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Diffusion MRI in cholesteatoma control. Advantages and pitfalls

Presenting Author: Constantino Morera

Published online by Cambridge University Press:  03 June 2016

Constantino Morera ,
Manuel Mateos  and
Fernando Mas
Constantino Morera
Affiliation:
La Fe University Hospital. University of Valencia
Manuel Mateos
Affiliation:
La Fe University Hospital. ENT Department
Fernando Mas
Affiliation:
La Fe University Hospital. Radiology Department. Eresa
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Abstract

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Introduction: Diffusion-weighted magnetic resonance imaging has been proven to be a very effective technique for the follow up and diagnosis of cholesteatoma. Non-eco-planar techniques offer the best results as far as sensibility and specificity are concerned. However, one of the main problems of these techniques is the appearance of false positives.

Objective: The aim of this study is to review the number of patients diagnosed of cholesteatoma since 2008 and evaluate sensitivity, specificity, positive predictor value and negative predictor value of PROPELLER diffusion-weighted magnetic resonance imaging in cholesteatoma diagnosis, with special attention to false positive and false negative cases.

Results: In a sample of 146 patients since 2008 we have found a sensitivity of 95′12%, specificity of 83′09%, positive predictive value of 86′66% and negative predictive value of 93′65%. We have found that the main cause for false positives to be the presence of middle ear infections. False negative cases are due to auto-evacuation or suction cleaning in the clinic before MRI is performed.

Conclusions: TI and diffusion sequences, and diffusion coefficient are useful in differentiating cholesteatoma from inflammatory/granulation tissue in order to avoid unnecessary surgical procedures due to false positive results. Suction cleaning is not recommended before radiological examination to avoid false negative cases.