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Touska P, Connor SEJ. ESR Essentials: imaging of middle ear cholesteatoma-practice recommendations by the European Society of Head and Neck Radiology. Eur Radiol 2024:10.1007/s00330-024-11021-x. [PMID: 39186104 DOI: 10.1007/s00330-024-11021-x] [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: 02/25/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 08/27/2024]
Abstract
Although non-malignant, middle ear cholesteatoma can result in significant complications due to local bone erosion and infection. The treatment of cholesteatoma is surgical, but residual disease is common and may be clinically occult, particularly when the canal wall is preserved or reconstructive techniques are employed. Imaging plays a pivotal role in the management of patients with middle ear cholesteatoma-aiding clinical diagnosis, identifying complications, planning surgery, and detecting residual disease at follow-up. Computed tomography is the primary imaging tool in the preoperative setting since it can provide both a surgical roadmap and detect erosive complications of cholesteatoma. The ability of magnetic resonance imaging with non-echoplanar diffusion-weighted sequences to accurately detect residual disease has led to a shift in the diagnostic paradigm for post-surgical follow-up of cholesteatoma, such that routine "second-look" surgery is no longer required. The following practice recommendations are aimed at helping the radiologist choose appropriate imaging approaches and understand the key diagnostic considerations for the evaluation of pre- and post-surgical middle ear cholesteatoma. KEY POINTS: In the preoperative setting, CT is the first-line imaging modality and MRI is reserved for rare clinical scenarios (low evidence). Non-echoplanar imaging (EPI) DWI is the optimal MRI sequence for the detection of residual cholesteatoma (moderate evidence). Non-EPI DWI plays an important role in the postoperative surveillance of cholesteatoma (moderate evidence).
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Affiliation(s)
- Philip Touska
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Steve E J Connor
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom.
- Department of Neuroradiology, Kings College Hospital NHS Trust, Denmark Hill, London, SE5 9RS, United Kingdom.
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London, United Kingdom.
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Díaz Zufiaurre N, Calvo-Imirizaldu M, Lorente-Piera J, Domínguez-Echávarri P, Fontova Porta P, Manrique M, Manrique-Huarte R. Toward Improved Detection of Cholesteatoma Recidivism: Exploring the Role of Non-EPI-DWI MRI. J Clin Med 2024; 13:2587. [PMID: 38731116 PMCID: PMC11084557 DOI: 10.3390/jcm13092587] [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: 03/23/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Cholesteatoma is a lesion capable of destroying surrounding tissues, which may result in significant complications. Surgical resection is the only effective treatment; however, the presence of cholesteatoma recidivism is common. This study evaluated the effectiveness of the Attic Exposure-Antrum Exclusion (AE-AE) surgical technique in treating cholesteatomas and identifying factors associated with recidivism. Additionally, the study aimed to assess the utility of non-echo-planar diffusion MRI (non-EPI-DWI MRI) in detecting cholesteatoma recidivism in patients undergoing AE-AE surgery. Methods: The study involved 63 patients who underwent AE-AE surgery for primary acquired cholesteatoma and were followed up clinically and radiologically for at least five years. The radiological follow-up included a non-EPI-DWI MRI. Results: Results showed that the AE-AE technique successfully treated cholesteatomas, with a recidivism rate of 5.2%. The study also found that non-EPI-DWI MRI was a useful diagnostic tool for detecting cholesteatoma recidivism, although false positives could occur due to the technique's high sensitivity. As Preoperative Pure-tone average (PTA) increases, there is a higher probability of cholesteatoma recidivism in imaging tests (p = 0.003). Conclusions: Overall, the study highlights the importance of the AE-AE surgical technique and non-EPI-DWI MRI in managing cholesteatoma recidivism in patients, providing valuable insights into associated risk factors and how to manage recidivism. Non-EPI-DWI MRI can assist in patient selection for revision surgery, reducing unnecessary interventions and associated risks while improving treatment outcomes and patient care.
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Affiliation(s)
- Natalia Díaz Zufiaurre
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (N.D.Z.); (M.M.); (R.M.-H.)
| | - Marta Calvo-Imirizaldu
- Radiology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (M.C.-I.); (P.D.-E.)
| | - Joan Lorente-Piera
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (N.D.Z.); (M.M.); (R.M.-H.)
| | | | | | - Manuel Manrique
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (N.D.Z.); (M.M.); (R.M.-H.)
| | - Raquel Manrique-Huarte
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (N.D.Z.); (M.M.); (R.M.-H.)
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Fong JB, McCool RR. Titanium Implant Obscuring Residual Cholesteatoma on Magnetic Resonance Imaging: A Case Report. EAR, NOSE & THROAT JOURNAL 2024:1455613241241112. [PMID: 38587331 DOI: 10.1177/01455613241241112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Cholesteatomas are benign growths of squamous epithelial tissue in the middle ear resulting in conductive hearing loss and/or erosion of the structures of the middle ear space. These lesions are surgically removed but require postoperative surveillance due to risk of recurrence or residual disease. Second-look surgery remains the gold standard for diagnosis and treatment of residual or recurrent cholesteatoma; however, advanced imaging modalities such as non-echoplanar diffusion weighted magnetic resonance imaging (non-EPI DWI-MRI) offer a less invasive alternative for surveillance. As surgeons become more reliant on advanced imaging, it is important to understand the limitations of the technology. We present a case of a delay in diagnosis of residual cholesteatoma due to a false-negative finding on non-EPI DWI-MRI screening in the presence of a titanium implant.
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Affiliation(s)
- Justin B Fong
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Ryan R McCool
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Surgery, Section of Otolaryngology, Audiology and Maxillofacial Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Zwierz A, Masna K, Burduk P, Hackenberg S, Scheich M. Renewed Concept of Mastoid Cavity Obliteration with the Use of Temporoparietal Fascial Flap Injected by Injectable Platelet-Rich Fibrin after Subtotal Petrosectomy for Cochlear Implant Patients. Audiol Res 2024; 14:280-292. [PMID: 38525686 PMCID: PMC10961696 DOI: 10.3390/audiolres14020025] [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: 11/06/2023] [Revised: 02/01/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Background: The subtotal petrosectomy procedure may be useful for cochlear implantation in selected patient groups. Although it is highly effective, complications can arise, which may have economic implications for the patient due to the high cost of the device. Therefore, several authors have attempted to identify the most effective concept for obliteration. Methods: We present a pilot descriptive study of application techniques for obliterating cavities after subtotal petrosectomy using a temporoparietal fascial flap (TPFF) modified with injectable platelet-rich fibrin (IPRF+) for three cochlear implant (CI) patients. Results: Our concept preserves important anatomical structures, such as the temporalis muscle, which covers the CI receiver-stimulator. Injection of IPRF+ also increases the available tissue volume for obliteration and enhances its anti-inflammatory and regenerative potential. Conclusions: To the best of our knowledge, the use of TPFF for filling the cavity has not been adopted for CI with SP and for blind sac closure. Our literature review and our experience with this small group of patients suggest that this procedure, when combined with IPRF+ injections, may reduce the risk of potential infection in the obliterated cavity, particularly when used with CI. This technique is applicable only in cases when the surgeons are convinced that the middle ear cavity is purged of cholesteatoma.
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Affiliation(s)
- Aleksander Zwierz
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (K.M.); (P.B.)
| | - Krystyna Masna
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (K.M.); (P.B.)
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (K.M.); (P.B.)
| | - Stephan Hackenberg
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, 97080 Würzburg, Germany; (S.H.); (M.S.)
| | - Matthias Scheich
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, 97080 Würzburg, Germany; (S.H.); (M.S.)
