Decoding cholesteatoma radiological dimensions: unveiling the discrepancy between CT and MRI imaging and development...

Cholesteatoma (CHO) presents a significant threat to middle ear integrity, potentially leading to severe complications. Radiological assessment is crucial for understanding CHO anatomy, with high-resolution CT scans commonly used despite limitations in sensitivity and size overestimation. Recent advancements in non-echo planar imaging (EPI) diffusion-weighted imaging (DWI) MRI offer improved sensitivity, but accessibility issues persist.

The objective of this study is to compare CHO volume, as measured by CT scans, and the gold standard non-EPI DWI MRI.

A prospective clinical trial involving 39 participants with middle-ear CHO compared CT and non-EPI DWI MRI volumes. Patients underwent both imaging modalities, and volumes were measured using a co-registration technique.

Median CHO volumes measured by MRI and CT showed a notable difference. The Bland-Altman plot indicated one outlier, removed for further analysis. Linear regression suggested a correlation, with CT volumes overestimating MRI volumes by a factor of four.

Our study establishes a formula to estimate CHO size, highlighting the tendency of CT scans to overestimate volumes. While non-EPI DWI MRI remains the gold standard for accurate measurements, our findings emphasize the complementary roles of CT and MRI in CHO diagnosis and post-surgical follow-up through fusion techniques.