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Identification of residual–recurrent cholesteatoma in operated ears: diagnostic accuracy of dual-energy CT and MRI

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Abstract

Purpose

The aim of this study was to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and dual-energy computed tomography (DECT) to identify residual–recurrent cholesteatoma using the second-look surgery as the reference standard.

Methods

This prospective, institutional review board-approved study included 19 consecutive patients (11 males and 8 females; mean age of 62.2, range 34–80 years). Since five patients were studied bilaterally, a total of 24 ears were evaluated with DECT and MRI between February 2017 and June 2018. Any abnormal middle ear attenuation on high-resolution CT images (HRCT) or DECT color-coded maps, and any abnormal signal on MRI images was evaluated by four experienced radiologists. Diagnostic accuracy values of HRCT, DECT maps and CT numbers (by using receiver operator curves) and MRI were compared. Interobserver and intraobserver agreement were calculated.

Results

Residual–recurrent cholesteatoma was diagnosed at surgery in 16/24 ears (66.6%). MRI and DECT revealed a total of 15/16 and 14/16 cholesteatomas, respectively. The sensitivity, specificity, PPV and NPV and accuracy of MRI and DECT were 93.7, 87.5, 93.7, 87.5, and 91.6% and 87.5, 87.5, 93.3, 87.5 and 87.5%, respectively. CT numbers were significantly different between positive (mean 57.6 HU, range − 65, 112 HU) and negative cases (mean 5.4 HU, range − 100, 66 HU) with p < 0.001. The interobserver and intraobserver agreement were k = 0.87 and k = 0.83, respectively.

Conclusion

DECT may provide an accurate demonstration of residual–recurrent middle ear cholesteatoma.

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Abbreviations

DECT:

Dual-energy computed tomography

MRI:

Magnetic resonance imaging

DWI:

Diffusion-weighted images

PPV:

Positive predictive value

NPV:

Negative predictive value

CT:

Computed tomography

DE:

Dual energy

ROI:

Region of interest

AUC:

Area under curve

HRCT:

High-resolution computed tomography

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Funding

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Authors and Affiliations

  1. Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy

    Giovanni Foti, Alberto Beltramello & Giovanni Carbognin

  2. Department of Otorhinolaryngology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy

    Giorgio Minerva & Sergio Albanese

  3. Department of Radiology, University of Verona, Verona, Italy

    Matteo Catania

  4. Department of Computer Science, University of Verona, Verona, Italy

    Massimo Guerriero

Authors
  1. Giovanni Foti
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  2. Alberto Beltramello
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  7. Giovanni Carbognin
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Correspondence to Giovanni Foti.

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All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

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This retrospective study received institutional review board and Informed consent was waived.

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Foti, G., Beltramello, A., Minerva, G. et al. Identification of residual–recurrent cholesteatoma in operated ears: diagnostic accuracy of dual-energy CT and MRI. Radiol med 124, 478–486 (2019). https://doi.org/10.1007/s11547-019-00997-y

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  • DOI: https://doi.org/10.1007/s11547-019-00997-y

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