserviceable hearing requires a specialized approach with regard to disease eradication and hearing rehabilitation. In this study, we investigated the advantages of subtotal petrosectomy (SP) combined with cochlear implantation (CI) in children with CSOM associated with unserviceable hearing and describe our experience with regard to the efficacy of this method, together with a literature review. SUBJECTS AND METHODS SP with sequential or simultaneous CI was performed in three children (four ears), and postoperative audiometric data were recorded. RESULTS The study included two male and one female patient. Mean age at the time of SP was 10.75 years (7-13 years). Sequential implantation was performed in three ears. Facial nerve palsy occurred after SP in one patient. The latest word recognition scores of Cases 1, 2, and 3 were 80% (at 60 dB), 75% (at 60 dB), and 70% (at 50 dB) and 90% (at 50 dB), respectively. CONCLUSIONS SP with CI may be safe and reliable in children with CSOM associated with unserviceable hearing.
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Affiliation(s)
- Peter Bako
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary,Regenerative Science, Sport and Medicine Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary,Address for correspondence Peter Bako, MD, PhD Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, 2 Munkacsy Street, H-7621 Pécs, Hungary Tel +36-72507312 Fax +36-72312151 E-mail
| | - Marton Kovacs
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Janos Uzsaly
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Andras Burian
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Greta Bodzai
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Adrienn Nemeth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Arnold Toth
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Istvan Szanyi
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Imre Gerlinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
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20
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Illés K, Meznerics FA, Dembrovszky F, Fehérvári P, Bánvölgyi A, Csupor D, Hegyi P, Horváth T. Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta-analysis. Laryngoscope 2022; 133:1297-1305. [PMID: 36169349 DOI: 10.1002/lary.30413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/18/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our study aims to evaluate the effectiveness of mastoid obliteration compared to the canal wall up (CWU) technique in cholesteatoma surgery based on the systematic review of the literature and the meta-analysis of the data. METHODS The systematic search was performed in four major databases (MEDLINE, Web of Science, Embase, and CENTRAL) on October 14, 2021. Studies comparing the CWU technique and mastoid obliteration were included. The exclusion criteria were less than 12 months follow-up, congenital cholesteatoma, indefinite description of the surgical method, and animal studies. The protocol was registered on Prospero (registration number: CRD42021282485). The risk of bias was evaluated with the ROBINS-I tool. Residual and recurrent disease proportions as primary outcomes, quality of life, ear discharge, infection rates, hearing results, and operation time as secondary outcomes were analyzed. In the quantitative synthesis, the random effect model was used, and heterogeneity was identified. RESULTS A total of 11 articles with 2077 operations' data were found eligible. All the identified studies were retrospective cohorts. The odds of pooled residual and recurrent disease proportion were significantly lower in the obliteration group compared to CWU (OR = 0.45, CI:0.28;0.80, p = 0.014). However, when separated, the proportion of ears with recurrent (OR = 0.41, CI:0.11;1.57, p = 0.140) or residual (OR = 0.59, CI:0.23, 1.50, p = 0.207) disease did not show a significant difference, even though the odds were quite similar. The qualitative synthesis identified no significant difference in the secondary outcomes, but obliteration elongated the operation time. CONCLUSION Mastoid obliteration significantly decreased the proportion of residual and recurrent cholesteatoma in pooled analyses compared to the CWU technique with low-quality of data. LEVEL OF EVIDENCE NA Laryngoscope, 2022.
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Affiliation(s)
- Kata Illés
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Fanni Adél Meznerics
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Fanni Dembrovszky
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Biomathematics and Informatics, University of Veterinary Medicine, Budapest, Hungary
| | - András Bánvölgyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Dezső Csupor
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamás Horváth
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
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21
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Sun WH, Fan JK, Huang TC. The Efficacy of DW and T1-W MRI Combined with CT in the Preoperative Evaluation of Cholesteatoma. J Pers Med 2022; 12:jpm12081349. [PMID: 36013298 PMCID: PMC9409941 DOI: 10.3390/jpm12081349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/20/2022] Open
Abstract
Objective: This study aims to assess the efficacy of diffusion-weighted (DW) and T1-weighted (T1W) magnetic resonance imaging (MRI) combined with high-resolution computed tomography (HRCT) (together as DW-T1W-CT) in the preoperative evaluation of the presence and extent of cholesteatoma, which helps determine whether a patient is suitable for transcanal endoscopic ear surgery (TEES). Methods: This retrospective study included 35 patients (18 male and 17 female) aged from 2 to 81 years diagnosed with chronic otitis media with or without cholesteatoma, who had received surgical treatment and a preoperative MRI and HRCT during the period of December 2015 to December 2020 at Cathay General Hospital. We compared the preoperative DW-T1W-CT findings with the intraoperative findings and final pathologic diagnosis. The accurate predictive value was evaluated using the presence of cholesteatoma and its extent. Results: Regarding the efficacy of detecting cholesteatoma, we found a sensitivity of 92% (23/25 cases with cholesteatoma), a specificity of 90% (9/10 cases without cholesteatoma), and an overall accurate predictive value of 91.4% (32/35) by using combined DW-T1W-CT imaging. With regard to evaluating the extent of cholesteatoma, the combined DW-T1W-CT images obtained an accurate predictive value of 84% (21/25 cases of cholesteatoma). Conclusion: Combined DW-T1W-CT has been proven to be a reliable tool in detecting the presence of cholesteatoma. It is also useful in preoperatively depicting the extent of cholesteatoma, which is crucial for determining whether a patient is suitable for TEES, aiding in surgical planning and patient consultation.
