The Journal of International
Advanced Otology
Original Article

Using Non-Echoplanar Diffusion Weighted MRI in Detecting Cholesteatoma Following Canal Wall Down Mastoidectomy - Our Experience with 20 Patient Episodes

1.

Clinic of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, Harrow, United Kingdom

2.

Clinic of Radiology, Northwick Park Hospital & Central Middlesex Hospital, Harrow, United Kingdom

J Int Adv Otol 2018; 14: 263-266
DOI: 10.5152/iao.2018.5033
Read: 378 Downloads: 117 Published: 03 September 2019

Abstract

 

OBJECTIVE: To our knowledge, there is no study exploring specifically the diagnostic performance of diffusion-weighted imaging (DWI) in patients with previous canal wall down (CWD) surgery when combined with appropriate clinical evaluation. The aim of the present study was to evaluate the performance of DWI in the detection of residual or recurrent disease in patients who have had a previous CWD mastoidectomy.

MATERIALS and METHODS: We identified 13 patients with a CWD mastoidectomy subsequently having at least one further DWI prior to further mastoid exploration that generated a total of 20 patient episodes. Magnetic resonance imaging was performed on a 1.5 T superconductive unit using a standard head matrix coil. Coronal 2 mm thick TSE T2-weighted images (TR: 4640 ms; TE: 103 ms; matrix: 245,384; field of view: 150×200 mm) were performed. Operative findings were reviewed for all 20 patient episodes to compare DWI findings with intraoperative findings. Based on this, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.

RESULTS: DWI had a sensitivity of 93%, specificity of 60%, PPV of 87%, NPV of 75%, and accuracy of 80%.

CONCLUSION: Given the high sensitivity of DWI in the detection of residual or recurrent disease, the present study supports DWI as a useful tool in the detection of residual or recurrent cholesteatoma in cases following CWD surgery, where clinical acumen suggests an ongoing disease process despite no overt cholesteatoma being visible.

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ISSN1308-7649 EISSN 2148-3817