Head and Neck Imaging - Original Article
Accuracy of turbo spin-echo diffusion-weighted imaging signal intensity measurements for the diagnosis of cholesteatoma
Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
Department of Biostatistics,Hacettepe University School of Medicine, Ankara, Turkey
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.