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Affiliation(s)
- Wan-Hsuan Sun
- Department of Otolaryngology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Jiun-Kai Fan
- Department of Radiology, Cathay General Hospital, Taipei 106, Taiwan
| | - Tzu-Chin Huang
- Department of Otolaryngology, Cathay General Hospital, Taipei 106, Taiwan
- Correspondence:
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22
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Accuracy of 2D BLADE Turbo Gradient- and Spin-Echo Diffusion Weighted Imaging for the Diagnosis of Primary Middle Ear Cholesteatoma. Otol Neurotol 2022; 43:e651-e657. [PMID: 35261384 DOI: 10.1097/mao.0000000000003521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of 2D BLADE turbo gradient- and spin-echo diffusion weighted imaging (TGSE BLADE DWI) for primary middle ear cholesteatoma diagnosis, using qualitative and quantitative methods. STUDY DESIGN Retrospective case series. SETTING University hospital. PATIENTS Participants included those with suspected primary middle ear cholesteatoma after assessment by clinical otorhinolaryngologists combined with magnetic resonance imaging (MRI) examination. Finally, of the 85 ears from 65 patients enrolled in the study, 73 had cholesteatoma, and 12 had otitis media. INTERVENTION Two radiologists independently assessed images and measured apparent diffusion coefficient (ADC) values. Sensitivity, specificity and accuracy were evaluated. Kappa (k) statistics, the intraclass correlation coefficient (ICC), the Kolmogorov-Smirnov normality test, the independent t test, and receiver operating characteristic (ROC) analysis were used for statistical analysis. Pair-wise comparison of the area under the ROC curve (AUC) was also performed using the Delong test. MAIN OUTCOME MEASURES Imaging and histopathologic findings. RESULTS The mean ADC value of cholesteatoma group (mean, 0.923 ± 0.246 × 10 -3 mm 2 /s) was significantly lower than that of noncholesteatoma group (mean, 1.744 ± 0.205 × 10 -3 mm 2 /s; p < 0.001). In ≤3 mm cholesteatoma group, the AUC of qualitative DWI was 0.846; the sensitivity, specificity, and accuracy for diagnosing cholesteatoma were 69.23%, 100%, and 84%, respectively; while the AUC of quantitative diagnosis was significantly increased to 1.0 ( p = 0.0209); and based on the optimal threshold of ADC, ≤1.352 × 10 -3 mm 2 /s, the sensitivity, specificity and accuracy improved to 100%. For >3 mm cholesteatoma group, there were no significant differences in diagnostic performance. Excellent interobserver agreement and ICC for the qualitative and quantitative evaluations (k = 0.90 and ICC = 0.80, respectively) was noted between reviewers. CONCLUSION TGSE BLADE DWI is useful for the detection of primary middle ear cholesteatomas, especially ≤3 mm lesions.
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23
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Fan X, Ding C, Liu Z. Comparison of the Utility of High-Resolution CT-DWI and T2WI-DWI Fusion Images for the Localization of Cholesteatoma. AJNR Am J Neuroradiol 2022; 43:1029-1035. [PMID: 35654492 DOI: 10.3174/ajnr.a7538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cholesteatoma is an aggressive disease that may lead to hearing impairment. This study aimed to compare the utility of high-resolution CT and TSE-DWI fusion images with that of T2WI and TSE-DWI fusion images in the localization of middle ear cholesteatoma. MATERIALS AND METHODS Seventy-one patients with middle ear cholesteatoma were retrospectively recruited. High-resolution CT, T2WI with fat suppression, and TSE-DWI scans were obtained, and image fusion was performed using a 3D reconstruction postprocessing workstation to form CT-DWI and T2WI-DWI fusion images. The quality of the 2 fused images was subjectively evaluated using a 5-point Likert scale with the horizontal semicircular canal transverse position as the reference. Receiver operating characteristic analysis was performed, and the diagnostic efficacies of CT-DWI and T2WI-DWI fusion images in localizing middle ear cholesteatoma were calculated. RESULTS The overall quality of T2WI-DWI fusion images was slightly higher than that of CT-DWI fusion images (P < .001), and the semicircular canal was slightly less clear on T2WI-DWI than on CT-DWI (P < .001). No statistical difference was found in the diagnostic confidence between them. In the localization of middle ear cholesteatoma, the accuracy, sensitivity, and specificity of T2WI-DWI fusion images and CT-DWI fusion images were equivalent for involvement of the attic, tympanic cavity, mastoid antrum, and mastoid process, with no statistically significant differences. CONCLUSIONS T2WI-DWI fusion images could replace CT-DWI in the preoperative selection of surgical options for middle ear cholesteatoma.
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Affiliation(s)
- X Fan
- From the Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - C Ding
- From the Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Z Liu
- From the Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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24
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D'Arco F, Mertiri L, de Graaf P, De Foer B, Popovič KS, Argyropoulou MI, Mankad K, Brisse HJ, Juliano A, Severino M, Van Cauter S, Ho ML, Robson CD, Siddiqui A, Connor S, Bisdas S. Guidelines for magnetic resonance imaging in pediatric head and neck pathologies: a multicentre international consensus paper. Neuroradiology 2022; 64:1081-1100. [PMID: 35460348 DOI: 10.1007/s00234-022-02950-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
Abstract
The use of standardized imaging protocols is paramount in order to facilitate comparable, reproducible images and, consequently, to optimize patient care. Standardized MR protocols are lacking when studying head and neck pathologies in the pediatric population. We propose an international, multicenter consensus paper focused on providing the best combination of acquisition time/technical requirements and image quality. Distinct protocols for different regions of the head and neck and, in some cases, for specific pathologies or clinical indications are recommended. This white paper is endorsed by several international scientific societies and it is the result of discussion, in consensus, among experts in pediatric head and neck imaging.
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Affiliation(s)
- Felice D'Arco
- Radiology Department, Great Ormond Street Hospital for Children, London, UK.,Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Livja Mertiri
- Radiology Department, Great Ormond Street Hospital for Children, London, UK. .,Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy.
