The consideration of diffusion MR imaging, dynamic contrast-enhanced MR and T2 relaxation time measurements in distinguishing of cholesteatoma with chronic otitis media

Abstract

Purpose: The aim of our study is to investigate the contribution of DWI, DCE-MRI, ADC measurements and T2 relaxometry in diagnosis of distinguishing cholesteatoma and COM

Materials and Methods: Our study is created by retrospectively reviewing MR images of a digital archive of totally 41 patients that were clinically or surgically diagnosed as COM and cholesteatoma. DWI, ADC values, T2 relaxation time, and CEP of lesions between the two groups were compared statistically. CEP was qualitatively evaluated. ROC analysis and McNemar statistics test were performed. Level of significance was determined as p<0.05.

Results: Cholesteatoma detection sensitivity in DWI is determined as 100%, and specificity was determined as 86%. ADC measurements revealed a statistically significant difference in differentiating COM and cholesteatoma (p<0.05). When T2 relaxometry were compared between two groups there was no statistically significant difference (p>0.05). When the groups were assessed according to the CEP, 13 of the COM cases showed type 1 (progressive heterogeneous enhancement), 2 cases did not show enhancement (type 3) and 6 cases showed type 4 (progressive homogeneous enhancement). Nineteen patients with cholesteatoma showed type 2 (rim-like enhancement), 1 case showed type 4. Statistical analysis of CEP revealed significant differences between types 1 and 2 (p<0.001), between types 2 and 3 (p=0.005) and between types 2 and 4 (p<0.001).

Conclusion: DWI, ADC values and DCE-MRI may be beneficial in detecting cases of cholesteatoma of a high percentage.