European Archives of Oto-Rhino-Laryngology

, Volume 269, Issue 3, pp 757–765 | Cite as

Predictive validity of MRI in detecting and following cholesteatoma

  • Milan Profant
  • Katarína Sláviková
  • Zuzana Kabátová
  • Peter Slezák
  • Iveta Waczulíková


High recurrence rate of the middle ear cholesteatoma requires regular postoperative follow-up. This study evaluated data from the patients investigated with DW MRI to ascertain (1) the strength of the technique in detecting primary, and residual recurrent cholesteatoma, and (2) its accuracy in differentiating cholesteatoma from postoperative tissue changes. The diagnostic accuracy of two different DW imaging (EPI and non-EPI) techniques was evaluated. The data have been collected prospectively from 33 consecutive patients with either primary cholesteatoma, or with suspicious symptoms for potential cholesteatoma recurrence. The findings from non-EPI (HASTE) DW MR and EPI DW MR images were blindly compared with those obtained during a primary or secondary surgery. Preoperative non-EPI (HASTE) DWI pointed to a cholesteatoma in 25 out of 33 patients. In this subgroup, cholesteatoma were confirmed also by the surgery. In five cases, the non-EPI (HASTE) DWI did not show a cholesteatoma in the temporal bone, which agreed with the surgical findings. Three misclassifications were made by non-EPI (HASTE) DWI, all in the subgroup of patients indicated for primary surgery. The resulting pooled sensitivity of non-EPI (HASTE) DW imaging for diagnosing cholesteatoma in our study amounted to 96.15% (95% confidence interval (CI) 80.36–99.9), specificity was 71.43% (95% CI 29.04–96.33). Positive predictive value was 92.59% (95% CI 75.71–99.09) and negative predictive value 83.33% (95% CI 35.88–99.58). In conclusion, we recommend the non-EPI (HASTE) DW MRI as a valid method for diagnosing cholesteatoma and follow-up after cholesteatoma surgery.


Otitis media chronica Cholesteatoma Primary surgery for cholesteatoma Second-look surgery CT Non-EPI (HASTE) DWI MRI 


Conflict of interest

This work was supported by the Slovak Research and Development Agency under the contract No. APVV-0148-10 and by the grant VEGA No. 1/0465/11.


  1. 1.
    Aikele P, Kittner T, Offergeld C, Kaftan H, Hüttenbrink KB, Laniado M (2003) Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery. AJR 181:261–265PubMedGoogle Scholar
  2. 2.
    Stangerup SE, Drozdziewicz D, Tos M, Hougaard-Jensen A (2000) Recurrence of attic cholesteatoma: different methods of estimating recurrence rates. Otolaryngol Head Neck Surg 123:283–287PubMedCrossRefGoogle Scholar
  3. 3.
    Darrouzet V, Duclos JY, Portmann D, Bebear JP (2000) Preference for the closed technique in the management of cholesteatoma of the middle ear in children: a retrospective study of 215 consecutive patients treated over 10 years. Am J Otol 21:474–481PubMedGoogle Scholar
  4. 4.
    Vartiainen E (2000) Ten-year results of canal wall down mastoidectomy for acquired cholesteatoma. Auris Nasus Larynx 27:227–229PubMedCrossRefGoogle Scholar
  5. 5.
    Kimitsuki T, Suda Y, Kawano H, Tono T, Komune S (2001) Correlation between MRI findings and second-look operation in cholesteatoma surgery. ORL 63:291–293PubMedCrossRefGoogle Scholar
  6. 6.
    Trojanowska A, Trojanowski P, Olszanski W, Klatka J, Drop A (2007) Differentiation between cholesteatoma and inflammatory process of the middle ear, based on contrast-enhanced computed tomography imaging. J Laryngol Otol 121:444–448PubMedCrossRefGoogle Scholar
  7. 7.
    Schwartz KM, Lane JI, Neff BA, Bolster BD Jr, Driscoll CL, Beatty CW (2010) Diffusion-weighted imaging for cholesteatoma evaluation. Ear Nose Throat J 89(4):E14–E19PubMedGoogle Scholar
  8. 8.
    Williams MT, Ayache D, Alberti C et al (2003) Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings. Eur Radiol 13:169–174PubMedGoogle Scholar
  9. 9.
    Stasolla A, Magliulo G, Parrotto D, Luppi G, Marini M (2004) Detection of postoperative relapsing/residual cholesteatomas with diffusion-weighted echo-planar magnetic resonance imaging. Otol Neurotol 25:879–884PubMedCrossRefGoogle Scholar
  10. 10.
    Dubrulle F, Souillard R, Chechin D, Vaneecloo FM, Desaulty A, Vincent C (2006) Diffusion-weighted MR imaging sequence in the detection of postoperative recurrent cholesteatoma. Radiology 238:604–610PubMedCrossRefGoogle Scholar
  11. 11.
    Vercruysse JP, De Foer B, Pouillon M, Somers T, Casselman J, Offeciers E (2006) The value of diffusion-weighted MR imaging in the diagnosis of primary acquired and residual cholesteatoma: a surgical verified study of 100 patients. Eur Radiol 16:1461–1467PubMedCrossRefGoogle Scholar
  12. 12.
    Rajan GP, Ambett R, Wun L, Dhepnorrarat RC, Kuthubutheen J, Chow Z, Wood B (2010) Preliminary outcomes of cholesteatoma screening in children using non-echo-planar diffusion-weighted magnetic resonance imaging. Int J Pediatr Otorhinolaryngol 74:297–301PubMedCrossRefGoogle Scholar
  13. 13.
    Cimsit NC, Cimsit C, Baysal B, Ruhi IC, Ozbilgen S, Aksoy EA (2010) Diffusion-weighted MR imaging in postoperative follow-up: reliability for detection of recurrent cholesteatoma. Eur J Radiol 74:121–123PubMedCrossRefGoogle Scholar
  14. 14.
    Dhepnorrarat RC, Wood B, Rajan GP (2009) Postoperative non-echo-planar diffusion-weighted magnetic resonance imaging changes after cholesteatoma surgery: implications for cholesteatoma screening. Otol Neurotol 30:54–58PubMedCrossRefGoogle Scholar
  15. 15.
    Thiriat S, Riehm S, Kremer S, Martin E, Veillon F (2009) Apparent diffusion coefficient values of middle ear cholesteatoma differ from abscess and cholesteatoma admixed infection. AJNR Am J Neuroradiol 30:1123–1126PubMedCrossRefGoogle Scholar
  16. 16.
    De Foer B, Vercuysse JP, Bernaerts A et al (2010) Middle ear cholesteatoma: non-echo-planar diffusion weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging-value in detection. Radiology 255:866–872PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Milan Profant
    • 1
  • Katarína Sláviková
    • 2
  • Zuzana Kabátová
    • 1
  • Peter Slezák
    • 3
  • Iveta Waczulíková
    • 4
  1. 1.Department of OtorhinolaryngologyUniversity Hospital BratislavaBratislavaSlovak Republic
  2. 2.Department of RadiologyUniversity Hospital BratislavaBratislavaSlovak Republic
  3. 3.Institute of Normal and Pathological PhysiologySlovak Academy of SciencesBratislavaSlovak Republic
  4. 4.Faculty of Mathematics, Physics and InformaticsComenius University BratislavaBratislavaSlovak Republic

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