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Evaluation of cholesteatoma: our experience with DW Propeller imaging
Amit Karandikar1, Siu Cheng Loke2, Julian Goh2
1Department of Radiology, Tan Tock Seng Hospital, Singapore amit_karandikar@ttsh.com.sg.
Background:
Cholesteatoma management includes early detection and surgical exploration. Due to its tendency to recur, it can be potentially locally aggressive. Magnetic resonance imaging (MRI), and in particular diffusion weighted imaging (DWI), plays an important role in management of these lesions.
Purpose:
To assess the accuracy of Propeller (Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction) DW sequence in detecting middle ear and mastoid cholesteatomas in non-operated ears by surgical correlation.
Material And Methods:
A retrospective review of 15 patients was done who underwent Propeller DWI with either clinically confirmed or suspected cholesteatomas. Surgical correlation was done in all cases.
Results:
All patients had hyperintense foci on Propeller DWI. Surgical correlation performed revealed that 13 patients had cholesteatomas while two patients had mastoid abscesses. The location, extent, and size of cholesteatomas on Propeller DWI matched with the operative findings. Of the 13 patients with cholesteatomas, three patients had multiple foci of hyperintensity on Propeller DWI, which corroborated with the surgical finding of multiple cholesteatomas. The average apparent diffusion coefficient value of cholesteatoma was 0.868 × 10(-3) mm(2)/s, found to be higher than that of abscess, which was 0.425 × 10(-3) mm(2)/s.
Conclusion:
Propeller DWI was accurate in assessing the location, extent, and size of cholesteatomas as corroborated with surgical findings. Propeller DWI is useful in detecting number of cholesteatoma foci, a vital finding as it may impact the choice of surgery.
Insights
Propeller diffusion-weighted imaging (DWI) accurately detects middle ear cholesteatomas. This technique precisely identifies cholesteatoma location, size, and number, aiding surgical planning.
Area of Science:
- Otolaryngology
- Radiology
- Medical Imaging
Background:
- Cholesteatoma requires early detection and surgical intervention due to its aggressive recurrence potential.
- Magnetic resonance imaging (MRI), especially diffusion-weighted imaging (DWI), is crucial for managing cholesteatoma.
- Accurate assessment of cholesteatoma is vital for effective treatment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the Propeller (Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction) DWI sequence.
- To assess its effectiveness in detecting middle ear and mastoid cholesteatomas in non-operated ears.
- To correlate imaging findings with surgical outcomes.
Main Methods:
- Retrospective review of 15 patients with suspected or confirmed cholesteatomas.
- All patients underwent Propeller DWI MRI.
- Surgical correlation was performed for all cases to validate imaging results.
Main Results:
- Propeller DWI showed hyperintense foci in all patients.
- Surgical correlation confirmed cholesteatomas in 13 patients and mastoid abscesses in two.
- The imaging accurately matched the location, extent, and size of cholesteatomas found during surgery. Multiple foci were correctly identified in three cases.
Conclusions:
- Propeller DWI demonstrates high accuracy in assessing cholesteatoma characteristics (location, extent, size) compared to surgical findings.
- This technique is valuable for identifying the number of cholesteatoma foci, which can influence surgical strategy.
- Propeller DWI is a reliable tool for cholesteatoma detection and characterization in non-operated ears.
