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Cholesteatoma imaging using modified echo-planar diffusion-weighted magnetic resonance imaging

E Flook^a1 c1, S Izzat^a2 and A Ismail^a3

^a1 ENT Department, Hope Hospital, Salford, UK

^a2 ENT Department, Royal Albert Edward Hospital, Wigan, UK

^a3 Radiology Department, Royal Albert Edward Hospital, Wigan, UK

Abstract

Introduction: Imaging of cholesteatomas can be useful especially in cases of recurrent disease. Computed tomography scans have been recommended before primary surgery, but cholesteatoma tissue looks similar to inflammatory tissue. Diffusion-weighted magnetic resonance imaging is both sensitive and specific in detecting cholesteatoma, which appears as a bright signal on a dark background. Non-echo-planar diffusion-weighted magnetic resonance imaging is superior to routine echo-planar diffusion-weighted magnetic resonance imaging as it minimises susceptibility artefacts; however, the addition of this facility involves expensive magnetic resonance scanner upgrading.

Method: To avoid the cost of such upgrading, we modified our echo-planar diffusion-weighted magnetic resonance imaging parameters and then scanned 15 consecutive cases of suspected cholesteatoma or suspected recurrent cholesteatoma.

Results: Imaging results correlated well with clinical and/or operative findings.

Conclusion: These results indicate that software adjustments can enable echo-planar diffusion-weighted magnetic resonance imaging to detect cholesteatomas reliably, and as effectively as non-echo-planar diffusion-weighted magnetic resonance imaging. This discovery has the potential to facilitate reliable delayed post-operative screening of canal wall up mastoidectomies, avoiding the need for a ‘second look’ procedure.

(Accepted April 26 2010)

(Online publication September 10 2010)

Key words

• Magnetic Resonance Imaging;
• Diffusion Magnetic Resonance Imaging;
• Cholesteatoma

Correspondence:

^c1 Address for correspondence: Mr E Flook, 17 Willow Way, Manchester M20 6JT, UK E-mail: edflook@yahoo.com

Footnotes

Presented as a registrar paper at the North of England ENT Conference, 25th September 2009, Bradford, UK.

Mr E Flook takes responsibility for the integrity of the content of the paper

Competing interests: None declared