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Diffusion-Weighted MR Imaging of Cholesteatoma in Pediatric and Adult Patients Who Have Undergone Middle Ear Surgery

¹ Department of Diagnostic Radiology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
² Clinic for Ear, Nose and Throat, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, D-01307 Dresden, Germany.

OBJECTIVE. The aim of this prospective study was to determine the role of diffusion-weighted MR imaging combined with conventional MR imaging for the detection of residual or recurrent cholesteatoma in patients who have undergone middle ear surgery.

SUBJECTS AND METHODS. Twenty-two patients who had undergone resection of cholesteatoma were referred for MR imaging. MR imaging (1.5 T) was performed using a diffusion-weighted single-shot spin-echo echoplanar sequence, a proton density and T2-weighted double-echo turbo spin-echo sequence, and T1-weighted spin-echo sequences before and after IV injection of gadopentetate dimeglumine (0.1 mmol/kg of body weight). An experienced reviewer evaluated the diffusion-weighted MR images for the presence of a high-signal-intensity cholesteatoma. Imaging findings were correlated with findings from surgery in 17 patients and with findings from clinical follow-up examination in five patients.

RESULTS. Diffusion-weighted MR imaging combined with conventional MR imaging depicted 10 of 13 cholesteatomas (sensitivity, 77%). The three lesions that were missed were smaller than 5 mm. All the MR images of patients without cholesteatoma were correctly interpreted as showing negative findings for cholesteatoma (specificity, 100%). The positive predictive value and negative predictive value were 100% and 75%, respectively.

CONCLUSION. Diffusion-weighted MR imaging combined with conventional MR imaging can confirm residual or recurrent cholesteatoma in patients who have undergone middle ear surgery by showing a high-signal-intensity lesion. Because tumors smaller than 5 mm may be missed, a diffusion-weighted MR imaging study with negative findings does not exclude small residual or recurrent cholesteatoma.

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