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Diffusion-weighted MR Imaging Sequence in the Detection of Postoperative Recurrent Cholesteatoma¹

¹ From the Departments of Radiology (F.D., R.S.), Otology and Otoneurosurgery (C.V., F.M.V.), and Otolaryngology (A.D.), Centre Hospitalier Universitaire, Lille, France; and Philips Medical Systems, Suresnes, France (D.C.). Received September 24, 2004; revision requested November 30; revision received January 21, 2005; accepted February 21; final version accepted March 18. Address correspondence to: F.D., Plateau Commun d'Imagerie, Hôpital Claude Huriez Centre Sud, Rue Michel Polonovski, 59037 Lille Cedex, France (e-mail: f-dubrulle{at}chru-lille.fr).

Purpose: To prospectively evaluate a fast spin-echo (SE) diffusion-weighted sequence for magnetic resonance (MR) imaging of recurrent cholesteatoma in patients who have undergone middle ear surgery.

Materials and Methods: The study was approved by the institutional review board, and informed consent was obtained from all patients. Twenty-four patients (10 female and 14 male patients; mean age, 44 years) who had undergone resection of cholesteatoma were referred for MR imaging. MR imaging was performed with a 1.5-T unit by using unenhanced diffusion-weighted fast SE imaging at b factors of 0 and 800 sec/mm², unenhanced T2-weighted fast SE imaging, unenhanced T1-weighted SE imaging, and delayed contrast material–enhanced T1-weighted imaging. Two radiologists evaluated the diffusion-weighted fast SE images for the presence of a high-signal-intensity cholesteatoma. Results from MR imaging were compared with reports from second- or third-look surgery. Interobserver agreement was assessed with the statistic.

Results: A recurrent cholesteatoma was correctly identified in 13 of 14 patients with diffusion-weighted fast SE images obtained with a b factor of 800 sec/mm², for a positive predictive value of 93%. In patients without recurrent cholesteatoma, all diffusion-weighted fast SE MR images obtained with a b factor of 800 sec/mm² were correctly interpreted as showing no high signal intensity. Thus, the negative predictive value was 100%. Sensitivity and specificity were 100% (13 of 13 patients) and 91% (10 of 11 patients), respectively. Interobserver agreement was excellent ( = 0.92). The smallest recurrent cholesteatoma was 5 mm in diameter, and this was correctly detected with the diffusion-weighted fast SE sequence.

Conclusion: Diffusion-weighted fast SE imaging enables the depiction of recurrent cholesteatoma in patients who have undergone middle ear surgery.

© RSNA, 2005

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