Evaluation of acquired cholesteatoma with PROPELLER diffusion imaging

• Published in: Egyptian journal of radiology and nuclear medicine 2011-03, Vol.42 (1), p.9-17
• Main Authors: El Mogy, Sabry A., Mazroa, Jehan A., Ghaffar, Mahmoud Abd El, El Mogy, Mohamed S., El Mogy, Ibraheem S.
• Format: Article
• Language: English
• Subjects: Acquired cholesteatoma; Imaging of middle ear lesions; PROPELLER diffusion
• ISSN: 0378-603X
• DOI: 10.1016/j.ejrnm.2011.02.003

Was to evaluate the role of periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) diffusion imaging in evaluation of middle ear acquired cholesteatomas (primary and recurrent) and differentiating them from middle ear granulation tissue. Forty two patients with suggested acquired cholesteatomas were included in this prospective study, they underwent spiral CT and MRI (PROPELLER diffusion) for all. The two radiologist analyzed the imaging data of plain spiral CT and PROPELLER diffusion MR images. Sensitivity and specificity were assessed. Results were compared with endoscopic and surgical results, which were regarded as the standard reference. Ten patients had middle ear granulation tissue, 21 patients had acquired primary cholesteatomas, and 11 patients had acquired recurrent (post operative) cholesteatomas. PROPELLER diffusion MR successfully diagnosed and differentiated between granulation tissue and cholesteatomas (primary and recurrent. Sensitivity (lesions detection) and specificity (lesions characterization) of PROPELLER diffusion MR was 100%. In recurrent cholesteatomas, plain CT detected abnormal densities without any differentiation resulting in 0% specificity while in primary cholesteatomas, CT successfully diagnosed them based on associated bone erosions/destruction. PROPPLER diffusion Imaging is both sensitive and specific for detection and characterization of primary and recurrent cholesteatomas as it lack susceptibility and chemical-shift artifacts, and ghosts in the phase-encoding direction which occur in Echo-planar diffusion, it can detect small cholestatoma as 3mm. It provides the highest sensitivity, specificity for detection and characterization of acquired cholesteatomas.