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AJNR - American Journal of Neuroradiology

Published ahead of print on October 22, 2008
doi: 10.3174/ajnr.A1352

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American Journal of Neuroradiology 30:423-427, February 2009
© 2009 American Society of Neuroradiology

HEAD & NECK

3T MR Imaging of Postoperative Recurrent Middle Ear Cholesteatomas: Value of Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction Diffusion-Weighted MR Imaging

P. Lehmann^a, G. Saliou^c, C. Brochart^a, C. Page^b, B. Deschepper^a, J.N. Vallée^a and H. Deramond^a

^a Department of Neuroradiology, Amiens University Hospital, Amiens, France
^b Department of Ear Nose Throat Surgery, Amiens University Hospital, Amiens, France
^c Le Kremlin-Bicêtre Neuroradiology, Le Kremlin-Bicêtre, France

Please address correspondence to Pierre Lehmann, MD, Neuroradiology, Amiens University Hospital, 1 Place Victor Pauchet, 80054 Amiens Cedex 1, France; e-mail: lehmann.pierre{at}chu-amiens.fr

BACKGROUND AND PURPOSE: MR diagnostic of postoperative recurrent cholesteatomas is difficult. Our purpose was to compare multishot fast spin-echo periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) diffusion-weighted MR imaging (DWI) with array spatial sensitivity encoding technique (ASSET) single-shot echo-planar DWI and late postgadolinium T1-weighted MR imaging for the detection of postoperative recurrent middle ear cholesteatomas with a 3T imaging unit.

MATERIALS AND METHODS: Thirty-five patients with suggested postoperative recurrent middle ear cholesteatoma underwent 3T MR imaging with PROPELLER DWI, ASSET echo-planar DWI, and late postgadolinium T1-weighted MR imaging. Three radiologists (2 seniors, 1 fellow) analyzed unlabeled images for visualization of recurrence. Interobserver and intraobserver agreement was assessed by using the Cohen statistic test. Sensitivity, specificity, and predictive value were assessed for the 3 observers.

RESULTS: Nineteen recurrent cholesteatomas were diagnosed. PROPELLER interobserver agreement was very good (1, 0.89, 0.89) among the 3 observers. Intraobserver agreement between PROPELLER and T1-weighted imaging was very good to moderate (0.88, 0.57, 0.58). PROPELLER DWI provided less interobserver variability than other sequences, and the best sensitivity, specificity, and predictive value.

CONCLUSIONS: On a 3T imaging unit, multishot fast spin-echo PROPELLER DWI allows an easier detection of postoperative recurrent middle ear cholesteatoma than T1-weighted imaging by reducing artifacts and by its better contrast. DWI with PROPELLER is diagnostically robust and accurate.