ISSN 1305-3825 | E-ISSN 1305-3612
Head and Neck Imaging - Original Article
Accuracy of turbo spin-echo diffusion-weighted imaging signal intensity measurements for the diagnosis of cholesteatoma
1 Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey  
2 Department of Biostatistics,Hacettepe University School of Medicine, Ankara, Turkey  
3 Department of Otolaryngology, Hacettepe University School of Medicine, Ankara, Turkey  
Diagn Interv Radiol ; : -

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Purpose: The purpose of this study was to evaluate the diagnostic accuracy of turbo spin-echo diffusion-weighted (TSE-DW) imaging, at 3T, for cholesteatoma diagnosis, using qualitative and quantitative methods with numerical assessment of signal intensity (SI), signal intensity ratios (SIR) and ADC values.


Methods: In this retrospective study, two blinded observers independently evaluated the pre-operative TSE-DWI images of 57 patients who were imaged with a presumed diagnosis of CS. Qualitative assessment with comparison to the SI of the adjacent cortex and quantitative measurements of SI, SIR and ADC values were performed. Chi-square test, Pearson correlation test and ROC curves were used in statistical comparisons.


Results: Surgery with histopathological examination revealed thirty CS patients and 27 patients with non-CS (NCS) lesions including chronic inflammation and cholesterol granuloma. On TSE-DW imaging, 96.7% of the CS lesions and none of the NCS lesions appeared hyperintense compared to the cortex. The mean DW-SI, DW-SIR indices of CS cases were significantly higher and the mean ADC values significantly lower compared to those of NCS (p<0.001). DW-SI and DWI-SIR with specific cut-off values (92.5 and 0.9 respectively) had 100% sensitivity and specificity for the diagnosis of CS. The use of quantitative imaging further increased the sensitivity of the TSE-DW technique.



Conclusion: The quantitative indices of DW-SI, DW-SIR and ADC with TSE-DW appear to be highly accurate parameters that can be used to confirm the diagnosis of cholesteatoma.

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