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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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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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Elzomor A, Firlie M, Orobello N, Murnick J, Reilly BK. Cholesteatoma: Canalplasty for External Auditory Stenosis in a Pediatric Patient. Cureus 2023; 15:e51188. [PMID: 38283428 PMCID: PMC10817763 DOI: 10.7759/cureus.51188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
External auditory canal (EAC) stenosis is the narrowing of the external auditory meatus to less than 4 mm. Severe stenosis of the EAC may inhibit the ability to conduct sound and may lead to the formation of a cholesteatoma. While most cases of EAC stenosis may be managed nonoperatively, the significant impact that the associated symptoms can have on patients may require surgical intervention. Progression of the cholesteatoma can erode the bony ossicles, may encase the facial nerve, and impact infection risk causing chronic otorrhea, and further worsening patient quality of life. We present the case of a pediatric patient who presented due to chronic left-sided hearing loss. Further examination and imaging demonstrated near-total obstruction of the left EAC secondary to a soft tissue mass and evidence of bony hypertrophy. Following a canalplasty, the patient now has returned to baseline hearing and has no associated complications. Canalplasty remains a safe, effective surgical intervention for EAC stenosis complicated by cholesteatoma.
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Affiliation(s)
- Amir Elzomor
- Division of Otolaryngology, Head and Neck Surgery, The George Washington University School of Medicine, Washington, USA
| | - Marissa Firlie
- Division of Otolaryngology, Head and Neck Surgery, The George Washington University School of Medicine, Washington, USA
| | - Nicklas Orobello
- Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, USA
| | - Jonathan Murnick
- Department of Pediatric Radiology, Children's National Medical Center, Washington, USA
| | - Brian K Reilly
- Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, USA
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Pontillo V, Ciprelli S, Grillo R, Quaranta N. Quality of life after revision mastoidectomy with mastoid obliteration. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:352-358. [PMID: 37331626 DOI: 10.1016/j.otoeng.2023.06.004] [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: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 06/20/2023]
Abstract
AIMS To evaluate the postoperative quality of life (QoL) after revision canal wall down mastoidectomy with mastoid obliteration (rCWD). MATERIAL AND METHODS A retrospective analysis was conducted on patients treated by rCWD for cholesteatoma between 2016 and 2019. A control group including all patients treated by primary canal wall down with mastoid obliteration (pCWD) for cholesteatoma between 2009 and 2014 was used for the comparison of the postoperative QoL, assessed by the COMQ-12. RESULTS The rCWD and pCWD groups respectively counted 38 and 78 patients with an average follow-up of 30 and 62 months respectively. No significant difference was found in terms of QoL between the two groups. An intra-group analysis among rCWD patients, showed that patients treated by canal wall down (CWD) at the primary surgery had a significantly worse post-revision QoL compared to those initially treated by canal wall up (CWU), specifically in the hearing and balance domains of the questionnaire. CONCLUSIONS Revision mastoid obliteration leads to similar QoL results to those obtained after primary CWD with obliteration. Patients who had undergone a CWD as primary surgery complain worse hearing and balance problems compared to those primarily submitted to CWU, even after revision surgery.
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Affiliation(s)
- Vito Pontillo
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Sabino Ciprelli
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Rossella Grillo
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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11
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Semiz-Oysu A, Oysu C, Kulali F, Bukte Y. PROPELLER diffusion weighted imaging for diagnosis of cholesteatoma in comparison with surgical and histopathological results: emphasis on false positivity and false negativity. Eur Arch Otorhinolaryngol 2023; 280:4845-4850. [PMID: 37149831 DOI: 10.1007/s00405-023-08001-0] [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: 01/17/2023] [Accepted: 04/26/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To investigate the role of non-echo planar diffusion weighted imaging (DWI) using "periodically rotated overlapping parallel lines with enhanced reconstruction" (PROPELLER) sequence for the diagnosis of cholesteatoma compared to surgical and histopathological results in an attempt to determine the factors causing false negative and false positive diagnoses. METHODS Patients who had PROPELLER DWI before ear surgery were retrospectively reviewed. The presence of a lesion with diffusion restriction on PROPELLER DWI was accepted as positive for cholesteatoma, and the results were compared to the intraoperative and histopathological findings. RESULTS A total of 112 ears in 109 patients were reviewed. On PROPELLER DWI, a lesion with diffusion restriction was found in 101 (90.2%) ears, while in 11 (9.8%) of the patients, no diffusion restriction was found. Surgery and histopathological analysis revealed a cholesteatoma in 100 (89.3%) ears, while in 12 (10.7%) ears, no cholesteatoma was found surgically. There were 96 (85.7%) true positives, 7 (6.2%) true negatives, 5 (4.5%) false positives and 4 (3.6%) false negatives. The accuracy, sensitivity, specificity, positive predictive and negative predictive values of non-echo planar DWI were calculated to be 91.96%, 96%, 58.33%, 95.05%, and 63.64%, respectively. CONCLUSION Non-echo planar DWI using PROPELLER sequence has high accuracy, sensitivity and positive predictive value and can be used for the detection of cholesteatoma. The external auditory canal, postoperative ears and small lesions should be evaluated with caution to avoid false results.
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Affiliation(s)
- Aslihan Semiz-Oysu
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Cagatay Oysu
- Department of Otorhinolaryngology and Head and Neck Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Fatma Kulali
- Department of Radiology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Yasar Bukte
- Department of Radiology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
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Bovi C, Luchena A, Bivona R, Borsetto D, Creber N, Danesi G. Recurrence in cholesteatoma surgery: what have we learnt and where are we going? A narrative review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S48-S55. [PMID: 37698100 PMCID: PMC10159641 DOI: 10.14639/0392-100x-suppl.1-43-2023-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 09/13/2023]
Abstract
Treatment of cholesteatoma is surgical and has historically encompassed two main techniques: canal wall up (CWU) and canal wall down (CWD) tympanoplasty. Follow-up for cholesteatoma is still debated and can be either radiological or with second-look surgery. MRI with diffusion weighted sequences has proved to have high sensitivity and specificity in detecting recurrent or residual disease. Specifically, non-echo planar imaging DWI (non-EPI DWI) has been shown to be superior to other imaging techniques, allowing, in some cases, to avoid second-look surgery. Both residual and recurrence rates are higher in CWU compared to CWD procedures. Endoscopic ear surgery (EES) has become popular with the advantage of “looking around corners”. The endoscope is used in addition to a microscope or exclusively to reduce cholesteatoma recurrence. In addition, it has been demonstrated that mastoid obliteration and the use of potassium titanyl phosphate laser (KTP) can reduce cholesteatoma recurrence, with better functional outcomes. A synthetic sulphur compound (MESNA) may have an interesting role in the overall improvement in recurrence and residual cholesteatoma disease. This narrative review critically appraises the factors associated with the risk of recurrent cholesteatoma.
