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AJNR - American Journal of Neuroradiology

Published ahead of print on April 16, 2008
doi: 10.3174/ajnr.A1100

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Comparison of Echo-Planar Diffusion-Weighted Imaging and Delayed Postcontrast T1-Weighted MR Imaging for the Detection of Residual Cholesteatoma

F. Venail^a,b, A. Bonafe^c, V. Poirrier^c, M. Mondain^a,b and A. Uziel^a,b

^a Ear, Nose, and Throat Department, University Hospital Gui de Chauliac, Montpellier, France
^b INSERM U583–Institute for Neurosciences in Montpellier, Montpellier, France
^c Neuroradiology Department, University Hospital Gui de Chauliac, Montpellier, France

View larger version (117K): [in this window] [in a new window]   Fig 1. EPI DWI and DPI for residual cholesteatoma detection. DWI axial b = 0 (A), b = 500 (B), b = 1000 (C) and coronal b = 0 (D), b = 500 (E), b = 1000 (F) EPI sequences. Early (G and I) and delayed (H and J) postconstrast T1-weighted axial (G and H) and coronal (I and J) sequences. With DWI, an increasing signal intensity (arrow) between b = 0 (A and D), b = 500 (B and E), and b = 1000 (C and F) sequences was observed in the left hypotympanum. A hypointense space-occupying lesion (arrows) was also observed in the left hypotympanum with early enhanced T1-weighted sequences (G and I). This lesion was more conspicuous on delayed imaging (H and J, large arrows), whereas scar tissue was intensely enhanced (small arrows). Thus, surgery confirmed a residual cholesteatoma of the left hypotympanum.

View larger version (108K): [in this window] [in a new window]   Fig 2. Mismatch between DWI and DPI, with a small lesion. EPI DWI axial b = 0 (A), b = 500 (B), b = 1000 (C) and coronal b = 0 (D), b = 500 (E), b = 1000 (F) sequences. Early coronal (H) and delayed postcontrast T1-weighted axial (G) and coronal (I) sequences. Progressive signal-intensity decay was observed in the right mastoid with DWI (A–F, small arrows). DWI was considered negative for residual cholesteatoma. Conversely, a hypointense lesion was observed on early-enhanced T1-weighted MR images (H, large arrow), with a ring enhancement on DPI (G and I, large arrows). At surgery, a 3-mm large pearl-like residual cholesteatoma was found.

View larger version (115K): [in this window] [in a new window]   Fig 3. FP examinations with DWI and DPI in 2 different patients. Axial (A) and coronal (B) EPI DWI b = 1000 and coronal DPI (C) sequences. Hyperintense foci were observed in the right mastoid with axial and coronal DWI (A and B, arrows). Lack of enhancement on coronal delayed T1-weighted MR image (C, arrow) led us to suspect a residual cholesteatoma. At surgery, only a silastic sheet filling the right mastoid was found. Axial (D) and coronal (F) EPI DWI b = 1000 and axial (E) and coronal (G) DPIs in another patient. DWI was negative for residual cholesteatoma (D and F). Note nonenhancing nodular masses in the left mesotympanum and mastoid on axial and coronal delayed T1-weighted MR images (E and G, arrows). Small-sized residual cholesteatomas were suspected. At surgery, only scar tissue was found.