Home Bratislava Medical Journal 2016 Bratislava Medical Journal Vol.117, No.9, p.515-520, 2016

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Published Monthly, in English
Founded: 1919
ISSN 0006-9248
(E)ISSN 1336-0345

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Bratislava Medical Journal Vol.117, No.9, p.515-520, 2016

Title: Recidivous cholesteatoma: DWI MR after canal wall up and canal wall down mastoidectomy
Author: T. Bakaj, L. Bakaj Zbrozkova, R. Salzman, M. Tedla, I. Starek

Abstract: OBJECTIVES: To investigate the correlation between preoperative non-echo planar diffusion-weighted (non-EPI DWI) MR imaging with surgical findings of recidivous middle ear cholesteatoma after canal wall up (CWU) and canal wall down (CWD) mastoidectomy.
BACKGROUND: The detection of recidive cholesteatoma after CWU and after CWD procedures, when the trepanation cavity is spontaneously closed by soft tissue, is possible by second-look and revision surgery. However, many cases prove to be negative of the disease. To avoid unnecessary operational risks we adopted a novel imaging method to evaluate its potential in the detection of recidivous cholesteatoma.
MATERIAL AND METHODS: The prospective study included 27 cases. Fifteen cases were revised after CWD and 12 cases were second-look surgeries after CWU procedures. All patients underwent the MR protocol: T2-weighted, T1-weighted and non-EPI DWI. The finding on MR correlated with peroperative presence of cholesteatoma.
RESULTS: Non-EPI DWI sequence showed an increased signal intensity in 16/27 (59 %) cases. This correlated with surgical findings in all 7 patients after CWU and in 8 patients after CWD.
The overall sensitivity, specificity, positive and negative predictive values of non-EPI DWI were 83.3 %, 88.8 %, 93.8 % and 72.7 %, respectively. DWI presented a sensitivity of 100 % and specificity of 85.7 % in the subgroup of patients after CWD mastoidectomy.
CONCLUSION: Residual and/or recurrent cholesteatoma can be accurately detected by DWI MR. It can be used as a screening method to select patients, who are indicated to second-look or revision surgery after CWU and CWD mastoidectomy (Tab. 1, Fig. 3, Ref. 49).

Keywords: canal wall down (CWD), canal wall up (CWU), recidivism, cholesteatoma, non-echo planar diffusion-weighted imaging (non-EPI DWI), MR.
Published online: 21-Sep-2016
Year: 2016, Volume: 117, Issue: 9 Page From: 515, Page To: 520

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