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Affiliation(s)
- Chiara Bovi
- Otolaryngology Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alberto Luchena
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - Rachele Bivona
- Department of Neurosciences, Section of Otorhinolaryngology and Skull Base Microsurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Daniele Borsetto
- Department of ENT Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nathan Creber
- Otolaryngology, Department of Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Giovanni Danesi
- Department of Neurosciences, Section of Otorhinolaryngology and Skull Base Microsurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Wiesmueller M, Wuest W, Mennecke A, May MS, Heiss R, Fuehres T, Janka R, Uder M, Doerfler A, Laun FB. Comparison of Diagnostic Performance and Image Quality between Topup-Corrected and Standard Readout-Segmented Echo-Planar Diffusion-Weighted Imaging for Cholesteatoma Diagnostics. Diagnostics (Basel) 2023; 13:diagnostics13071242. [PMID: 37046460 PMCID: PMC10093611 DOI: 10.3390/diagnostics13071242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
This study compares the diagnostic performance and image quality of single-shot turbo spin-echo DWI (tseDWI), standard readout-segmented DWI (rsDWI), and a modified rsDWI version (topupDWI) for cholesteatoma diagnostics. Thirty-four patients with newly suspected unilateral cholesteatoma were examined on a 1.5 Tesla MRI scanner. Diagnostic performance was evaluated by calculating and comparing the sensitivity and specificity using histopathological results as the standard of reference. Image quality was independently reviewed by two readers using a 5-point Likert scale evaluating image distortions, susceptibility artifacts, image resolution, lesion conspicuity, and diagnostic confidence. Twenty-five cholesteatomas were histologically confirmed after surgery and originated in the study group. TseDWI showed the highest sensitivity with 96% (95% confidence interval (CI): 88–100%), followed by topupDWI with 92% (95% CI: 81–100%) for both readers. The sensitivity for rsDWI was 76% (95% CI: 59–93%) for reader 1 and 84% (95% CI: 70–98%) for reader 2, respectively. Both tseDWI and topupDWI revealed a specificity of 100% (95% CI: 66–100%) and rsDWI of 89% (95% CI: 52–100%). Both tseDWI and topupDWI showed fewer image distortions and susceptibility artifacts compared to rsDWI. Image resolution was consistently rated best for topupDWI, followed by rsDWI, which both outperformed tseDWI. TopupDWI and tseDWI showed comparable results for lesions’ conspicuity and diagnostic confidence, both outperforming rsDWI. Modified readout-segmented DWI using the topup-correction method is preferable to standard rsDWI and may be regarded as an accurate alternative to single-shot turbo spin-echo DWI in cholesteatoma diagnostics.
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14
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Orobello N, Harrington C, Reilly BK. Updates in paediatric cholesteatoma. Curr Opin Otolaryngol Head Neck Surg 2022; 30:422-425. [PMID: 36165030 DOI: 10.1097/moo.0000000000000850] [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
PURPOSE OF REVIEW The management of paediatric patients with cholesteatoma is complex, as the disease process is more aggressive in children than adults. New technologies and practice adaptations currently help optimize the surgical management and monitoring of these challenging patients. RECENT FINDINGS Several options of surgical management are available and are associated with equal if not improved outcomes. Technologic advancements in endoscopic ear surgery, the discovery of chemical-assisted dissection of cholesteatoma and advanced imaging protocols have enabled surgeons to better care for patients with this complex disease process. SUMMARY The advances in endoscopic ear surgery, the discovery of Mesna as a chemically assisted dissection agent to improve recidivism rates and the use of specific diffusion-weighted MRI protocols enable the otologic surgeon to better care for these paediatric patients.
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Affiliation(s)
- Nick Orobello
- George Washington University Medical Center, Children's National Hospital, Washington, District of Columbia, USA
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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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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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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: 2] [Impact Index Per Article: 1.0] [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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Lin M, Geng Y, Sha Y, Zhang Z, Zhou K. Performance of 2D BLADE turbo gradient- and spin-echo diffusion-weighted imaging in the quantitative diagnosis of recurrent temporal bone cholesteatoma. BMC Med Imaging 2022; 22:132. [PMID: 35883055 PMCID: PMC9327346 DOI: 10.1186/s12880-022-00860-z] [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: 02/26/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) has become an important tool for the detection of cholesteatoma. The purpose of this study was to explore the value of 2D BLADE turbo gradient- and spin-echo imaging (TGSE BLADE) DWI in the quantitative diagnosis of recurrent temporal bone cholesteatoma (CS). METHODS From March 2018 to October 2021, 67 patients with suspected recurrence of temporal bone CS after assessment by clinical otorhinolaryngologists who had undergone previous ear surgery for CS were prospectively evaluated by magnetic resonance imaging (MRI). Two radiologist assessed images independently. Quantitative parameters such as signal intensity ratio (SIR) calculated using, as a reference, the inferior temporal cortex (SIRT) and the background noise (SIRN), apparent diffusion coefficient (ADC) value, and ADC ratio (with pons as reference) measured on TGSE BLADE sequences were assessed. Using receiver operating characteristic (ROC) curve analysis, the optimal threshold and diagnostic performance for diagnosing recurrent CS were determined. Pair-wise comparison of the ROC curves was performed using the area under the ROC curve (AUC). RESULTS Finally, 44 patients were included in this study, including 25 CS and 19 non-cholesteatoma (NCS). Mean SIRT and mean SIRN on TGSE BLADE DWI were significantly higher for CS than NCS lesions (p < 0.001). Meanwhile, mean ADC values and mean ADC ratios on ADC maps were significantly lower in the CS group than in the NCS group (p < 0.001). According to ROC analysis, the diagnostic efficacy of quantitative parameters such as SIRT (AUC = 0.967), SIRN (AUC = 0.979), ADC value (AUC = 1.0), and ADC ratio (AUC = 0.983) was significantly better than that of qualitative DWI (AUC = 0.867; p = 0.007, 0.009, 0.011 and 0.037, respectively). CONCLUSIONS Residual/recurrent temporal bone CS can be accurately detected using quantitative evaluation of TGSE BLADE DWI.
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Affiliation(s)
- Mengyan Lin
- grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, Shanghai, 200032 China
| | - Yue Geng
- grid.411079.a0000 0004 1757 8722Department of Radiology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031 China
| | - Yan Sha
- grid.411079.a0000 0004 1757 8722Department 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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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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Yosefof E, Yaniv D, Tzelnick S, Sokolov M, Ulanovski D, Raveh E, Kornreich L, Hilly O. Post-operative MRI detection of residual cholesteatoma in pediatric patients - The yield of serial scans over a long follow-up. Int J Pediatr Otorhinolaryngol 2022; 158:111172. [PMID: 35526314 DOI: 10.1016/j.ijporl.2022.111172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 04/20/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Non-echo-planar diffusion weighted magnetic resonance imaging (Non-EPI DWI MRI) is commonly used for follow-up after cholesteatoma surgery. MRI has a critical role in the evaluation of residual disease, where physical examination will commonly demonstrate an intact tympanic membrane. The aim of our study was to assess the timing of residual cholesteatoma identification on serial MRI scans and the yield of MRI follow up after canal wall up tympano-mastoidectomy. METHODS A retrospective chart review of children that underwent canal wall up tympano-mastoidectomy due to cholesteatoma in Schneider Children's Medical Center during 2004-2016, and were followed up both clinically and with MRI. RESULTS Seventy-seven children (89 ears) were included, who altogether underwent 166 surgeries (77 revisions). Average follow-up was 66 ± 34.4 months. During follow up, 244 scans were performed; 19 cases of residual disease were diagnosed by MRI and confirmed in surgery. The mean time from surgery and an MRI positive for residual disease was 29.7 ± 16 months (range: 10-66). In 9/19 cases (47%), at least one negative MRI preceded the scan positive for residual disease, and in 4 cases at least two initial scans were negative. CONCLUSIONS MRI plays an important role in the diagnosis of residual disease after cholesteatoma surgery. In our cohort. Almost half of the cases diagnosed with residual disease had at least one negative scan prior to the positive one, emphasizing the importance of close radiological follow-up with serial scans after surgery.
