American Journal of Neuroradiology 2009;30:423.
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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1352
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
From the Departments of Neuroradiology (P.L., C.B., B.D., H.D., J.N.V.), and Ear Nose Throat Surgery (C.P.), Amiens University Hospital, Amiens, France; and Le Kremlin-Bicêtre Neuroradiology (G.S.), 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.