Cholesteatoma vs granulation tissue: a differential diagnosis by DWI-MRI apparent diffusion coefficient

Area of Science:

• Otolaryngology
• Radiology
• Medical Imaging

Background:

• Diagnosing cholesteatoma, especially when not visible through tympanic perforation, requires advanced imaging techniques.
• Computed tomography (CT) and magnetic resonance imaging (MRI) are effective for middle ear cholesteatoma diagnosis.
• Diffusion-weighted imaging (DWI) has become integral for qualitative assessment, prompting quantitative analysis.

Purpose of the Study:

• To quantitatively analyze cholesteatoma using apparent diffusion coefficient (ADC) values.
• To investigate the ability of ADC values to differentiate cholesteatoma from other inflammatory tissues.
• To assess the utility of ADC values in both preoperative and postoperative settings.

Main Methods:

• Included 109 patients with suspected primary, residual, or recurrent cholesteatoma.
• All patients underwent preoperative CT and MRI with diffusion sequences.
• Apparent diffusion coefficient (ADC) values were calculated before surgery.

Main Results:

• Cholesteatoma exhibited significantly lower ADC values compared to non-cholesteatoma tissues.
• The median ADC value for cholesteatoma was 0.84 × 10^-3 mm²/s, distinct from inflammatory granulation tissue (2.21 × 10^-3 mm²/s).
• A logistic regression model identified an optimal ADC cut-off value of 1.37 × 10^-3 mm²/s with high specificity (1.0) and sensitivity (0.97).

Conclusions:

• Apparent diffusion coefficient (ADC) values provide a valuable quantitative parameter for differentiating cholesteatomas from inflammatory middle ear diseases preoperatively.
• ADC values are also effective for the postoperative diagnosis of recurrent or residual cholesteatomas.
• Quantitative ADC analysis enhances diagnostic accuracy in middle ear pathologies.