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

  • Giovanni FotiEmail author
  • Alberto Beltramello
  • Giorgio Minerva
  • Matteo Catania
  • Massimo Guerriero
  • Sergio Albanese
  • Giovanni Carbognin



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.


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.


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.


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


Cholesteatoma Magnetic resonance imaging Diffusion-weighted images Dual-energy CT Recurrence 



Dual-energy computed tomography


Magnetic resonance imaging


Diffusion-weighted images


Positive predictive value


Negative predictive value


Computed tomography


Dual energy


Region of interest


Area under curve


High-resolution computed tomography



We did not receive any funds for this paper.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

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


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyIRCCS Sacro Cuore Don Calabria HospitalNegrarItaly
  2. 2.Department of OtorhinolaryngologyIRCCS Sacro Cuore Don Calabria HospitalNegrarItaly
  3. 3.Department of RadiologyUniversity of VeronaVeronaItaly
  4. 4.Department of Computer ScienceUniversity of VeronaVeronaItaly

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