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bert De Foer
- Radiology Department, GZA Hospitals, Antwerp, Belgium
| | - Katarina S Popovič
- Neuroradiology Department, Clinical Institute of Radiology, University Medical Center Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Maria I Argyropoulou
- Department of Clinical Radiology and Imaging, Medical School, University of Ioannina, Ioannina, Greece
| | - Kshitij Mankad
- Radiology Department, Great Ormond Street Hospital for Children, London, UK
| | - Hervé J Brisse
- Imaging Department, Institut Curie, Paris, France.,Institut Curie, Paris Sciences Et Lettres (PSL) Research University, Paris, France
| | - Amy Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | - Sofie Van Cauter
- Department of Medical Imaging, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Mai-Lan Ho
- Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Caroline D Robson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ata Siddiqui
- Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Steve Connor
- Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, UK
| | - Sotirios Bisdas
- Lysholm Department of Neuroradiology, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
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25
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Pierce C, Ginat DT. Postsurgical and Postradiation Findings in the Head and Neck Imaging. Neuroimaging Clin N Am 2022; 32:299-313. [DOI: 10.1016/j.nic.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Lin M, Lin N, Sheng Y, Sha Y, Zhang Z, Zhou K. Detection of cholesteatoma: 2D BLADE turbo gradient- and spin-echo imaging versus readout-segmented echo-planar diffusion-weighted imaging. Eur Arch Otorhinolaryngol 2022; 279:5223-5229. [PMID: 35482118 DOI: 10.1007/s00405-022-07370-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study is to compare the accuracy of 2D BLADE turbo gradient- and spin-echo imaging (TGSE BLADE) diffusion-weighted imaging (DWI) with that of readout-segmented echo-planar (RESOLVE) DWI in the detection of primary and residual/recurrent temporal bone cholesteatoma. METHODS The prospective study population consisted of 58 patients who were underwent magnetic resonance (MR) imaging for the evaluation of suspected temporal bone cholesteatoma. Two radiologists independently evaluated the two sequences. Kappa (k) statistics, the intra-class correlation coefficient (ICC), and a paired t test were used for statistical analysis. RESULTS Of the 58 patients included, all had histo-pathologically confirmed cholesteatomas. In ≤ 3 mm group (n = 13), TGSE BLADE sequence correctly identified all cases except one that was recorded as equivocal on both sequences because of high signal intensity on T1WI; while on RESOLVE sequences, 6 were positive, 4 were equivocal, and 3 were false negative. For > 3 mm group (n = 45), detection performance was similar between the two sequences. The mean ADC of cholesteatoma on TGSE BLADE DWI was 0.923 × 10-3 mm2/s, and the mean ADC of cholesteatoma on RESOLVE DWI was 0.949 × 10-3 mm2/s, with no significant difference in the mean ADC values of cholesteatoma measured on the two sequences (p = 0.9216). CONCLUSION TGSE BLADE outperforms RESOLVE in the detection of small temporal bone cholesteatoma ≤ 3 mm.
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Affiliation(s)
- Mengyan Lin
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.,Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Naier Lin
- Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yaru Sheng
- Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| | - Zhongshuai Zhang
- Scientific Marketing, Siemens Healthcare, Shanghai, 200336, China
| | - Kun Zhou
- Scientific Marketing, Siemens Healthcare, Shanghai, 200336, China
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27
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Comparative evaluation of temporal subtraction computed tomography and non-echoplanar diffusion-weighted imaging for the mastoid extension of middle ear cholesteatoma. Auris Nasus Larynx 2022; 49:956-963. [PMID: 35341626 DOI: 10.1016/j.anl.2022.03.015] [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: 01/07/2022] [Revised: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Preoperative imaging assessment influences the decision to perform mastoidectomy for the mastoid extension of middle ear cholesteatoma. This study compared the performance of temporal subtraction CT (TSCT) and non-echoplanar diffusion-weighted imaging (non-EP DWI) in evaluating such mastoid extensions. METHODS We retrospectively evaluated 239 consecutive patients with surgically proven middle ear cholesteatoma between April 2016 and April 2021. The diagnostic performance of TSCT, wherein the presence of black color indicated progressive bone erosion, and non-EP DWI, wherein high signal intensity in the mastoid region suggested mastoid extension, was compared using Fisher's exact test. RESULTS In 34 patients with evaluable TSCT images, black color was significantly more common in patients with mastoid extension than in those without; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TSCT were 1.00, 0.95, 0.94, 1.00, and 0.97, respectively. In 90 patients with evaluable non-EP DWI, high signal intensity was significantly more common in patients with mastoid extension than in those without; the sensitivity, specificity, PPV, NPV, and accuracy of non-EP DWI were 0.88, 0.85, 0.91, 0.81, and 0.87, respectively. In 16 patients with both evaluable TSCT and non-EP DWI, the diagnostic performance of the TSCT was slightly superior to that of the non-EP DWI for predicting mastoid extension, although the difference was not significant. CONCLUSIONS TSCT images generated using consecutively acquired preoperative high-resolution CT images are useful for predicting mastoid extension of middle ear cholesteatoma, and the diagnostic performance of TSCT is non-inferior to that of non-EP DWI.
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28
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Balık AÖ, Şeneldir L, Verim A, Zer Toros S. The Role of Fusion Technique of Computed Tomography and Non-echo-planar Diffusion-weighted Imaging in the Evaluation of Surgical Localization of Cholesteatoma. Medeni Med J 2022; 37:13-20. [PMID: 35306781 PMCID: PMC8939452 DOI: 10.4274/mmj.galenos.2022.28928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: In recent years, the fusion of computed tomography (CT) and non-echo-planar diffusion-weighted magnetic resonance imaging (non- EPI DWI) has been preferred in cholesteatoma localizations. This study aimed to investigate the role of CT and non-EPI DWI fusion imaging in cholesteatoma localizations. Methods: This retrospective study included 39 patients who underwent chronic otitis media operation [mean age of 35.10±15.33 years (18-67 years), 64.1% female, and 35.9% male] and had preoperative high-resolution temporal bone CT and non-EPI DWI examinations. Images were sent to the Advantage Workstation VolumeShare 7 for fusion. These selected images were fused on the workstation and were manually corrected by the radiologist. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies of fused images of CT and non-EPI DWI were evaluated according to anatomic cholesteatoma localizations based on surgical data. Results: The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies of non-EPI DWI for detecting cholesteatomas were 97.14%, 75.00%, 97.14%, 75.00%, and 94.87%, respectively. Three true-negative, one false-positive, and one false-negative case were observed according to surgical results in detecting the presence of a cholesteatoma with non-EPI DWI. Moderate agreement was determined between the surgical and radiological results in detecting the presence of a cholesteatoma (k=0.721). Detecting the lesion of localization on the fused images compared to surgical found an almost perfect agreement in the mastoid antrum (k=0.948), strong agreement in the hypotympanum and mastoid cells (k=0.894), moderate agreement in the epitympanum (k=0.653), and weak agreement in those in the mesotympanum (k=0.540). Conclusions: The surgeons’ determinations are supported by the guidance of temporal CT and non-EPI DWI fused images. Therefore, preferring the fusion imaging technique could increase the quality of life by reducing unnecessary operations.
