Explore This IssueAugust 2018
What is the usefulness of T1-weighted (T1W) imaging on diagnostic magnetic resonance (MR) imaging for cholesteatoma?
T1W imaging may aid in the exclusion of false-positive cases on diagnostic non-EP DW MR imaging for cholesteatomas. A combination of non-EP DW and T1W imaging may improve the specificity and accuracy compared with non-EP DW imaging alone.
Study design: retrospective case review.
Setting: Tertiary referral center, Hokkaido University, Hokkaido, Japan
Synopsis: The authors identified 53 patients (57 ears) suspected to have cholesteatomas. Intervention included preoperative MR imaging, including non-echo planar (non-EP) diffusion-weighted (DW) and T1W imaging.
The primary outcome measures included the comparison between the diagnostic accuracy for the detection of cholesteatomas using non-EP DW imaging alone (criterion 1) and non-EP DW imaging along with T1W imaging (criterion 2). Diagnostic accuracy was evaluated in each case by comparing MR imaging with surgical findings. Secondary outcome measures included the comparison of the rates of cases showing a high T1W signal between cholesteatomas and noncholesteatomas, which showed a high non-EP DW signal.
The authors found that the sensitivity, specificity, and accuracy according to criterion 1 were 93.5, 63.6, and 87.7% and according to criterion 2 were 89.1, 100, and 91.2%, respectively. Of 43 cholesteatoma cases indicating a high non-EP DW signal, only two cases showed a high T1W signal (5%). On the other hand, all four noncholesteatoma cases indicating high non-EP DW signal showed a high T1W signal (100%), and these rates were significantly different (p < 0.001).