Diagnostic accuracy of non-echo-planar diffusion-weighted MRI versus other MRI sequences in cholesteatoma

Introduction: Non-echo-planar imaging (EPI) MRI has been recently introduced to improve the detection of small-sized cholesteatoma and decrease different artefacts occurring in the EPI-diffusion-weighted (DW) technique. This technique is also time saving in comparison to delayed post-contrast imaging. We prospectively assessed the diagnostic accuracy of MRI including delayed post-contrast standard MRI, EPI and non-EPI-DW sequences in the detection of middle ear cholesteatoma.

Methods: We evaluated 35 patients suspected of having cholesteatoma who underwent MRI including delayed post-contrast MRI, EPI and non-EPI-DW sequences prior to their planned surgery, and the MR findings were compared with surgical findings. Two experienced radiologists reported the images. Sensitivity, specificity and predictive values of MRI were estimated.

Results: We detected 26 cases of cholesteatoma at surgery. Sensitivity and specificity of delayed post-contrast MRI, EPI DW and non-EPI DW were 73.1 and 77.8%, 61.5 and 88.9%, and 96.2 and 100%, respectively, as interpreted by the first radiologist. Sensitivity and specificity of delayed post-contrast MRI, EPI-DW sequence and non-EPI-DW sequence were 84.6 and 88.9%, 50 and 88.9%, and 92.3 and 100%, respectively, as interpreted by the second radiologist.

Conclusion: The non-EPI MRI technique is a more accurate method in detecting middle ear cholesteatoma in comparison to other conventional sequences.