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29
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van der Toom HFE, van Dinther JJS, Zarowski A, Baazil AHA, De Foer B, Bernaerts A, Casselman JW, Offeciers E. Radiological Follow-up After the Bony Obliteration Tympanoplasty in Detecting Residual Cholesteatoma: Towards an Optimal Postoperative MR Imaging Protocol. Otol Neurotol 2022; 43:e79-e87. [PMID: 34607996 DOI: 10.1097/mao.0000000000003348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIM There is no consensus in literature on the most optimal follow-up imaging protocol for non-echoplanar diffusion-weighted magnetic resonance imaging (non-EP DW MRI) after the canal wall-up bony obliteration tympanoplasty. Clearly, no residual cholesteatoma should be missed but on the other hand, unnecessary MR controls should be avoided. The aim of this study is to evaluate the postoperative results of non-EP DW MRI after canal wall-up bony obliteration tympanoplasty surgery at our Institute and to propose an optimal postoperative MR imaging scheme based on our data. MATERIAL AND METHODS Retrospective cohort study; all 271 patients who underwent the bony obliteration tympanoplasty between January 2010 and January 2016 with follow-up at our Institute were included. A postoperative MR imaging was systematically performed at 1 year after surgery and repeated at either 5 or both 3 and 5 years after surgery, based on the preferences of the surgeon. Variables of interest were retrieved from electronic patient records. RESULTS The median follow-up time was 60 months (inter-quartile range 56-62 mo). Two hundred seventy-one patients (100%) received a 1-year MRI, 107 (39%) a 3-year MRI, and 216 (79.7%%) a 5-year MRI. Residual cholesteatoma was found in nine cases (3.3%), corresponding with an estimated residual rate at 5 years follow-up of 3.7% when using Kaplan-Meier analysis. Of these nine cases, six cases of residual cholesteatoma (66.7%) were detected at the 1-year MRI (12-14 mo postsurgery), two cases (22.2%) at the 3-year MRI (35-39 mo postsurgery), and one case (11.1%) at the 5-year MRI (51 mo postsurgery, in this patient no 3-year MRI was performed). An uncertain MRI result was found in 15 cases, presenting as relatively hyperintense lesions. However, subsequent follow-up scans did not show persistent evidence for residual disease in 14 of these 15 cases. CONCLUSIONS A postoperative MRI scan after 1 and 5 years is essential to detect early and late residual cholesteatoma. In our cohort, 22.2% of residual cases were detected at the 3-year MRI. However, this percentage could potentially have been higher when all patients would have received a 3-year MRI. Therefore, in order to detect residual disease as soon as possible, we propose to perform an MRI scan at 1, 3, and 5 years after the bony obliteration tympanoplasty. In cases with an unclear MR result, we suggest a repeat MRI after 12 months.
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Affiliation(s)
- Hylke F E van der Toom
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
| | - Joost J S van Dinther
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
| | - Andrzej Zarowski
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
| | - Adrianus H A Baazil
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
| | - Bert De Foer
- Department of Radiology, Sint-Augustinus, GZA Hospital, Antwerp
| | - Anja Bernaerts
- Department of Radiology, Sint-Augustinus, GZA Hospital, Antwerp
| | - Jan W Casselman
- Department of Radiology, Sint-Augustinus, GZA Hospital, Antwerp
- Department of Radiology, AZ Sint-Jan Brugge-Oostende av, Campus Brugge, Bruges, Belgium
| | - Erwin Offeciers
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
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30
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Abstract
The petrous apex may be affected by a range of lesions, commonly encountered as incidental and asymptomatic findings on imaging performed for other clinical reasons. Symptoms associated with petrous apex lesions commonly relate to mass effect and/or direct involvement of closely adjacent structures. Petrous apex lesions are optimally assessed using a combination of high-resolution CT and MRI of the skull base. Management of petrous apex lesions varies widely, reflecting the range of possible pathologies, with imaging playing a key role, including lesion characterization, surveillance, surgical planning, and oncological contouring.
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Affiliation(s)
- Gillian M Potter
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford NHS Foundation Trust, Greater Manchester, England M6 8HD, UK.
| | - Rekha Siripurapu
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford NHS Foundation Trust, Greater Manchester, England M6 8HD, UK
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31
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Russo C, Di Lullo AM, Cantone E, Klain M, Motta G, Elefante A, Cavaliere M. Combining Thin-Section Coronal and Axial Diffusion Weighted Imaging: Good Practice in Middle Ear Cholesteatoma Neuroimaging. Front Neurol 2021; 12:606692. [PMID: 34557138 PMCID: PMC8454914 DOI: 10.3389/fneur.2021.606692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 08/02/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Camilla Russo
- Dipartimento di Scienze Biomediche Avanzate - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Antonella Miriam Di Lullo
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche - Università degli Studi di Napoli "Federico II", Naples, Italy.,CEINGE - Advanced Biotechnology, Naples, Italy
| | - Elena Cantone
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Michele Klain
- Dipartimento di Scienze Biomediche Avanzate - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Gaetano Motta
- Dipartimento di Scienze Anestesiologiche, Chirurgiche e dell'Emergenza - Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Elefante
- Dipartimento di Scienze Biomediche Avanzate - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Michele Cavaliere
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche - Università degli Studi di Napoli "Federico II", Naples, Italy
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32
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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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Fischer N, Plaikner M, Schartinger VH, Kremser C, Riechelmann H, Schmutzhard J, Gottfried T, Dejaco D, Tauber H, Josip E, Henninger B. MRI of middle ear cholesteatoma: The importance of observer reliance from diffusion sequences. J Neuroimaging 2021; 32:120-126. [PMID: 34398501 DOI: 10.1111/jon.12919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging(DWI) in MRI has been developed as an important tool for the detection of cholesteatoma. Various DWI sequences are available. This study aims to evaluate the importance of the observer's reliance level for the detection of cholesteatoma. METHODS Forty patients meeting the following criteria were included in the study: (1) chronic otitis media, (2) preoperative MRI including various DWI sequences, and (3) middle-ear surgery. The MRI protocol contained the following sequences: (1) axial and (2) coronal echoplanar imaging (EPI) readout-segmented (RESOLVE) DWI with Trace acquisition and (3) coronal non-EPI half-Fourier acquired single-shot turbo spin-echo (HASTE) DWI. Cholesteatoma diagnosis was based on standard diagnostic criteria for cholesteatoma with DWI. Additionally, the radiologists were asked to grade personal reliance on their diagnosis using a Likert-type scale from 1 = very insecure to 5 = very secure. RESULTS Axial and coronal RESOLVE DWI showed a sensitivity of 77.3% and a specificity of 72.2%, respectively. The mean reliance was 3.9 for axial and 3.8 for coronal images. HASTE DWI had a sensitivity/specificity of 81.8%/66.7% with the highest reliance of all evaluated sequences (4.4). Cases with a reliance level of 5 showed a sensitivity/specificity of 100% in all sequences. A reliance level of 5 was given in the axial and coronal RESOLVE DWI in 32.5% of cases and in the HASTE DWI in 57.5%. CONCLUSION The evaluated DWI sequences showed comparable results. The reliance level significantly improved the predictor of cholesteatoma disease with MRI techniques.
