T1W Imaging May Aid in Diagnosing Cholesteatomas

Comment: The non-echo planar diffusion-weighted MRI (non-EP DWI) sequence is efficient in identifying the restricted diffusion in the substance of cholesteatoma, and, thanks to its sensitivity and precision, has changed the way otolaryngologists manage chronic ear disease. Even in diagnostic testing with high sensitivity and specificity, false positives and false negatives occur. In an attempt to decrease the incidence of erroneous results, we can examine the role of T1 imaging in cholesteatoma diagnosis. On T1 imaging, cholesteatomas are characteristically hypointense.
These authors examined 57 ears in 53 patients. A positive non-EP DWI alone identified 93% of the 46 ears with cholesteatoma (sensitivity), but a negative non-EP DWI only excluded cholesteatoma in 63% of patients who did not harbor cholesteatomas (specificity). When T1 imaging was added, 89% of cholesteatomas were correctly identified (sensitivity), but all (100%) 11 patients who did not have cholesteatoma were identified (specificity). Accuracy as defined by (true positives + true negatives)/all patients, improved from 87.7% for non-EP DWI alone to 91.2% with the addition of T1 imaging.
Because not every patient with nonspecific opacification of the mastoid on CT has cholesteatoma, and because non-cholesteatomatous ear disease may not require surgery, the results from the study could further help clinicians make decisions about treatment of the patient with chronic ear disease. —Samuel H. Selesnick, MD

What is the usefulness of T1-weighted (T1W) imaging on diagnostic magnetic resonance (MR) imaging for cholesteatoma?

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