Correlation between DWI-MRI and Findings at Cholesteatoma Surgery: Should DWI-MRI Be Standardized Prior to Surgery?

Abstract

Objectives:

Evaluate the accuracy of diffusion-weighted imaging magnetic resonance imaging (DWI-MRI) in diagnosis of cholesteatoma and the planning of surgery in our hospital.

Methods:

We conducted a retrospective study of all patients who had cholesteatoma surgery in our hospital from November 2007 until September 2013 that had undergone a DWI-MRI previous to the surgery.

Results:

A total of 24 patients were found. A total of 22 DWI-MRI findings were correctly correlated to findings in operation. There was 1 false positive where cholesteatoma was identified on imaging and mucosal disease was found in surgery; and 1 false negative that failed to identify a small cholesteatoma found during surgery. Of the 22 accurate correlations, 4 were of mucosal disease and the rest were correctly diagnosed as cholesteatomas. The DWI-MRI was able to localize the location of the cholesteatoma (from middle ear, attic, mastoid, aditus, hypotympanium and Eustachian tube) in 78% of the cases (14/18).

Conclusions:

DWI MRI is highly sensitive in the identification of the presence of cholesteatoma. Negative findings should be followed up because imaging sequences can miss cholesteatomas smaller than 3 mm. There is still a learning curve in the diagnosis and use of DWI MRI.