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Affiliation(s)
- Natalie Fischer
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michaela Plaikner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Volker H Schartinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Timo Gottfried
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmuth Tauber
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Ena Josip
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Fourez AL, Akkari M, Gascou G, Lefevre PH, Duflos C, Kaderbay A, Mondain M, Venail F. Optimal Duration of MRI Follow-up to Safely Identify Middle Ear Residual Cholesteatoma. AJNR Am J Neuroradiol 2021; 42:1313-1319. [PMID: 33858822 DOI: 10.3174/ajnr.a7116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/15/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have demonstrated the usefulness of non-EPI DWI for detection of residual cholesteatoma. However, limited data are available to determine the suitable duration of imaging follow-up after a first MR imaging with normal findings has been obtained. The present study aimed to determine the optimal duration of non-EPI DWI follow-up for residual cholesteatoma. MATERIALS AND METHODS A retrospective, monocentric study was performed between 2013 and 2019 and included all participants followed up after canal wall up tympanoplasty with at least 2 non-EPI DWI examinations performed on the same 1.5T MR imaging scanner. MR images were reviewed independently by 2 radiologists. Sensitivity and specificity values were calculated as a function of time after the operation. Receiver operating characteristic curves were analyzed to determine the optimal follow-up duration. RESULTS We analyzed 47 MRIs from 17 participants. At the end of the individual follow-up period, a residual cholesteatoma had been found in 41.1% of cases. The follow-up duration ranged from 20 to 198 months (mean, 65.9 [SD, 43.9] months). Participants underwent between 2 and 5 non-EPI DWI examinations. Analyses of the receiver operating characteristic curves revealed that the optimal diagnostic value of non-EPI DWI occurred 56 months after the operation when the first MR imaging performed a mean of 17.3 (SD, 6.8) months after the operation had normal findings (sensitivity = 0.71; specificity = 0.7, Youden index = 0.43). CONCLUSIONS Repeat non-EPI DWI is required to detect slow-growing middle ear residual cholesteatomas. We, therefore, recommend performing non-EPI DWI for at least the first 5 years after the initial operation.
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Affiliation(s)
- A-L Fourez
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - M Akkari
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - G Gascou
- Neuroradiology (G.G., P.-H.L.), University Hospital Gui de Chauliac
| | - P-H Lefevre
- Neuroradiology (G.G., P.-H.L.), University Hospital Gui de Chauliac
| | - C Duflos
- Department of Medical Information and Biostatistics (C.D.), University Hospital La Colombière, University of Montpellier, Montpellier, France
| | - A Kaderbay
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - M Mondain
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - F Venail
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
- Institute for Neurosciences de Montpellier (F.V.), Institut National de la Santé et de la Recherche Médicale U1051 and University of Montpellier, Montpellier, France
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Ishiyama G. Selected Otologic Disorders Causing Dizziness. ACTA ACUST UNITED AC 2021; 27:468-490. [PMID: 34351115 DOI: 10.1212/con.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article details updated clinical presentations and current treatment paradigms of the common otologic disorders that may present to the neurologist for vertigo, including Ménière disease, superior semicircular canal dehiscence syndrome, perilymphatic fistula, barotrauma, cholesteatoma, Ramsay Hunt syndrome, enlarged vestibular aqueduct syndrome, and autoimmune inner ear disease including Cogan syndrome. RECENT FINDINGS The recent data on modern imaging techniques with three-dimensional delayed IV contrast in Ménière disease, findings on the clinical and testing parameters to diagnose semicircular canal dehiscence and barotrauma, and clinical findings in Ramsay Hunt syndrome, cholesteatoma, and enlarged vestibular aqueduct syndrome are discussed in the article. The most recent findings on the treatment and evaluation of autoimmune inner ear disease and Cogan syndrome are also covered. SUMMARY This article discusses the common clinical otologic entities in patients who may present to the neurologist for vertigo, and it can be used as a guide in the diagnosis of these conditions with the use of auditory, vestibular, and imaging results.
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Baba A, Kurihara S, Fukuda T, Yamauchi H, Matsushima S, Ikeda K, Kurokawa R, Ota Y, Takahashi M, Sakurai Y, Motegi M, Komori M, Yamamoto K, Yamamoto Y, Kojima H, Ojiri H. Non-echoplanar diffusion weighed imaging and T1-weighted imaging for cholesteatoma mastoid extension. Auris Nasus Larynx 2021; 48:846-851. [PMID: 33461853 DOI: 10.1016/j.anl.2021.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES A broad mastoid extension limits cholesteatoma resection via a transmeatal approach including endoscopic ear surgery. Therefore, a preoperative diagnosis of mastoid extension is a the most critical factor to determine whether to perform mastoidectomy. The purpose of this study was to assess the efficacy of non-echoplanar diffusion-weighted imaging (non-EPI DWI) and T1-weighted imaging in the evaluation of mastoid extension in cholesteatomas of the middle ear. METHODS Patients who underwent magnetic resonance imaging (MRI) for pretreatment evaluation before primary surgery for pars flaccida or tensa cholesteatoma, which revealed a high-signal intensity in the mastoid on T2-weighed imaging were retrospectively evaluated. Two board-certified radiologists retrospectively evaluated the extent of cholesteatomas on MRI with non-EPI DWI, non-EPI DWI- and T1-weighted axial imaging. The presence of a high signal intensity on non-EPI DWI or low or high signal intensity on T1-weighted imaging in the mastoid was evaluated. All cases were subclassified as M+ (surgically mastoid extension-positive) or M- (surgically mastoid extension-negative). RESULTS A total of 59 patients with middle ear cholesteatoma were evaluated. There were 37 M+ cases and 22 M- cases. High-signal intensity on non-EPI DWI exhibited a sensitivity of 0.89 and specificity of 0.82, whereas partial low-signal intensity on T1-weighted imaging exhibited a sensitivity of 0.84 and specificity of 0.91 for detecting mastoid involvement. Complete high-signal intensity on T1-weighted imaging exhibited a sensitivity of 0.73 and specificity of 0.89 for detecting non-involvement of the mastoid. The sensitivity (0.92) and specificity (0.96) of combined non-EPI DWI and T1-weighted imaging evaluation were higher than those of with non-EPI DWI or T1-weighted imaging alone. The interobserver agreement for the presence of high-signal intensity in the mastoid cavity on non-EPI DWI was very good at 0.82, that of a partial low-signal intensity area in the mastoid cavity lesions on T1-weighted imaging was good, at 0.76 and that of complete high-signal intensity in the mastoid cavity lesions on T1-weighted imaging was good, at 0.67. CONCLUSIONS The signal intensity on non-EPI DWI and T1-weighted imaging of the mastoid could be used to accurately assess the extent of middle ear cholesteatoma, which could facilitate surgical treatment planning.
