The value of echoplanar diffusion weighted magnetic resonance imaging in the diagnosis of cholesteatoma in chronic suppurative otitis media patients

Purpose: The aim of this prospective study was to determine the role of echoplanar diffusion weighted magnetic resonance imaging on the detection of primary acquired cholesteatoma patients who underwent middle ear surgery.Materials and Methods: Fifty eight patients(34 male and 24 female) who underwent middle ear surgery in between April 2009 and September 2010 due to suspected primary acquired cholesteatoma were included in to the study. Ages of these patients ranged in 9 to 67 years, with a mean age of 22 years. Tissue segments were taken from all of the patients for histopathological diagnosis. echoplanar diffusion weighted magnetic resonance and T2 weighted conventional magnetic resonance imaging were performed in between 2 and 14 days before the operation. A radiologist with long-standing experience in head and neck imaging prospectively evaluated all the magnetic resonance images without knowing the cilinical data. The criteria for the diagnosis of cholesteatoma on magnetic resonance imaging were an area of markedly hyperintense signal compared with that of brain tissue on diffusion-weighted magnetic resonance imaging and a soft-tissue mass seen on the conventional magnetic resonance sequencesResults: Cholesteatoma was determined in 37 of the patients during the operation. Fifty of the patients were assigned the correct diagnosis on the basis of diffusion weighted magnetic resonance imaging: true positive findings for cholesteatoma were recorded in 31 and true negative findings in 19 patients. In 6 patients, echoplanar diffusion weighted magnetic resonance imaging failed in diagnosing surgically verified cholesteatoma. The cause of the false negative diagnosis was the dry autoevacuated retraction pockets in 2 patient, the air-bone susceptibility artefacts at the skull base in 1 patient and minimal cholesteatoma which greatest diameter was less than 5 mm in 3 patient. False positive findings were recorded in 2 patients on echoplanar diffusion weighted magnetic resonance imaging. The false positive diagnosis were connected the motion artefacts in 1 patient and extensive tympanosclerosis in 1 patient. The sensitivity, specificity, positive and negative predictive values of echoplanar diffusion weighted magnetic resonance were 83%, 90%, 93% and 76%, respectively.Conclusion: Echoplanar diffusion weighted magnetic resonance is a valuable imaging method for imaging of the cholesteatoma especially which is greater than 5 mm.Keywords:Chronic Otitis Media, Cholesteatoma, Diffusion Weighted Magnetic Resonance