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Affiliation(s)
- Eyal Yosefof
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Yaniv
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Tzelnick
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meirav Sokolov
- Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Ulanovski
- Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Raveh
- Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liora Kornreich
- Department of Imaging, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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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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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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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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Baba A, Matsushima S, Fukuda T, Yamauchi H, Fujioka H, Hasumi J, Yoshimoto S, Shoji T, Kurihara S, Yamamoto Y, Kojima H, Kurokawa R, Kurokawa M, Ota Y, Ojiri H. Improved assessment of middle ear recurrent/residual cholesteatomas using temporal subtraction CT. Jpn J Radiol 2022; 40:271-278. [PMID: 34689305 PMCID: PMC8891190 DOI: 10.1007/s11604-021-01209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/10/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to investigate the usefulness of temporal subtraction CT (TSCT) of temporal bone CT for the detection of postoperative recurrent/residual cholesteatoma of the middle ear. METHODS Thirty-two consecutive patients with surgically proven postoperative recurrent/residual cholesteatoma and 14 consecutive patients without recurrent/residual lesion matched the selection criteria and were retrospectively evaluated. TSCT imaging was generated with the use of serial postoperative CT. Two experienced radiologists and two residents evaluated the presence of bone erosive change by comparison serial CT studies, and CT and TSCT. The detection rate of bone erosive change, sensitivity and specificity of the recurrence/residual lesions, and reading time for each reader were evaluated. RESULTS TSCT + CT significantly improved the detection of bone erosive changes compared to CT-only evaluation (17.4-41.3% vs. 37.0-58.7%, p = 0.008-0.046). The mean sensitivity and specificity of TSCT + CT for experienced radiologists were 0.77 and 1.00, and 0.52 and 0.97 without TSCT. The mean sensitivity and specificity of TSCT + CT for residents were 0.64 and 1.00, and 0.41 and 1.00 without TSCT. Sensitivity showed an increase in all readers. The use of TSCT significantly reduced the reading time per case in all readers (p < 0.001). CONCLUSION TSCT improves the depiction of newly occurring progressive bone erosive changes, and detection sensitivity and reading time in postoperative recurrence/residual cholesteatoma of middle ear.
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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.
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Satoshi Matsushima
- Department of Radiology, 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
| | - Hiroaki Fujioka
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Jun Hasumi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shohei Yoshimoto
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tomokazu Shoji
- 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-Head and Neck Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Miyazaki, 889-1692, 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
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - 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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Kamal D, Malhotra T, Nadiger S, Thakur V. Ossicular chain reconstruction in austin-kartush type A and B defects using titanium prosthesis: Audiological and anatomical outcomes. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_163_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Özgür A, Yemiş T, Turgut NF, Özdemir D, Mehel DM, Akgül G, Çelebi M. Reconstruction of ear canal wall with superior pedicled composite multi-fractured osteoperiosteal flap: a new technique and preliminary outcomes. J Laryngol Otol 2021; 135:1-4. [PMID: 34674784 DOI: 10.1017/s0022215121003078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study evaluated the functional results of the superior pedicled composite multi-fractured osteoperiosteal flap technique. This method is a novel technique for the reconstruction of the external auditory canal. The study also examined the effect of the superior pedicled composite multi-fractured osteoperiosteal flap technique on patients' disease-related quality of life. METHOD A total of 37 patients who underwent the superior pedicled composite multi-fractured osteoperiosteal flap technique were enrolled in the study. Their functional hearing results and disease-related quality of life scores were evaluated. RESULTS A significant improvement was observed in the patients' hearing scores at the post-operative sixth month relative to the pre-operative period, and the patients' disease-related quality of life increased significantly. CONCLUSION The superior pedicled composite multi-fractured osteoperiosteal flap method can be safely used, especially in patients undergoing retrograde mastoidectomy because of limited cholesteatoma. This method contributes to improving patients' hearing levels and disease-related quality of life.
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Affiliation(s)
- A Özgür
- Department of Otorhinolaryngology, İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital, İstanbul, Turkey
| | - T Yemiş
- Department of Otorhinolaryngology, Gümüşhane State Hospital, Turkey
| | - N F Turgut
- Department of Otorhinolaryngology, Samsun Health Practices and Research Center, University of Health Sciences Turkey, Turkey
| | - D Özdemir
- Department of Otorhinolaryngology, Samsun Health Practices and Research Center, University of Health Sciences Turkey, Turkey
| | - D M Mehel
- Department of Otorhinolaryngology, Samsun Health Practices and Research Center, University of Health Sciences Turkey, Turkey
| | - G Akgül
- Department of Otorhinolaryngology, Samsun Health Practices and Research Center, University of Health Sciences Turkey, Turkey
| | - M Çelebi
- Department of Otorhinolaryngology, Samsun Health Practices and Research Center, University of Health Sciences Turkey, Turkey
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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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Magnetic resonance non-echo planar diffusion-weighted imaging accuracy in detecting cholesteatoma in comparison with clinical and surgical findings. The Journal of Laryngology & Otology 2021; 136:208-214. [PMID: 34405776 DOI: 10.1017/s0022215121002188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
OBJECTIVE Chronic ear disease presents a unique challenge to otolaryngologists in both rural and urban settings. Cholesteatoma remains a difficult disease to treat in rural populations due to limited healthcare access and high risk of recurrence. The purpose of this study was to determine if there are differences in surgical outcomes among patients with acquired cholesteatoma residing in rural versus urban settings. STUDY DESIGN Single-surgeon retrospective case series with chart review. SETTING Tertiary care private otolaryngology practice. PATIENTS One hundred twenty-two patients presenting to the Kentuckiana ENT otology and neurotology practice from January 2011 to May 2017. MAIN OUTCOME MEASURES Surgical outcomes including recurrence, air-bone gap improvement, ossicular integrity, and complications were reviewed and compared between the rural and urban cohorts. RESULTS Presence of postoperative residual cholesteatoma (OR = 8.667, 95% CI = 2.022-37.141, p = 0.008) and number of surgeries per patient (OR = 5.185, 95% CI = 1.086-24.763, p = 0.024) were significantly increased among patients in rural nonmetropolitan areas. No significant differences were found when comparing risk of recurrence, size of cholesteatoma, presence of complications, air-bone gap improvement, and ossicular chain integrity. There were significantly more second-look surgeries performed in privately insured patients (OR = 8.582, 95% CI = 1.937-38.017, p = 0.001). CONCLUSIONS Patients in rural communities have an increased number of surgeries and postoperative risk for residual cholesteatoma compared to patients residing in urban settings. This study provides the basis for larger, multicenter, prospective examinations of outcomes among urban versus rural patients, which would enable a better understanding of difference in surgical outcomes between rural and urban cohorts.Level of Evidence: IV.
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Müller M, Honegger F, Podvinec M, Metternich F, Gürtler N. Silastic sheeting in staged ear surgery: Is there still a role for this procedure? Eur Arch Otorhinolaryngol 2021; 279:1203-1210. [PMID: 33760955 DOI: 10.1007/s00405-021-06744-2] [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: 08/27/2020] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review long-term outcomes for chronic otitis media with and without cholesteatoma in staged canal-wall-up tympanoplasty with temporary silastic sheeting and to compare hearing and recurrence results with the literature. METHODS Retrospective data analysis of all patients suffering from chronic otitis media with or without cholesteatoma (COMC/COM) and treated by staged canal-wall-up (CWU) technique with silastic insertion between 1992 and 2012. Literature analysis in PubMed 1990-2017. RESULTS 74 cases were included in the analysis. In COMC (n = 47) a total of 2 (4%) recurrent and 14 (30%) residual cholesteatoma were documented. The postoperative hearing test showed a pure-tone-average (PTA) of 36 dB hearing level (HL) and an air-bone-gap (ABG) of 21 dB HL. A significant improvement was only observed for stage I disease (PTA 8 dB HL and ABG 9 dB HL). In COM (n = 27) postoperative PTA and ABG were significantly improved by 33 dB HL and 23 dB HL, respectively. Mean postoperative follow-up was 47 months (12-173) for COMC and 22 months (2-120) for COM. CONCLUSIONS The cholesteatoma recurrence rate in this study reflects contemporary published rates. Assessment of hearing outcome is difficult due to the low number of cases and very high heterogeneity of published data. Still, the staged CWU procedure with temporary silastic sheeting seems to bear some advantages in regard to hearing. The role of additional factors such as Eustachian Tube function to assess outcome should be considered. An internationally agreed upon reporting system should be followed, if various surgical approaches are to be compared. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Martin Müller
- Hals-Nasen-Ohrenklinik Kantonsspital Aarau, Klinik Für Hals- und Gesichtschirurgie, Aarau, Switzerland
| | - Flurin Honegger
- Hals-Nasen-Ohren-Universitätsklinik, University Hospital Basel, University Basel, Basel, Switzerland
| | | | - Frank Metternich
- Hals-Nasen-Ohrenklinik Kantonsspital Aarau, Klinik Für Hals- und Gesichtschirurgie, Aarau, Switzerland
| | - Nicolas Gürtler
- Hals-Nasen-Ohren-Universitätsklinik, University Hospital Basel, University Basel, Basel, Switzerland.
