Detection of postoperative residual cholesteatoma with non-echo-planar diffusion-weighted magnetic resonance imaging

Otol Neurotol. 2008 Jun;29(4):513-7. doi: 10.1097/MAO.0b013e31816c7c3b.


Objective: The aim of this study was to analyze the role of non-echo-planar imaging (non-EPI)-based diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of residual cholesteatoma after canal wall-up mastoidectomy before eventual second-look surgery.

Study design: Prospective and blinded study.

Setting: Tertiary referral center.

Patients: The study group included the surgical, clinical, and imaging follow-up of 32 consecutive patients after primary cholesteatoma surgery.

Interventions: All patients were investigated with MRI, including late postgadolinium T1-weighted sequence and non-EPI-DW sequence, 10 to 18 months after first-stage cholesteatoma surgery by experienced surgeons using a canal wall-up mastoidectomy. The non-EPI-DW images were evaluated for the presence of a high-signal intensity lesion consistent with residual cholesteatoma. Imaging findings were correlated with findings from second-stage surgery in 19 patients, clinical follow-up examination in 11 patients, and, in 2 patients, clinical and MRI follow-up examination.

Results: Non-EPI-DW sequences depicted 9 of 10 residual cholesteatomas. The only lesion missed was a 2-mm cholesteatoma in an examination degraded by motion artifacts in a child. All other diagnosed cholesteatomas measured between 2 and 6 mm. Sensitivity, specificity, positive predictive value, and negative predictive value were 90, 100, 100, and 96%, respectively.

Conclusion: Except for motion artifact-degraded examinations, non-EPI-DW MRI is able to detect even very small residual cholesteatoma after first-stage surgery by showing a high-signal intensity lesion. It has the capability of selecting patients for second-look surgery, avoiding unnecessary second-look surgery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Artifacts
  • Child
  • Child, Preschool
  • Cholesteatoma, Middle Ear / diagnosis*
  • Cholesteatoma, Middle Ear / surgery*
  • Diffusion Magnetic Resonance Imaging
  • Double-Blind Method
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Male
  • Mastoid / surgery*
  • Middle Aged
  • Otologic Surgical Procedures*
  • Prospective Studies