Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings

Eur Radiol. 2003 Jan;13(1):169-74. doi: 10.1007/s00330-002-1423-1. Epub 2002 Jul 16.


Our objective was to assess the value of delayed contrast-enhanced T1-weighted spin-echo MR imaging in the detection of residual cholesteatoma in patients who have undergone canal wall-up tympanoplasty procedure. The MR imaging was obtained prior to revision surgery in 18 patients with opacity of the post-operative cavity at CT examination 12-18 months after canal wall-up tympanoplasty. In each patient the following was performed: precontrast T1- and T2-weighted images; and early and delayed contrast-enhanced axial and coronal T1-weighted imaging. Early and delayed MR imaging results were separately compared with surgical second-look findings. Sensitivity, specificity, and predictive values were evaluated for early and delayed post-contrast MR imaging, compared with second-look surgery findings. A residual cholesteatoma was correctly identified in 8 of 9 cases with delayed contrast-enhanced T1-weighted MR imaging. Mean sensitivity, specificity, positive predictive value, and interobserver agreement (evaluated by kappa statistics) were, respectively, 85.2, 92.6, 92.6%, and kappa=0.78 for the delayed contrast-enhanced MR imaging technique. The same parameters were, respectively, 96.3, 33.3, 60.6, and 0.30 for the early contrast-enhanced T1-weighted MR images. We conclude that delayed contrast-enhanced T1-weighted MR imaging is reliable for the detection of residual cholesteatomas of the middle ear in patients who have undergone canal wall-up tympanoplasty.

MeSH terms

  • Adolescent
  • Adult
  • Cholesteatoma, Middle Ear / diagnosis*
  • Cholesteatoma, Middle Ear / diagnostic imaging
  • Cholesteatoma, Middle Ear / surgery
  • Contrast Media*
  • Female
  • Gadolinium DTPA*
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Observer Variation
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed


  • Contrast Media
  • Gadolinium DTPA