- Hals-Nasen-Ohren-Klinik, Universitätskinderspital Beider Basel, 4031, Basel, Switzerland.
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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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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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Hermann R, Blanc J, Fieux M, Desternes G, Coudert A, Truy E. Multi-operated cholesteatoma: when two surgeries are not enough. Eur Arch Otorhinolaryngol 2020; 278:665-673. [PMID: 32535859 DOI: 10.1007/s00405-020-06104-6] [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] [Received: 03/02/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Most studies regarding residual and recurrent cholesteatoma focus on single relapse. This study examines patients who had to undergo at least three surgeries for complete eradication of their cholesteatoma, with the aim of bringing to light risk factors and assessing the functional impact of multiple surgeries on hearing. METHOD We include 27 patients who underwent 3 consecutive surgeries for cholesteatoma between 2006 and 2016. This population represented 3.1% of all cholesteatoma operated on during that same period (868 patients). RESULTS Cases of multi-residual and/or recurrent cholesteatoma (RRC) were significantly younger (13.1 years old), than single-RRC or cases with No-RRC (respectively, 28.0 and 38.5 years old) (p < 0.01). Furthermore, there was a significant difference in cholesteatoma location especially for combined attical and mesotympanic location between the three groups (no-RCC 26%; single-RRC 34% and multi-RRC 66%) (p < 0.01). There was also a significant difference in ossicular erosion of the malleus, incus and stapes between the three groups (p < 0.01). In our study, the type of surgery did not influence multi-RRC rates. We did not observe any significant impact on hearing between the first and third surgeries. Mean duration between the first and second surgeries was significantly shorter for multi-RRC (14.5 months SD 8.3) than for single-RRC (23.3 months SD 18.1) (p < 0.05). CONCLUSION Special care should be given in case of combined attical and mesotympanic extension, ossicular erosion and young children. Delaying the realization of MRI, and/or of second-look surgery, could decrease the risk of multi-RRC.
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Affiliation(s)
- Ruben Hermann
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,University Claude Bernard Lyon 1, Lyon, France.
| | - Jacques Blanc
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Maxime Fieux
- University Claude Bernard Lyon 1, Lyon, France.,Department of Otology and Otoneurology, Lyon Sud Hospital, Hospice Civils de Lyon, Lyon, France
| | - Gauvain Desternes
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Aurélie Coudert
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Eric Truy
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,University Claude Bernard Lyon 1, Lyon, France
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Negative Predictive Value of Non-Echo-Planar Diffusion Weighted MR Imaging for the Detection of Residual Cholesteatoma Done at 9 Months After Primary Surgery Is not High Enough to Omit Second Look Surgery. Otol Neurotol 2020; 40:911-919. [PMID: 31219966 DOI: 10.1097/mao.0000000000002270] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate non echo-planar diffusion weighted magnetic resonance imaging (non-EP DW MRI) at 9 months after primary surgery to rule out residual cholesteatoma in patients scheduled before second-look-surgical exploration. STUDY DESIGN Prospective observational study. SETTING Secondary teaching hospital. PATIENTS/INTERVENTIONS Patients who were scheduled for second-look-surgery after primary canal wall up repair of cholesteatoma underwent 1.5 T MRI including non-EP DWI and high-resolution coronal T1 and T2-FS SE sequences. MAIN OUTCOME MEASURES Imaging studies were evaluated for the presence of cholesteatoma by three independent observers. Intraoperative observations were regarded the standard of reference. Ear, nose, throat (ENT) surgeons were blinded for imaging findings. The primary outcome was the negative predictive value (NPV) of MR imaging, secondary outcomes were sensitivity, specificity, and positive predictive value. RESULTS Thirty-three patients underwent both MRI and surgery, among whom 22 had a cholesteatoma. Mean time between primary surgery and MRI was 259 days (standard deviation [SD] 108). NPV of non-EP DW MRI in detecting recurrent cholesteatoma was 53% (95% CI: 32-73%). Sensitivity and specificity were 59% (39-77%) and 91% (62-98%), respectively. The positive predictive value was 93% (69-99%). In five out of nine false-negative cases, recurrent cholesteatoma measured 3 mm or less. Using a 3 mm detection threshold, NPV increased to 79%. CONCLUSION Non-EP DW MRI cannot replace second look surgery in ruling-out residual cholesteatoma at 9 months after primary surgery. It could be used in a follow-up strategy in low risk patients. Further research is needed which types of residual cholesteatoma are not revealed by MRI.
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Kavanagh RG, Liddy S, Carroll AG, Purcell YM, Smyth AE, Khoo SG, McNeill G, Malone DE, Killeen RP. Rapid diffusion-weighted MRI for the investigation of recurrent temporal bone cholesteatoma. Neuroradiol J 2020; 33:210-215. [PMID: 32336206 DOI: 10.1177/1971400920920784] [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: 01/20/2023] Open
Abstract
BACKGROUND Suspected cholesteatoma recurrence is commonly investigated with magnetic resonance imaging (MRI) of the temporal bone. Non-echo planar diffusion-weighted imaging (non-EP DWI) has become the sequence of choice. PURPOSE To assess the agreement between an MRI protocol incorporating both non-EP DWI and contrast-enhanced sequences, and a shortened protocol without contrast-enhanced sequences in the assessment of suspected cholesteatoma recurrence. MATERIALS AND METHODS One hundred consecutive MRIs, consisting of T2-weighted, non-EP DWI and pre- and post-contrast T1-weighted sequences, were reviewed by two radiologists at a tertiary referral centre. Agreement between the two protocols was assessment by means of a weighted Cohen kappa coefficient. RESULTS We found a near perfect agreement between the two protocols (kappa coefficient with linear weighting 0.98; 95% confidence interval 0.95-1.00). There were two cases in which the two protocols were discordant. In both cases, the lesion measured <3 mm and images were degraded by artefact at the bone-air interface. The shortened protocol without post-contrast sequences yielded a 32% reduction in acquisition time. CONCLUSION When non-EP DWI is available, contrast-enhanced sequences can be omitted in the vast majority of cases without compromising diagnostic accuracy. Contrast-enhanced sequences may provide additional value in equivocal cases with small (<3 mm) lesions or in cases where images are degraded by artefact.
