The accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with Apparent Diffusion Coefficients in diagnosis of recurrent cholesteatoma

Abstract

Objective: To evaluate the accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with ADC value combined with MDCT in evaluating recurrent cholesteatoma. Patients: Thirty patients (20 females and 10 males), their age ranged from 10 to 40years, had undergone a tympanomastoid surgery for a cholesteatoma of the middle ear underwent MDCT and MR DWI examination before second- or third-look surgery from May 2015 to October 2016. Results: CT showed partial opacification of the tympanomastoid cavity in 10 ears and complete opacification in 21 ears. CT detects 10 cases out of 20 cases of recurrent cholesteatoma with sensitivity 47.6%, specificity 100%, and NPP 47.6%. DWI depicted 21 out of 20 cases proved cholesteatoma patients (sensitivity 100%, specificity 90%, PPV 95.2% and P value is 0.001). All MRI of patients without cholesteatoma were correctly interpreted as showing negative findings for cholesteatoma (specificity = 100%). The ADC of cholesteatoma group (21 ears) were ranged from 553 to 759 × 10−3 mm2/s and the ADCs of non cholesteatoma group (10 ears) was ranged from 1495.8 to 1766.8 × 10−3 mm2/s. Cut off value of cholesteatoma is ≤759 × 10−3 mm2/s. Conclusion: MR DWI with ADC combined with MDCT has high sensitivity, specificity, accuracy in detecting recurrent cholesteatoma. Keywords: Recurrent cholesteatoma, Magnetic Resonance Diffusion weighted imaging, Apparent diffusion coefficient, Multidetector computed tomography