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Affiliation(s)
- Akira Baba
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hideomi Yamauchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Satoshi Matsushima
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Koshi Ikeda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoshiaki Ota
- Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA
| | - Masahiro Takahashi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Yuika Sakurai
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Masaomi Motegi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Manabu Komori
- Department of Otolaryngology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Kazuhisa Yamamoto
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Yutaka Yamamoto
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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Correlation of pre-operative computed tomography, intra-operative findings and surgical outcomes in revision tympanomastoidectomy. The Journal of Laryngology & Otology 2021; 134:1096-1102. [PMID: 33407963 DOI: 10.1017/s0022215120002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy. METHODS This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans. RESULTS Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05). CONCLUSION Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.
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Feeney C, Lingam RK, Lee V, Rahman F, Nagendran S. Non-EPI-DWI for Detection, Disease Monitoring, and Clinical Decision-Making in Thyroid Eye Disease. AJNR Am J Neuroradiol 2020; 41:1466-1472. [PMID: 32796099 DOI: 10.3174/ajnr.a6664] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/16/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The Clinical Activity Score is widely used to grade activity of thyroid eye disease and guide treatment decisions, but as a subjective measurement and being confined to the anterior orbit, it has limitations. Non-EPI-DWI of the extraocular muscles may offer advantages as a functional imaging technique with reduced skull base artifacts, but the correlation with the Clinical Activity Score and patient outcome is unknown. Our aim was to establish the correlation between the Clinical Activity Score and non-EPI-DWI and to describe the additional value provided by adjunctive non-EPI-DWI in making clinical decisions. MATERIALS AND METHODS This was a retrospective longitudinal study of 31 patients seen in a multidisciplinary thyroid eye disease clinic during 5 years who had at least 1 ophthalmic and endocrine assessment including the Clinical Activity Score and a non-EPI-DWI ADC calculation. The Spearman rank correlation coefficient was used to determine the relationship between the Clinical Activity Score and non-EPI-DWI. A patient flow chart was constructed to evaluate clinical decision-making, and receiver operating characteristics were generated. RESULTS From 60 non-EPI-DWI scans, 368 extraocular muscles were selected for analysis. There was a significant positive correlation between the Clinical Activity Score and ADC (r s = 0.403; 95% CI, 0.312-0.489; P < .001). ADC values were significantly higher in the Clinical Activity Score ≥ 3 group compared with the Clinical Activity Score < 3 group (P < .001). Our patient flow chart identified a third intermediate-severity cohort in which the non-EPI-DWI was particularly useful in guiding clinical decisions. CONCLUSIONS The non-EPI-DWI correlated well with the Clinical Activity Score in our patients and was a useful adjunct to the Clinical Activity Score in making clinical decisions, especially in patients with intermediate activity and severity of thyroid eye disease.
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Affiliation(s)
- C Feeney
- From the Eye Department (C.F., V.L., F.R., S.N.), Central Middlesex Hospital, London, UK.,Imperial Centre for Endocrinology (C.F.), North West Thames, UK
| | - R K Lingam
- Department of Radiology (R.K.L.), Northwick Park & Central Middlesex Hospital, London Northwest University Healthcare National Health Service Trust, London, UK
| | - V Lee
- From the Eye Department (C.F., V.L., F.R., S.N.), Central Middlesex Hospital, London, UK
| | - F Rahman
- From the Eye Department (C.F., V.L., F.R., S.N.), Central Middlesex Hospital, London, UK
| | - S Nagendran
- From the Eye Department (C.F., V.L., F.R., S.N.), Central Middlesex Hospital, London, UK
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Kálmán J, Horváth T, Liktor B, Dános K, Tamás L, Gődény M, Polony G. Limitations of non-echo planar diffusion weighted magnetic resonance imaging (non-EPI MRI) in cholesteatoma surveillance after ossicular chain reconstruction. A prospective study. Auris Nasus Larynx 2020; 48:630-635. [PMID: 33303286 DOI: 10.1016/j.anl.2020.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Non-echo planar diffusion weighted magnetic resonance imaging is a reliable surveillance tool of residual cholesteatoma nowadays. It is not known whether the material of the ossicular chain prosthesis modifies the sensitivity and specificity of MRI in these cases. The aim of the study was to compare the sensitivity, specificity and a localization-specific accuracy of non-EPI DW MRI sequences for residual cholesteatoma in the following 3 subgroups: patients with titanium ossicular prosthesis (group T), with autologous cortical bone columella (group A) or without any reconstruction (group WR) of hearing bones. METHODS This prospective study covered 28 cases with cholesteatoma of the middle ear undergone second-look surgery, who had preoperative PROPELLER DW-MRI. Surgical findings were compared to the results of the DWI-MRI. RESULTS The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were: 0.76-0.8-0.76-0.8. Group T, group A and group WR sensitivity was 0.83-0.6-1, specificity: 0.75-0.75-0.85, PPV: 0.83-0.75-0.66, NPV: 0.75-0.6-1. Overall accuracy was 0.78. Size of missed cholesteatoma was 2-4 mm (mean: 2.66±1.15). CONCLUSIONS Various materials are suitable for ossicular chain reconstruction. The poor detectability of residual or recurrent cholesteatoma in the middle ears reconstructed with autologous bony prosthesis may still claim second-look surgery instead of the usage of non- EPI DWI sequences independently in these patients.