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Affiliation(s)
| | - Stephen Liddy
- Department of Radiology, St Vincent's University Hospital, Ireland
| | - Anne G Carroll
- Department of Radiology, St Vincent's University Hospital, Ireland
| | - Yvonne M Purcell
- Department of Radiology, St Vincent's University Hospital, Ireland
| | - Anna E Smyth
- Department of Radiology, St Vincent's University Hospital, Ireland
| | - S Guan Khoo
- Department of Otolaryngology, St Vincent's University Hospital, Ireland
| | - Graeme McNeill
- Department of Radiology, St Vincent's University Hospital, Ireland.,Department of Radiology, Royal Victoria Eye and Ear Hospital, Ireland
| | - Dermot E Malone
- Department of Radiology, St Vincent's University Hospital, Ireland.,Department of Radiology, Royal Victoria Eye and Ear Hospital, Ireland
| | - Ronan P Killeen
- Department of Radiology, St Vincent's University Hospital, Ireland.,Department of Radiology, Royal Victoria Eye and Ear Hospital, Ireland
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Sharma SD, Hall A, Bartley AC, Bassett P, Singh A, Lingam RK. Surgical mapping of middle ear cholesteatoma with fusion of computed tomography and diffusion-weighted magnetic resonance images: Diagnostic performance and interobserver agreement. Int J Pediatr Otorhinolaryngol 2020; 129:109788. [PMID: 31775116 DOI: 10.1016/j.ijporl.2019.109788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/16/2019] [Accepted: 11/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the diagnostic performance in detecting primary cholesteatoma at various anatomical subsites using Computed Tomography (CT), Diffusion-weighted Magnetic Resonance Imaging (DWMRI) and Fusion of CT and DWMRI (Fusion CT-MRI) images. STUDY DESIGN A retrospective study of 22 children identified from a prospective database of surgically treated cholesteatoma cases over a five year period. All cases underwent pre-operative CT, non-echo planar DWMRI and Fusion CT-DWMRI, and with clearly documented surgical findings. For each imaging modality, two radiologists scored for the presence or absence of cholesteatoma with confidence levels at different anatomical subsites. The radiologists were blinded to the surgical findings to which their findings were compared. SETTING Large Teaching Hospital in London. PATIENTS 22 children with cholesteatoma confirmed surgically. INTERVENTION CT, DWMRI imaging and fusion CT-MRI. MAIN OUTCOME MEASURE Diagnostic performance of subsite localisation of cholesteatoma by CT, DWMRI and fusion CT-MRI imaging with intra-operative findings. RESULTS Twenty-two patients were included (12 women and 10 men). The median age of patients was 11 years. When considering all subsites combined, the result for all imaging methods suggested 'good' agreement between both observers. When all subsites were examined together, all methods had relatively high sensitivity values (87% for CT vs 84% for DWMRI vs 85% for fusion CT-DWMRI). Specificity was highest with fusion CT-DWMRI (46% for CT vs 76% for DWMRI vs 97% for fusion CT-DWMRI), as was accuracy (66% for CT vs 80% for DWMRI vs 91% for fusion). CONCLUSIONS Our study has demonstrated that fusion CT-DWMRI is superior to DWMRI or CT separately in localizing cholesteatoma at various middle ear cleft subsites and bony relations, making it a valuable tool for surgical planning.
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Affiliation(s)
- Sunil Dutt Sharma
- Department of Radiology & Otolaryngology, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, London, United Kingdom.
| | - Andrew Hall
- Department of Radiology & Otolaryngology, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, London, United Kingdom.
| | - Anthony C Bartley
- Department of Radiology & Otolaryngology, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, London, United Kingdom.
| | - Paul Bassett
- Department of Radiology & Otolaryngology, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, London, United Kingdom.
| | - Arvind Singh
- Department of Radiology & Otolaryngology, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, London, United Kingdom.
| | - Ravi K Lingam
- Department of Radiology & Otolaryngology, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, London, United Kingdom.
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Hall A, St Leger D, Singh A, Lingam RK. The utility of computed tomography and diffusion-weighted magnetic resonance imaging fusion in cholesteatoma: illustration with a UK case series. J Laryngol Otol 2020; 134:1-6. [PMID: 31910915 DOI: 10.1017/s0022215119002640] [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: 11/07/2022]
Abstract
OBJECTIVE Post-processing imaging techniques allow high-resolution computed tomography and diffusion-weighted magnetic resonance imaging of the temporal bone to be superimposed and viewed simultaneously (fusion imaging). This study aimed to highlight the practical utility of fusion imaging for disease localisation and evaluation in a UK case series of primary and post-operative cholesteatoma. METHOD Fusion of computed tomography and diffusion-weighted magnetic resonance b1000 images was performed using specific software. Axial computed tomography images and coronal b1000 images were selected for fusion. RESULTS A case series of primary and post-operative cholesteatoma in which computed tomography and magnetic resonance imaging fusion assisted the management of both the patient pathway and surgical approach is reviewed. CONCLUSION Computed tomography and magnetic resonance imaging fusion can assist in pre-operative surgical planning and patient counselling through assessment of disease in both primary and revision scenarios. Computed tomography and magnetic resonance imaging fusion can assist the operative surgeon through accurate localisation that can influence both the operative technique and optimise operation theatre utilisation.
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Affiliation(s)
- A Hall
- Department of Otorhinolaryngology, Northwick Park and Central Middlesex Hospitals, London North West University Healthcare NHS Trust, London, UK
| | - D St Leger
- Department of Radiology, Northwick Park and Central Middlesex Hospitals, London North West University Healthcare NHS Trust, London, UK
| | - A Singh
- Department of Otorhinolaryngology, Northwick Park and Central Middlesex Hospitals, London North West University Healthcare NHS Trust, London, UK
| | - R K Lingam
- Department of Radiology, Northwick Park and Central Middlesex Hospitals, London North West University Healthcare NHS Trust, London, UK
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40
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Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy. The Journal of Laryngology & Otology 2019; 133:1083-1086. [DOI: 10.1017/s0022215119002421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy.MethodsA prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients.ResultsCholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ= 0.72,p= 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ= 0.57,p= 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ= 0.994,p= 0.001).ConclusionDiffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.
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Luu K, Chi D, Kiyosaki KK, Chang KW. Updates in Pediatric Cholesteatoma. Otolaryngol Clin North Am 2019; 52:813-823. [DOI: 10.1016/j.otc.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Rayneau P, Aussedat C, Trinh TT, Bobillier C, Lescanne E, Robier A, Bakhos D. Influence of surgical technique on residual cholesteatoma location and prevalence. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:13-16. [PMID: 31564619 DOI: 10.1016/j.anorl.2019.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Compared to canal wall up (CWU) tympanoplasty, canal wall reconstruction (CWR) allows better visualization of cholesteatoma extension. The canal wall up approach provides good functional outcomes, but with higher rates of residual cholesteatoma. The aim of this study was to compare residual cholesteatoma prevalence and location between the two approaches. METHOD Subjects were adult patients with residual cholesteatoma following CWU or CWR surgery between January 1, 2010 and December 31, 2015. During this period, 94 patients underwent CWU and 71 CWR; 22 presented with residual cholesteatoma: 16 after CWU (R-CWU group) and 6 after CWR (R-CWR group). RESULTS There was no significant inter-group difference in residual cholesteatoma prevalence: 17% after CWU, 8.4% after CWR. Locations comprised: 13 (81%) in the attic, 9 (56%) in the tympanic cavity and 4 (25%) in the mastoid in the R-CWU group, and 6 (100%) in the attic in the R-CWR group. There were significantly fewer tympanic cavity locations after CWR compared to CWU (P=0.046). CONCLUSION Residual cholesteatoma prevalence did not significantly differ between the CWU and CWR approaches. The most frequent location was the attic; significantly more locations were in the tympanic cavity with the CWU approach. These findings are important for surgeons and neuro-radiologists during follow-up.
