Abstract
Background Several research studies have demonstrated the utility of diffusion-weighted imaging
(DWI) in detecting middle ear cholesteatomas, especially with the non-echoplanar imaging
(non-EPI) DWI technique. REadout Segmentation Of Long Variable Echo trains (RESOLVE),
a multishot-EPI DWI, has better spatial resolution at a thinner section acquisition
with reduced image distortion compared to the single-shot-EPI DWI technique.
Purpose In this study, we evaluated the diagnostic ability of RESOLVE -DWI in middle ear
cholesteatomas with surgical and histopathological support.
Patients and Methods Fifty patients with clinical suspicion of primary cholesteatoma or postoperative
recurrence were subjected to routine sequences and RESOLVE-DWI on magnetic resonance
imaging (MRI). Thirty-eight patients had unilateral disease, while 12 patients had
bilateral disease. The bilateral temporal bones of 50 patients were evaluated on MRI.
The results attained by RESOLVE-DWI were correlated with intraoperative and histopathological
findings.
Results RESOLVE-DWI truly detected 55 of the 58 surgically proven cholesteatomas. RESOLVE-DWI
could not detect three cholesteatoma lesions due to their small size and falsely diagnosed
one case each of impacted wax and non-cholesteatomatous otitis media as cholesteatoma.
With a 95% confidence interval, RESOLVE-DWI showed 94.8% sensitivity, 95.2% specificity,
96% positive predictive value, 93% negative predictive value, and 95% diagnostic accuracy
in cholesteatoma detection.
Conclusion RESOLVE-DWI is a sensitive and specific DWI technique for detecting middle ear cholesteatoma.
However, RESOLVE-DWI has limitations in the diagnosis of small (<3 mm) cholesteatomas.
Keywords
cholesteatoma - hyperintense - keratin - MS-EPI - RESOLVE-DWI - sensitivity - specificity
