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Cartilage grafts mimicking cholesteatoma recurrence on diffusion-weighted magnetic resonance imaging: a case series

Published online by Cambridge University Press:  08 February 2023

H Walters Open the ORCID record for H Walters [Opens in a new window] ,
L Lee-Warder ,
Y Mentias  and
P Arullendran
H Walters*
Affiliation:
ENT Department, Sunderland Royal Hospital, Sunderland, UK
L Lee-Warder
Affiliation:
ENT Department, Sunderland Royal Hospital, Sunderland, UK
Y Mentias
Affiliation:
ENT Department, Sunderland Royal Hospital, Sunderland, UK
P Arullendran
Affiliation:
ENT Department, Sunderland Royal Hospital, Sunderland, UK
*
Author for correspondence: Dr H Walters, ENT Department, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK E-mail: holt.walters@nhs.net
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Abstract

Background

Cholesteatomas present a high risk for residual and recurrent disease, and the surveillance of post-operative patients can be challenging. Diffusion-weighted magnetic resonance imaging is becoming the preferred method for investigating recidivism; however, false positive imaging findings increase the risk of patients undergoing unnecessary second look surgery.

Case reports

This study reports two patients with false positive diffusion restriction associated with cartilage grafts that mimicked cholesteatoma and resulted in second look surgery with no disease found at operation. This study also discusses the related medical literature, including potential causes of abnormal diffusion restriction and methods to negate this.

Conclusion

Caution should be exercised when considering second look surgery in the presence of a cartilage graft and a high confidence of disease clearance. A multi-disciplinary approach is recommended for the operating surgeon to review the images with a radiologist.

Keywords

CholesteatomaDiffusion Magnetic Resonance ImagingEarMiddle/PathologyEarMiddle/Diagnostic Imaging

Information

Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 8 , August 2023 , pp. 938 - 941
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr H Walters takes responsibility for the integrity of the content of the paper

References

Tomlin, J, Chang, D, McCutcheon, B, Harris, J. Surgical technique and recurrence in cholesteatoma: a meta-analysis. Audiol Neurootol 2013;18:135–42CrossRefGoogle ScholarPubMed
Corrales, CE, Blevins, NH. Imaging for evaluation of cholesteatoma: current concepts and future directions. Curr Opin Otolaryngol Head Neck Surg 2013;21:461–7CrossRefGoogle ScholarPubMed
Lingam, RK, Nash, R, Majithia, A, Kalan, A, Singh, A. Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl. Insights Imag 2016;7:669–78CrossRefGoogle ScholarPubMed
Jindal, M, Riskalla, A, Jiang, D, Connor, S, O'Connor, AF. A systematic review of diffusion-weighted magnetic resonance imaging in the assessment of postoperative cholesteatoma. Otol Neurotol 2011;32:1243–9CrossRefGoogle ScholarPubMed
Muhonen, EG, Mahboubi, H, Moshtaghi, O, Sahyouni, R, Ghavami, Y, Maducdoc, M et al. False-positive cholesteatomas on non-echoplanar diffusion-weighted magnetic resonance imaging. Otol Neurotol 2020;41:588–92CrossRefGoogle ScholarPubMed
Steens, S, Venderink, W, Kunst, D, Meijer, A, Mylanus, E. Repeated postoperative follow-up diffusion-weighted magnetic resonance imaging to detect residual or recurrent cholesteatoma. Otol Neurotol 2016;37:356–61CrossRefGoogle ScholarPubMed