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Research ArticleHead and Neck Imaging
Open Access

Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics

M. Wiesmueller, W. Wuest, M.S. May, S. Ellmann, R. Heiss, M. Saake, R. Janka, M. Uder and F.B. Laun
American Journal of Neuroradiology April 2021, DOI: https://doi.org/10.3174/ajnr.A7112
M. Wiesmueller
aFrom the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
bImage Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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  • ORCID record for M. Wiesmueller
W. Wuest
aFrom the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
bImage Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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M.S. May
aFrom the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
bImage Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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S. Ellmann
aFrom the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
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R. Heiss
aFrom the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
bImage Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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M. Saake
aFrom the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
bImage Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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R. Janka
aFrom the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
bImage Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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M. Uder
aFrom the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
bImage Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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F.B. Laun
aFrom the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
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  • FIG 1.
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    FIG 1.

    Histograms displaying Likert scale scores ranging from 1 (worst) to 5 (best) points. The histograms show the combined frequencies of both readers. The frequencies of axial and coronal images were added.

  • FIG 2.
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    FIG 2.

    Images of a 20-year-old patient with a left-sided cholesteatoma (white arrows). A, tseDWI. B, rsDWI. The lesion can be seen clearly in tseDWI and rsDWI. It is, however, not spheric in the coronal rsDWI but rather is elongated and tilted due to image distortions in phase directions. Field inhomogeneities generate a bright spot in the rsDWI that might be mistaken for a lesion (arrowheads). The tseDWI displayed in A is more blurred than the rsDWI and shows less contrast in the brain. For example, unlike in the rsDWI, both white matter and gray matter are not discernible in the tseDWI.

  • FIG 3.
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    FIG 3.

    Images of a 55-year-old patient with a left-sided cholesteatoma (white arrows). A, tseDWI. B, rsDWI. The lesion can be seen clearly in the tseDWI. In the rsDWI, however, the lesion is displayed with reduced contrast and is hardly visible; therefore, both readers did not diagnose a cholesteatoma in this case in the rsDWI dataset. Again, a bright spot is present in the coronal rsDWI next to the temporal bone on the right side due to field inhomogeneities, which might be mistaken for a true lesion (arrowhead).

  • FIG 4.
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    FIG 4.

    Images of a 38-year-old patient with a recurrent cholesteatoma (white arrows). A stapes prosthesis implant caused major image distortions in the rsDWI (arrowheads).

  • FIG 5.
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    FIG 5.

    Histograms displaying the scores obtained with Likert scores ranging from −2 (rsDWI much better than tseDWI) to 2 points (tseDWI much better than rsDWI). The histograms show the added frequencies of both readers.

Tables

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    Table 1:

    DWI sequence parameters

    SequencetseDWIrsDWI
    TR (ms)20004000
    TE (ms)10366 (and 91 for phase-correction scan)
    Voxel size (mm³)1.1 × 1.5 × 31.4 × 1.4 × 3
    FOV (mm²)220230
    FOV in-phase direction100%65%
    Phase directionAnterior-posterior (axial), right to center (coronal)Right to center (axial and coronal)
    Phase resolution75%100%
    Partial Fourier50% (phase)87.5% (readout)
    Matrix192 × 144160 × 104
    Section distance10%10%
    No. of slices13 (axial)11 (coronal)13 (axial)11 (coronal)
    Parallel imagingGRAPPA ×2GRAPPA ×2
    Bandwidth (Hz/pixel)554977
    Echo spacing (ms)4.480.36
    Readout segments15
    Flip angle150°180°
    b-values (s/mm2)10000, 1000
    Averages101 (for b=0 s/mm²), 2 (for b=1000 s/mm²)
    Diffusion mode3D diagonal4-scan trace
    Diffusion schemeBipolarBipolar
    Acquisition time (minute:second)4:22 (axial), 3:42 (coronal)3:06
    • Note:—GRAPPA indicates generalized autocalibrating partially parallel acquisition.

    • View popup
    Table 2:

    Likert score evaluation per reader

    CategoryCoronal/AxialtseDWI (Likert Categories 4 and 5)rsDWI (Likert Categories 4 and 5)Mean Difference(tseDWI and rsDWI)
    Reader 1Reader 2Reader 1Reader 2Reader 1Reader 2
    1) Geometric image distortionCor97%97%0%0%1.92
    1) Geometric image distortionAx93%93%17%13%1.51.5
    2) Ghosting artifactsCor100%100%100%100%00
    2) Ghosting artifactsAx100%100%100%100%00
    3) Signal voids or other artifactsCor100%100%100%100%00
    3) Signal voids or other artifactsAx100%100%100%100%00
    4) Bright-appearing regionCor97%97%0%0%22
    4) Bright-appearing regionAx100%100%13%13%1.71.8
    5) Subjective image resolutionCor3%3%90%90%–1.6–1.7
    5) Subjective image resolutionAx3%3%90%93%–1.5–1.6
    6) Lesion conspicuityCor97%93%33%23%1.61.7
    6) Lesion conspicuityAx90%90%20%17%1.51.5
    7) Diagnostic confidenceCor/Ax93%93%7%3%1.81.8
    • Note:—Cor indicates coronal; Ax, axial.

    • View popup
    Table 3:

    Cohen κ values quantifying the interreader agreement

    κ (tseDWI, Axial) κ (tseDWI, Coronal) κ (rsDWI, Axial) κ (rsDWI, Coronal)
    1) Geometric image distortion0.640.620.830.58
    2) Ghosting artifacts1111
    3) Signal voids1111
    4) Bright-appearing region0.790.780.820.78
    5) Subjective image resolution0.790.780.710.77
    6) Lesion conspicuity0.710.620.830.53
    κ (tseDWI)κ (rsDWI)
    7) Diagnostic confidence with κ (tseDWI, axial and coronal combined) and κ (rsDWI, axial and coronal combined)0.820.77
    κ (tseDWI vs. rsDWI)
    9) Lesion conspicuity with κ (tseDWI vs. rsDWI)0.80
    10) Subjective diagnostic confidence0.68
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M. Wiesmueller, W. Wuest, M.S. May, S. Ellmann, R. Heiss, M. Saake, R. Janka, M. Uder, F.B. Laun
Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics
American Journal of Neuroradiology Apr 2021, DOI: 10.3174/ajnr.A7112

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Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics
M. Wiesmueller, W. Wuest, M.S. May, S. Ellmann, R. Heiss, M. Saake, R. Janka, M. Uder, F.B. Laun
American Journal of Neuroradiology Apr 2021, DOI: 10.3174/ajnr.A7112
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