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Affiliation(s)
- Judit Kálmán
- Department of Otorhinolaryngology - Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Tamás Horváth
- Department of Otorhinolaryngology - Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Bálint Liktor
- Department of Otorhinolaryngology - Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Kornél Dános
- Department of Otorhinolaryngology - Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - László Tamás
- Department of Otorhinolaryngology - Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Mária Gődény
- Department of Diagnostic Radiology, National Institute of Oncology, Budapest, Hungary
| | - Gábor Polony
- Department of Otorhinolaryngology - Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
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Preoperative predictive criteria for mastoid extension in pars flaccida cholesteatoma in assessments using temporal bone high-resolution computed tomography. Auris Nasus Larynx 2020; 48:609-614. [PMID: 33257106 DOI: 10.1016/j.anl.2020.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We aimed to clarify the usefulness of high-resolution computed tomography (HRCT) and establish HRCT criteria for presurgical assessment of the mastoid extension in pars flaccida cholesteatomas of the middle ear. METHODS Retrospective observational study. Patients who underwent primary surgery for pars flaccida cholesteatoma and those who underwent temporal bone HRCT for pretreatment evaluation were reviewed. The distance in the anterior-most portion of the mastoid sinus on HRCT was measured, and the presence of surgically verified mastoid extension of cholesteatoma was evaluated. All cases were subclassified as M+ (surgically mastoid extension-positive) or M- (surgically mastoid extension-negative). RESULTS A total of 107 patients with pars flaccida cholesteatoma were included. The distance in the M+ cases was significantly longer than that in the M- cases, and the cutoff value was 3.6 mm. The difference between the ipsilateral/diseased-side distance and the contralateral/evaluable side (difference value) in M+ cases was larger than that in M- cases, with a cutoff value of 0.6 mm. The inter-rater reliability of this distance measurement was excellent, regardless of imaging experience. CONCLUSIONS The cutoff values of the distance and the difference value can be used for pretreatment HRCT evaluation of mastoid extension in middle ear cholesteatoma with relatively high accuracy, regardless of the experience and skill levels of the evaluator.
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Saxby AJ, Jufas N, Kong JHK, Newey A, Pitman AG, Patel NP. Novel Radiologic Approaches for Cholesteatoma Detection: Implications for Endoscopic Ear Surgery. Otolaryngol Clin North Am 2020; 54:89-109. [PMID: 33153729 DOI: 10.1016/j.otc.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Technological advancement in computed tomography (CT) and MRI has improved cholesteatoma detection rates considerably in the past decade. Accurately predicting disease location and extension is essential for staging, planning, and preoperative counseling, in particular in the newer approach of endoscopic ear surgery. Improved sensitivity and specificity of these radiological methods may allow the surgeon to confidently monitor patients, therefore avoiding unnecessary surgery. This article outlines recent advances in CT and MRI technology and advantages and disadvantages of the newer techniques. Emphasis on improving the feedback loop between the radiologist and surgeon will increase the accuracy of these new technologies.
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Affiliation(s)
- Alexander J Saxby
- Department of Otolaryngology-Head and Neck Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Sydney, Australia.
| | - Nicholas Jufas
- Department of Otolaryngology-Head and Neck Surgery, Royal North Shore Hospital, 1 Reserve Road, St. Leonards, NSW 2065, Sydney, Australia
| | - Jonathan H K Kong
- Department of Otolaryngology-Head and Neck Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Sydney, Australia
| | - Allison Newey
- Department of Radiology, Royal North Shore Hospital, 1 Reserve Road, St. Leonards, NSW 2065, Sydney, Australia
| | - Alexander G Pitman
- Department of Radiology, Northern Beaches Hospital, 105 Frenchs Forest Road W, Frenchs Forest, NSW 2086, Sydney, Australia
| | - Nirmal P Patel
- Department of Otolaryngology-Head and Neck Surgery, Royal North Shore Hospital, 1 Reserve Road, St. Leonards, NSW 2065, Sydney, Australia
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Chiao W, Chieffe D, Fina M. Endoscopic Management of Primary Acquired Cholesteatoma. Otolaryngol Clin North Am 2020; 54:129-145. [PMID: 33131767 DOI: 10.1016/j.otc.2020.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Endoscopic ear surgery is increasingly accepted as a primary modality for cholesteatoma surgery. A major advantage is the enhanced visualization of the middle ear in traditionally poorly accessible locations by the microscope. We discuss novel techniques for selective mastoid obliteration when a canal wall down mastoidectomy is necessary. Postoperatively, indications for non-echo planar diffusion-weighted imaging MRI versus second-look surgery are discussed. Finally, outcome data for endoscopic versus microscopic ear surgery are reviewed, which show equivalent outcomes regarding residual and recurrent disease, similar rates of complications, decreased pain, and shorter healing time.
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Affiliation(s)
- Whitney Chiao
- Department of Otolaryngology, University of Minnesota, Phillips Wangensteen Building, 516 Delaware Street Southeast #8A, Minneapolis, MN 55455, USA
| | - Doug Chieffe
- Department of Otolaryngology, University of Minnesota, Phillips Wangensteen Building, 516 Delaware Street Southeast #8A, Minneapolis, MN 55455, USA
| | - Manuela Fina
- Department of Otolaryngology, University of Minnesota, Phillips Wangensteen Building, 516 Delaware Street Southeast #8A, Minneapolis, MN 55455, USA.
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Touska P, Connor S. Imaging of the temporal bone. Clin Radiol 2020; 75:658-674. [DOI: 10.1016/j.crad.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
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Casazza G, Carlson ML, Shelton C, Gurgel RK. The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common Pathology. Ann Otol Rhinol Laryngol 2020; 130:38-46. [PMID: 32602346 DOI: 10.1177/0003489420937731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Describe the outcomes of treatment for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base. STUDY DESIGN Retrospective case series. SETTING Two tertiary care academic centers. PATIENTS Patients surgically managed for medially-invasive cholesteatoma at two tertiary care institutions from 2001 to 2017. INTERVENTIONS Surgical management of medially-invasive cholesteatomas. MAIN OUTCOME MEASURES The presenting symptoms, imaging, pre- and post-operative clinical course, and complications were reviewed. RESULTS Seven patients were identified. All patients had pre-operative radiographic evidence of invasive cholesteatoma with erosion into the otic capsule beyond just a lateral semicircular canal fistula. Five patients had a complex otologic history with multiple surgeries for recurrent cholesteatoma including three with prior canal wall down mastoidectomy surgeries. Average age at the time of surgery was 41.3 years (range 20-83). Two patients underwent a hearing preservation approach to the skull base while all others underwent a surgical approach based on the extent of the lesion. Facial nerve function was maintained at the pre-operative level in all but one patient. No patient developed cholesteatoma recurrence. CONCLUSIONS The medially-invasive cholesteatoma demonstrates an aggressive, endophytic growth pattern, invading into the otic capsule or through the perilabyrinthine air cells to the petrous apex. Surgical resection remains the best treatment option for medially-invasive cholesteatoma. When CSF leak is a concern, a subtotal petrosectomy with closure of the ear is often necessary.
