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
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)
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