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Research ArticleHead and Neck Imaging

Comparison of Echo-Planar Diffusion-Weighted Imaging and Delayed Postcontrast T1-Weighted MR Imaging for the Detection of Residual Cholesteatoma

F. Venail, A. Bonafe, V. Poirrier, M. Mondain and A. Uziel
American Journal of Neuroradiology August 2008, 29 (7) 1363-1368; DOI: https://doi.org/10.3174/ajnr.A1100
F. Venail
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A. Bonafe
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V. Poirrier
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M. Mondain
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A. Uziel
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    Fig 1.

    EPI DWI and DPI for residual cholesteatoma detection. DWI axial b = 0 (A), b = 500 (B), b = 1000 (C) and coronal b = 0 (D), b = 500 (E), b = 1000 (F) EPI sequences. Early (G and I) and delayed (H and J) postconstrast T1-weighted axial (G and H) and coronal (I and J) sequences. With DWI, an increasing signal intensity (arrow) between b = 0 (A and D), b = 500 (B and E), and b = 1000 (C and F) sequences was observed in the left hypotympanum. A hypointense space-occupying lesion (arrows) was also observed in the left hypotympanum with early enhanced T1-weighted sequences (G and I). This lesion was more conspicuous on delayed imaging (H and J, large arrows), whereas scar tissue was intensely enhanced (small arrows). Thus, surgery confirmed a residual cholesteatoma of the left hypotympanum.

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    Fig 2.

    Mismatch between DWI and DPI, with a small lesion. EPI DWI axial b = 0 (A), b = 500 (B), b = 1000 (C) and coronal b = 0 (D), b = 500 (E), b = 1000 (F) sequences. Early coronal (H) and delayed postcontrast T1-weighted axial (G) and coronal (I) sequences. Progressive signal-intensity decay was observed in the right mastoid with DWI (A–F, small arrows). DWI was considered negative for residual cholesteatoma. Conversely, a hypointense lesion was observed on early-enhanced T1-weighted MR images (H, large arrow), with a ring enhancement on DPI (G and I, large arrows). At surgery, a 3-mm large pearl-like residual cholesteatoma was found.

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    Fig 3.

    FP examinations with DWI and DPI in 2 different patients. Axial (A) and coronal (B) EPI DWI b = 1000 and coronal DPI (C) sequences. Hyperintense foci were observed in the right mastoid with axial and coronal DWI (A and B, arrows). Lack of enhancement on coronal delayed T1-weighted MR image (C, arrow) led us to suspect a residual cholesteatoma. At surgery, only a silastic sheet filling the right mastoid was found. Axial (D) and coronal (F) EPI DWI b = 1000 and axial (E) and coronal (G) DPIs in another patient. DWI was negative for residual cholesteatoma (D and F). Note nonenhancing nodular masses in the left mesotympanum and mastoid on axial and coronal delayed T1-weighted MR images (E and G, arrows). Small-sized residual cholesteatomas were suspected. At surgery, only scar tissue was found.

Tables

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    Table 1:

    Results of DWI, DPI, and surgical findings in 31 patients

    PatientDWI CholesteatomaDPI CholesteatomaSurgery TissueSurgery Size (mm)/Type
    1NNScar
    2YYCholesteatoma3/pearl
    3NNInflammatory
    4YYCholesteatoma5/infiltrating
    5YYScar*
    6YYCholesteatoma4/pearl
    7NYCholesteatoma3/pearl
    8YYScar*
    9YYCholesteatoma3/pearl
    10YYCholesteatoma10/infiltrating
    11YYInflammatory
    12NYCholesteatoma2/pearl
    13NYScar*
    14NNCholesteatoma3/pearl
    15YYCholesteatoma10/infiltrating
    16YYCholesteatoma8/infiltrating
    17NNScar
    18NYCholesteatoma3/infiltrating
    19NYCholesteatoma2/pearl
    20YYCholesteatoma3/pearl
    21NNInflammatory
    22NNCholesteatoma3/pearl
    23YYCholesteatoma6/infiltrating
    24NYCholesteatoma4/infiltrating
    25NNScar
    26YYCholesteatoma10/infiltrating
    27YYCholesteatoma10/infiltrating
    28NNScar
    29NYCholesteatoma5/pearl
    30NNScar
    31NYScar*
    • Note:—Y indicates yes; N, no; pearl, pearl-like cholesteatoma; infiltrating, infiltrating form of cholesteatoma.

    • * Presence of a silastic sheet.

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    Table 2:

    Summary of the diagnostic values of DWI and DPI sequences according to residual cholesteatoma size

    DWIDPI
    Total SeriesTumor >3 mmTumor >5 mmTotal SeriesTumor >3 mmTumor >5 mm
    Se60.0075.00100.0090.00100.00100.00
    Spe72.7384.2188.0054.5575.0080.00
    PPV80.0075.0066.6778.2668.7554.55
    NPV50.0084.21100.0075.00100.00100.00
    • Note:—Se indicates sensitivity; Spe, specificity; PPV, positive predictive value; NPV, negative predictive value.

    • View popup
    Table 3:

    Summary of the diagnostic values of DWI and/or DPI sequences according to residual cholesteatoma size*

    DWI or DPIDWI and DPI
    Total SeriesTumor >3 mmTumor >5 mmTotal SeriesTumor >3 mmTumor >5 mm
    Se90.00100.00100.0060.0075.00100.00
    Spe54.5575.0080.0072.7384.2188.00
    PPV78.2668.7554.5580.0075.0066.67
    NPV75.00100.00100.0050.0084.21100.00
    • Note:—Se indicates sensitivity; Spe, specificity; PPV, positive predictive value; NPV, negative predictive value.

    • * DWI or DPI diagnosis of cholesteatoma with any of these 2 examinations is sufficient to suggest a residual lesion. DWI and DPI diagnosis of cholesteatoma with both examinations is necessary to suggest a residual lesion.

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American Journal of Neuroradiology: 29 (7)
American Journal of Neuroradiology
Vol. 29, Issue 7
August 2008
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Cite this article
F. Venail, A. Bonafe, V. Poirrier, M. Mondain, A. Uziel
Comparison of Echo-Planar Diffusion-Weighted Imaging and Delayed Postcontrast T1-Weighted MR Imaging for the Detection of Residual Cholesteatoma
American Journal of Neuroradiology Aug 2008, 29 (7) 1363-1368; DOI: 10.3174/ajnr.A1100

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Comparison of Echo-Planar Diffusion-Weighted Imaging and Delayed Postcontrast T1-Weighted MR Imaging for the Detection of Residual Cholesteatoma
F. Venail, A. Bonafe, V. Poirrier, M. Mondain, A. Uziel
American Journal of Neuroradiology Aug 2008, 29 (7) 1363-1368; DOI: 10.3174/ajnr.A1100
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