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Affiliation(s)
- P Rayneau
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France.
| | - C Aussedat
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France
| | - T T Trinh
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France
| | - C Bobillier
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France
| | - E Lescanne
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France; UMR-S930, université François-Rabelais de Tours, CHRU de Tours, Tours, France
| | - A Robier
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France; UMR-S930, université François-Rabelais de Tours, CHRU de Tours, Tours, France
| | - D Bakhos
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France; UMR-S930, université François-Rabelais de Tours, CHRU de Tours, Tours, France
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Three-dimensional reversed fast imaging with steady-state precession diffusion-weighted imaging for the detection of middle ear cholesteatoma. Clin Radiol 2019; 74:898.e7-898.e13. [PMID: 31439285 DOI: 10.1016/j.crad.2019.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/19/2019] [Indexed: 11/23/2022]
Abstract
AIM To determine the usefulness of three-dimensional reversed fast imaging with steady-state precession diffusion-weighted imaging (3D-PSIF DWI) for the detection of middle ear cholesteatoma. MATERIALS AND METHODS The study population consisted of 81 patients who underwent 3D-PSIF-DWI at 3 T. They included cholesteatoma in 73 cases, otitis media in five, and cholesterol granuloma in three. Two observers independently performed qualitative evaluations for the detection of cholesteatoma and measured apparent diffusion coefficient (ADC) values and ADC ratios of the lesions. Kappa (κ) statistics, the intraclass correlation coefficient (ICC), the independent t-test, and receiver operating characteristic (ROC) analysis were used for statistical analysis. Pair-wise comparison of the ROC curves was performed using the area under the ROC curve (AUC). RESULTS Interobserver agreement and ICC for the qualitative and quantitative evaluations were excellent (κ=0.92 and ICC=0.90-0.92, respectively). The ADC value and the ADC ratio were significantly lower for cholesteatoma than non-cholesteatoma lesions (p<0.0001). In <5 mm cholesteatoma group, the diagnostic performance of the ADC value (AUC=0.97) and the ADC ratio (AUC=1) was significantly superior to qualitative 3D-PSIF-DWI (AUC=0.76; p=0.0001 and <0.0001, respectively). For ≥5 mm cholesteatoma group, there were no significant differences in diagnostic performance among the three parameters. CONCLUSION 3D-PSIF-DWI sequence is useful for the detection of middle ear cholesteatomas, especially <5 mm lesions.
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Felici F, Scemama U, Bendahan D, Lavieille JP, Moulin G, Chagnaud C, Montava M, Varoquaux A. Improved Assessment of Middle Ear Recurrent Cholesteatomas Using a Fusion of Conventional CT and Non-EPI-DWI MRI. AJNR Am J Neuroradiol 2019; 40:1546-1551. [PMID: 31413008 DOI: 10.3174/ajnr.a6141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recurrent middle ear cholesteatomas are commonly preoperatively assessed using MR imaging (non-EPI-DWI) and CT. Both modalities are used with the aim of distinguishing scar tissue from cholesteatoma and determining the extent of bone erosions. Inflammation and scar tissue associated with the lesions might hamper a proper delineation of the corresponding extensions on CT images. Using surgical findings as the criterion standard, we assessed the recurrent middle ear cholesteatoma extent using either uncoregistered or fused CT-MR imaging datasets and determined the corresponding accuracy and repeatability. MATERIALS AND METHODS Twenty consecutive patients with suspected recurrent middle ear cholesteatoma and preoperative CT-MR imaging datasets were prospectively included. A double-blind assessment and coregistration of the recurrent middle ear cholesteatoma extent and manual delineation of 18 presumed recurrent middle ear cholesteatomas were performed by 2 radiologists and compared with the criterion standard. "Reliability score" was defined to qualify radiologists' confidence. For each volume, segmentation repeatability was assessed on the basis of intraclass correlation coefficient and overlap indices. RESULTS For the whole set of patients, recurrent middle ear cholesteatoma was further supported by surgical results. Two lesions were excluded from the analysis, given that MR imaging did not show a restricted diffusion. Lesions were accurately localized using the fused datasets, whereas significantly fewer lesions (85%) were correctly localized using uncoregistered images. Reliability scores were larger for fused datasets. Segmentation repeatability showed an almost perfect intraclass correlation coefficient regarding volumes, while overlaps were significantly lower in uncoregistered (52%) compared with fused (60%, P < .001) datasets. CONCLUSIONS The use of coregistered CT-MR images significantly improved the assessment of recurrent middle ear cholesteatoma with a greater accuracy and better reliability and repeatability.
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Affiliation(s)
- F Felici
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - U Scemama
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - D Bendahan
- North Hospital, and CNRS, CRMBM-CEMEREM UMR 7339, 13385 (D.B., A.V.)
| | - J-P Lavieille
- La Conception University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery (J.-P.L., M.M.).,UMRT 24 IFSTTAR (J.-P.L., M.M.), Aix-Marseille University, Marseille, France
| | - G Moulin
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - C Chagnaud
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - M Montava
- La Conception University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery (J.-P.L., M.M.).,UMRT 24 IFSTTAR (J.-P.L., M.M.), Aix-Marseille University, Marseille, France
| | - A Varoquaux
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.) .,North Hospital, and CNRS, CRMBM-CEMEREM UMR 7339, 13385 (D.B., A.V.)
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Lips LMJ, Nelemans PJ, Theunissen FMD, Roele E, van Tongeren J, Hof JR, Postma AA. The diagnostic accuracy of 1.5 T versus 3 T non-echo-planar diffusion-weighted imaging in the detection of residual or recurrent cholesteatoma in the middle ear and mastoid. J Neuroradiol 2019; 47:433-440. [PMID: 30951771 DOI: 10.1016/j.neurad.2019.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE AND BACKGROUND This study retrospectively compares diagnostic performance of 1.5 T versus 3 T non-echo planar diffusion weighted imaging with or without additional T1 and T2 sequences in the detection of residual and/or recurrent cholesteatoma. METHODS Patients with clinically suspected recurrent cholesteatoma or postoperative routine survey MR who subsequently underwent surgical procedure were retrospectively included (135 patients, 164 operated ears) from a large database. Patients underwent 1.5 T (128 ears) or 3 T MRI (36 ears), with non-echo planar DWI, T1 and T2 acquisitions. Two radiologists independently reassessed the images. Definitive surgical diagnosis was used as gold standard. Sensitivity, specificity and diagnostic odds ratio were evaluated. RESULTS According to surgical diagnosis a cholesteatoma was present in 124 of 164 ears, corresponding with a prevalence of 75%. Sensitivity and specificity were lower for 3 T compared to 1.5 T, irrespective of whether additional T1 and T2-weighted sequences were used or not. Diagnostic odds ratios were higher for 1.5 T (34 and 12 for reader 1 and 2, respectively) compared to 3 T (3 and 4 for reader 1 and 2, respectively). Adding T1 and T2 sequences lowers sensitivity but increases specificity. CONCLUSION Non-epi DWI for the detection of residual/recurrent cholesteatoma is preferably performed on 1.5 T scanners over 3 T. The use of additional sequences regarding detection of cholesteatoma is debatable as it lowers sensitivity but increases specificity. However, these sequences may also be of use in diagnosing complications and planning surgical procedures in some hospitals.
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Affiliation(s)
- L M J Lips
- Department of radiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands.
| | - P J Nelemans
- Department of Epidemiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - F M D Theunissen
- Department of radiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - E Roele
- Department of radiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - J van Tongeren
- Department of Otorhinolaryngology. Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - J R Hof
- Department of Otorhinolaryngology. Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - A A Postma
- Department of radiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
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Diffusion-weighted magnetic resonance imaging in the detection of residual and recurrent cholesteatoma in children: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2019; 118:90-96. [PMID: 30599286 DOI: 10.1016/j.ijporl.2018.12.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of residual and recurrent cholesteatoma in children. METHODS A systematic review and meta-analysis was conducted as per PRISMA guidelines using the following databases from their date of inception: MEDLINE, PubMed, Embase, Cochrane Library, Web of Science. Bivariate meta-analysis using a random effects model was used to calculate summarized pooled estimates of sensitivity, specificity, and diagnostic odds ratios, using second-look surgery as the gold standard comparison. RESULTS A total of ten articles (141 cases) were included for qualitative and quantitative analysis. Pooled sensitivity and specificity of non-echo planar imaging (non-EPI) DW-MRI were 89.4% (95%CI 51.9%-98.5%) and 92.9% (95%CI 81.4%-97.5%) respectively. DW-MRI appears limited in its ability to detect lesions less than 3 mm in size. CONCLUSION Non-EPI DW-MRI is highly specific but carries uncertain sensitivity in the detection of residual and recurrent cholesteatoma in children. Further research is warranted to determine the specific role of DW-MRI in this patient group, namely when and how often children should be referred for imaging and in which cases the method can be used to completely replace second-look surgery.
