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Preliminary outcomes of cholesteatoma screening in children using non-echo-planar diffusion-weighted magnetic
Gunesh P Rajan1, Ranjeeta Ambett, Lisa Wun
1Dept. of Otolaryngology, Head & Neck Surgery, School of Surgery, University of Western Australia, Level 6, T-Block, Fremantle Hospital, Fremantle, Australia. Gunesh.Rajan@health.wa.gov.au
Objective:
Diffusion-weighted (DW) MRI imaging is evolving into an alternative to second look surgery in detection of cholesteatoma recurrence. Insights into the DW MRI appearances of postoperative or inflammatory mucosal changes have recently described using non-echo-planar, turbo spin-echo (TSE) DW MRI which reliably distinguishes between postoperative changes and cholesteatoma. We investigated the use of TSE DW MRI in our pediatric population in order to validate a rapid and cost-effective MRI sequence that can be used to screen for cholesteatoma.
Methods:
Prospective comparative study with adult and pediatric patients at a tertiary referral centre. Patients in the study underwent TSE DW MRI prior to second look or revision surgery for cholesteatoma. A Siemens 1.5 T scanner was employed, using the HASTE sequence (EPI DW MRI) as well as standard echo-planar DWI, T1 and T2 sequences. The MRI findings were then correlated with the intraoperative findings at surgery 9-15 months after primary surgery, or of revision surgery in the cases that were referred from other centres. Detection and localisation of cholesteatoma on TSE DW MRI were compared with the findings at second surgery, long considered the gold standard for detection of residual or recurrent disease. Scanning time between the TSE sequence and the standard planar DW MR were also compared.
Results:
In a cohort of 92 patients, 21 pediatric patients were identified. 15 patients have had their 15 second look or revision procedures and DW MRI prior to their surgery. TSE DW MRI detected cholesteatoma and reliably identified the location of the cholesteatoma in 2 patients whom all had disease confirmed at surgery. The 13 cases with negative preoperative DW MRI for cholesteatoma were all confirmed to be disease free at surgery. Scanning time of the TSE sequence takes 100 s as opposed to 20 min using standard echo-planar DW MRI techniques without the requirement of a contrast agent and without the need for a general anaesthetic for any of the children.
Conclusion:
TSE (HASTE) DW MRI is emerging as a cost effective, noninvasive alternative to second look surgery for detection and screening for cholesteatoma in pediatric patients.
Insights
Turbo spin-echo (TSE) diffusion-weighted (DW) MRI is a rapid, cost-effective tool for detecting cholesteatoma recurrence in children. This noninvasive imaging technique can replace second look surgery for screening pediatric patients.
Area of Science:
- Medical Imaging
- Otolaryngology
- Pediatric Surgery
Background:
- Cholesteatoma recurrence detection often relies on second look surgery.
- Diffusion-weighted (DW) MRI is an emerging alternative for identifying cholesteatoma.
- Turbo spin-echo (TSE) DW MRI shows promise in distinguishing postoperative changes from cholesteatoma.
Purpose of the Study:
- To investigate the efficacy of TSE DW MRI for detecting cholesteatoma recurrence in pediatric patients.
- To validate TSE DW MRI as a rapid, cost-effective, and noninvasive screening tool.
- To compare TSE DW MRI findings with intraoperative results.
Main Methods:
- Prospective comparative study involving pediatric patients undergoing surgery for cholesteatoma.
- Utilized Siemens 1.5 T scanner with HASTE (TSE DW MRI) and standard echo-planar DWI sequences.
- Correlated MRI findings with intraoperative findings from second look or revision surgeries.
Main Results:
- TSE DW MRI accurately detected cholesteatoma in 2 pediatric patients, with findings confirmed at surgery.
- All 13 patients with negative preoperative TSE DW MRI were disease-free at surgery.
- TSE DW MRI scanning time was significantly shorter (100 s) compared to standard echo-planar DW MRI (20 min), without contrast or general anesthesia.
Conclusions:
- TSE (HASTE) DW MRI is a cost-effective, noninvasive alternative for cholesteatoma detection and screening in pediatric patients.
- This rapid MRI sequence can potentially replace second look surgery.
- Further validation supports its use in clinical practice for pediatric cholesteatoma management.
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