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Affiliation(s)
- Geoffrey Casazza
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Clough Shelton
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
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Norris CD, Quick SE, Parker JG, Koontz NA. Diffusion MR Imaging in the Head and Neck: Principles and Applications. Neuroimaging Clin N Am 2020; 30:261-282. [PMID: 32600630 DOI: 10.1016/j.nic.2020.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diffusion imaging is a functional MR imaging tool that creates tissue contrast representative of the random, microscopic translational motion of water molecules within human body tissues. Long considered a cornerstone MR imaging sequence for brain imaging, diffusion-weighted imaging (DWI) increasingly is used for head and neck imaging. This review reports the current state of diffusion techniques for head and neck imaging, including conventional DWI, DWI trace with apparent diffusion coefficient map, diffusion tensor imaging, intravoxel incoherent motion, and diffusion kurtosis imaging. This article describes background physics, reports supportive evidence and potential pitfalls, highlights technical advances, and details practical clinical applications.
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Affiliation(s)
- Carrie D Norris
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 North University Boulevard, Room 0663, Indianapolis, IN 46202, USA. https://twitter.com/CarrieDNorrisMD
| | - Sandra E Quick
- Department of Radiology, Richard L. Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, IN 46202, USA
| | - Jason G Parker
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 North University Boulevard, Room 0663, Indianapolis, IN 46202, USA
| | - Nicholas A Koontz
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 North University Boulevard, Room 0663, Indianapolis, IN 46202, USA; Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Prediction of skull base osteomyelitis in necrotising otitis externa with diffusion-weighted imaging. The Journal of Laryngology & Otology 2020; 134:404-408. [PMID: 32498734 DOI: 10.1017/s0022215120001073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To predict skull base osteomyelitis in patients with necrotising otitis externa using diffusion-weighted imaging. METHODS A retrospective analysis was conducted of 25 necrotising otitis externa patients with skull base osteomyelitis (n = 10) or without skull base involvement (n = 14) who underwent a single-shot diffusion-weighted imaging of the skull base. RESULTS The respective mean apparent diffusion coefficient values of the skull base, as determined by two reviewers, were 0.851 ± 0.15 and 0.841 ± 0.14 ×10-3mm2/s for the skull base osteomyelitis patients, and 1.065 ± 0.19 and 1.045 ± 0.20 ×10-3mm2/s for the necrotising otitis externa patients without skull base involvement. The difference in apparent diffusion coefficients between the groups was significant, for both reviewers (p = 0.008 and 0.012). The optimal threshold apparent diffusion coefficient for predicting skull base osteomyelitis in necrotising otitis externa patients was 0.945 ×10-3mm2/s and 0.915 ×10-3mm2/s, with an area under the curve of 0.825 and 0.800, accuracy of 87.5 and 83.3 per cent, sensitivity of 85.7 and 90.0 per cent, and specificity of 90.0 and 78.6 per cent, for each reviewer respectively. CONCLUSION Apparent diffusion coefficient is a non-invasive imaging parameter useful for predicting skull base osteomyelitis in necrotising otitis externa patients.
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Muhonen EG, Mahboubi H, Moshtaghi O, Sahyouni R, Ghavami Y, Maducdoc M, Lin HW, Djalilian HR. False-Positive Cholesteatomas on Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging. Otol Neurotol 2020; 41:e588-e592. [DOI: 10.1097/mao.0000000000002606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Russo C, Elefante A, Cavaliere M, Di Lullo AM, Motta G, Iengo M, Brunetti A. Apparent diffusion coefficients for predicting primary cholesteatoma risk of recurrence after surgical clearance. Eur J Radiol 2020; 125:108915. [PMID: 32114332 DOI: 10.1016/j.ejrad.2020.108915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/18/2020] [Accepted: 02/23/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Beside the well-known accuracy of non-EPI DWI techniques and relative ADC maps in detecting cholesteatomatous tissue, ADC can also represent a useful tool for stratifying cholesteatoma risk of recurrence. Aim of this study is to test the role of ADC in determining risk of recurrence for primary middle ear cholesteatoma, proposing stratification based on pre-operative mean (mADC) and normalized (nADC) ADC values. METHODS In this prospective study, 60 patients with primary unilateral middle ear cholesteatoma underwent a three-years-long follow-up to assess the presence of recurrent disease after macroscopically complete excisional surgery. Baseline MRI examination mADC and nADC values in the group with early evidence of recurrent cholesteatoma were compared to the group with no evidence of recurrence by using T statistics. RESULTS ADC values on pre-operative MRI examination were lower in cholesteatomas with early evidence of recurrence, and statistical significance was slightly higher for nADC compared to mADC measurements. We also determined a cut-off between the two groups, proposing stratification in high-risk of recurrence cholesteatomas (mADC≤ 1000 or nADC< 1.3) and low-risk cholesteatomas (mADC>1000 or nADC≥1.3). CONCLUSIONS ADC values resulted discriminating in identifying cholesteatomas with higher risk of early recurrence, both for mean and normalized ADC, with optimized tissue characterization and outcome prediction.
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Affiliation(s)
- Camilla Russo
- Dipartimento di Scienze Biomediche Avanzate - Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Andrea Elefante
- Dipartimento di Scienze Biomediche Avanzate - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Michele Cavaliere
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Antonella M Di Lullo
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Gaetano Motta
- Dipartimento di Scienze Anestesiologiche, Chirurgiche e dell'Emergenza - Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Iengo
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Arturo Brunetti
- Dipartimento di Scienze Biomediche Avanzate - Università degli Studi di Napoli "Federico II", Naples, Italy
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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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Diagnosis and management of spontaneous cerebrospinal fluid fistula and encephaloceles. Curr Opin Otolaryngol Head Neck Surg 2020; 27:369-375. [PMID: 31361611 DOI: 10.1097/moo.0000000000000568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To describe the current state in the diagnosis and management of spontaneous cerebrospinal fluid (sCSF) fistula and encephaloceles. RECENT FINDINGS The increased incidence of obesity has resulted in more cases of sCSF fistula and encephaloceles. Obesity results in increased intracranial pressure and a greater chance of developing a sCSF fistula or encephalocele. Obstructive sleep apnea can also result in transient increase in intracranial pressure and has been shown to be common in patients with sCSF fistula. Treatment of CSF fistula is usually necessary because of the increased risk of meningitis. The use of hydroxyapatite bone cements to repair the temporal bone defects has been described with a high success rate of closing the fistula and a low complication rate. Concurrent superior semicircular canal dehiscent can be seen in up to 15% of cases and should be suspected during the surgical approach to avoid potential sensorineural hearing loss and chronic imbalance. SUMMARY sCSF fistula and encephaloceles are an uncommon cause of hearing loss, middle ear effusion, and otorrhea, but should be recognized and repaired because of the risk of meningitis.
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