The role of diffusion-weighted magnetic resonance imaging in cholesteatoma diagnosis and follow-up: A single center , retrospective review

Objectives: The aim of our study was to evaluate the effectiveness of Diffusion Weighted Magnetic Resonance Imaging (DWMRI), which has been widely used in Chronic Otitis Media (COM) cases in recent years, in the primary diagnosis of cholesteatoma and in the follow-up of recurrence or residual in the postoperative period. In addition, we aimed to comparatively evaluate the efficacy of two different Diffusion Weighted Magnetic Resonance Imaging protocols obtained with 1.5 and 3 Tesla currents. Materials and Methods: All patients who underwent surgery at Karadeniz Technical University Faculty of Medicine, Department of Otorhinolaryngology, and whose diagnosis was confirmed by clinical findings or pathology diagnosis and whose preoperative imaging was available on the PACS system were retrospectively reviewed between May 2018 and August 2022 and included in this study. Demographic and clinical characteristics, complaints, examination findings, pathology data and imaging results were recorded retrospectively. Findings: Forty-two ears were included in our study. 25 (67.6%) were male and 12 (32.4%) were female with a mean age of 38.3 years. In our study group, the sensitivity of DWMRI in detecting cholesteatoma was 82.8%, specificity 84.6%, positive predictive value 92.3% and negative predictive value 68.8%. When the effectiveness of DWMRI was evaluated separately in 6 postoperative ears, sensitivity was 83.3% and positive predictive value was 100%. In the group of 30 ears examined with 1.5 Tesla, DWMRI sensitivity was 100%, positive predictive value was 90.5%, specificity was 81.8% and negative predictive value was 100%. In the 3 Tesla group, there were 12 ears and the sensitivity was 50%, positive predictive value was 100%, specificity was 100% and negative predictive value was 26%. When these results were compared, imaging with 1.5 Tesla was statistically more effective in terms of sensitivity and negative predictive value. Conclusıons: Diffusion Weighted Magnetic Resonance Imaging is an imaging modality with high sensitivity and specificity in the diagnosis of primary cholesteatoma and postoperative follow-up. Imaging protocols obtained with 1.5 Tesla current may be preferred in diffusion-weighted Magnetic Resonance Imaging.