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48
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Dudau C, Draper A, Gkagkanasiou M, Charles-Edwards G, Pai I, Connor S. Cholesteatoma: multishot echo-planar vs non echo-planar diffusion-weighted MRI for the prediction of middle ear and mastoid cholesteatoma. BJR Open 2019; 1:20180015. [PMID: 33178911 PMCID: PMC7592409 DOI: 10.1259/bjro.20180015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/31/2018] [Accepted: 12/15/2018] [Indexed: 01/15/2023] Open
Abstract
Objective We aimed to compare a newer readout-segmented echoplanar imaging (RS-EPI) technique with the established single shot turbo spin echo (SS-TSE) non-EPI diffusion-weighted imaging (DWI) in detecting surgically validated cholesteatoma. Methods We retrospectively reviewed 358 consecutive MRI studies in 285 patients in which both RS-EPI and non-EPI DWI sequences were performed. Each diffusion sequence was reviewed independently and scored negative, indeterminate or positive for cholesteatoma in isolation and after reviewing the T 1W sequence. Average artefacts scores were evaluated and the lesion size measured as a distortion indicator. The imaging scores were correlated with surgical validation, clinical and imaging follow-up. Results There were 239 middle ear and central mastoid tract and 34 peripheral mastoid lesions. 102 tympanomastoid operations were performed. The positive predictive value ( PPV), post-operative PPV, primary PPV, negative predictive value were 93%, 95%, 87.5%, 70% for RS-EPI and 92.5%, 93.6%, 90%, 79% for non-EPI DWI. There was good agreement between the two techniques (k = 0.75). Non-EPI DWI is less susceptible to skull base artefacts although the mean cholesteatoma measurement difference was only 0.53 mm. Conclusion RS-EPI has comparable PPV with non-EPI DWI in both primary and post-operative cholesteatoma but slightly lower negative predictive value. When there is a mismatch, non-EPI DWI better predicts the presence of cholesteatoma. There is good agreement between the sequences for cholesteatoma diagnosis. The T 1W sequence is very important in downgrading indeterminate DWI signal lesions to a negative score. Advances in knowledge This is, to our knowledge, the first study to compare a multishot EPI DWI technique with the established non- EPI DWI in cholesteatoma diagnosis.
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Affiliation(s)
- Cristina Dudau
- Department of Radiology, Guy's and St Thomas' Hospital, and Department of Neuroradiology, King's College Hospital, London
| | - Ashleigh Draper
- GKT School of Medicine, King's College, London, United Kingdom
| | | | - Geoffrey Charles-Edwards
- Department of Medical Physics, Guy's and St Thomas' Hospital, and School of Biomedical Engineering and Imaging Sciences, King's College London, London
| | - Irumee Pai
- Department of Otolaryngology, Guy's and St. Thomas' Hospital, London
| | - Steve Connor
- Department of Radiology, Guy's and St Thomas' Hospital, and Department of Neuroradiology, King's College Hospital, London
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Laske RD, Roth TN, Baráth K, Schuknecht B, Huber AM, Röösli C. The Role of Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging in Diagnosis of Primary Cholesteatoma and Cholesteatoma Recidivism as an Adjunct to Clinical Evaluation. Ann Otol Rhinol Laryngol 2018; 127:919-925. [DOI: 10.1177/0003489418800833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The aim of this study was to analyze the sensitivity and specificity of non-echoplanar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of cholesteatoma, with a focus on its value as an adjunct to clinical examination. Methods: In a prospective cohort study, 92 cases were divided into 2 groups: “clinically cholesteatoma” ( n = 79) and “clinically no cholesteatoma” ( n = 13). Non-EPI DW MRI was performed preoperatively in all cases. The presence of a cholesteatoma was assessed by clinicians otoscopically, by neuroradiologists on non-EPI DW MRI, by the surgeon intraoperatively, and finally by the pathologist postoperatively. Data analysis was performed for specificity, sensitivity, positive predictive value, negative predictive value, and interrater variability. Results: The sensitivity and specificity were 89.3% and 75%, respectively, in the “clinically cholesteatoma” group and 0% and 100% in the “clinically no cholesteatoma” group. Non-EPI DW MRI had a positive predictive value of 98.5% when cholesteatoma was suspected clinically and a negative predictive value of 84.6% when cholesteatoma was not suspected clinically. Conclusion: If cholesteatoma is suspected clinically, non-EPI DW MRI is not necessary. If there is no clinical suspicion of cholesteatoma in second-look situations, sensitivity is low and serial follow-up MRI with long intervals is advised.
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Affiliation(s)
- Roman D. Laske
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Thomas N. Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | | | | | - Alexander M. Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Cavaliere M, Di Lullo AM, Cantone E, Scala G, Elefante A, Russo C, Brunetti L, Motta G, Iengo M. Cholesteatoma vs granulation tissue: a differential diagnosis by DWI-MRI apparent diffusion coefficient. Eur Arch Otorhinolaryngol 2018; 275:2237-2243. [PMID: 30088076 DOI: 10.1007/s00405-018-5082-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/31/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To diagnose cholesteatoma when it is not visible through tympanic perforation, imaging techniques are necessary. Recently, the combination of computed tomography and magnetic resonance imaging has proven effective to diagnose middle ear cholesteatoma. In particular, diffusion weighted images have integrated the conventional imaging for the qualitative assessment of cholesteatoma. Accordingly, the aim of this study was to obtain a quantitative analysis of cholesteatoma calculating the apparent diffusion coefficient value. So, we investigated whether it could differentiate cholesteatoma from other inflammatory tissues both in a preoperative and in a postoperative study. METHODS This study included 109 patients with clinical suspicion of primary or residual/recurrent cholesteatoma. All patients underwent preoperative computed tomography and magnetic resonance imaging with diffusion sequences before primary or second-look surgery to calculate the apparent diffusion coefficient value. RESULTS We found that the apparent diffusion coefficient values of cholesteatoma were significantly lower than those of non cholesteatoma. In particular, the apparent diffusion coefficient median value of the cholesteatoma group (0.84 × 10- 3 mm2/s) differed from the inflammatory granulation tissue (2.21 × 10- 3 mm2/s) group (p < 2.2 × 10- 16). Furthermore, we modeled the probability of cholesteatoma by means of a logistic regression and we determined an optimal cut-off probability value of ~ 0.86 (specificity = 1.0, sensitivity = 0.97), corresponding to an apparent diffusion coefficient cut-off value of 1.37 × 10- 3 mm2/s. CONCLUSIONS Our study has demonstrated that apparent diffusion coefficient values constitute a valuable quantitative parameter for preoperative differentiation of cholesteatomas from other middle ear inflammatory diseases and for postoperative diagnosis of recurrent/residual cholesteatomas.
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Affiliation(s)
- M Cavaliere
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, ENT Unit, University of Naples "Federico II", Pansini Street no. 5, 80131, Naples, Italy
| | - Antonella Miriam Di Lullo
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, ENT Unit, University of Naples "Federico II", Pansini Street no. 5, 80131, Naples, Italy.
| | - E Cantone
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, ENT Unit, University of Naples "Federico II", Pansini Street no. 5, 80131, Naples, Italy
| | - G Scala
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - A Elefante
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Pansini Street no. 5, 80131, Naples, Italy
| | - C Russo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Pansini Street no. 5, 80131, Naples, Italy
| | - L Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Pansini Street no. 5, 80131, Naples, Italy
| | - G Motta
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, ENT Unit, University of Naples "Federico II", Pansini Street no. 5, 80131, Naples, Italy
| | - M Iengo
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, ENT Unit, University of Naples "Federico II", Pansini Street no. 5, 80131, Naples, Italy
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