Elsevier

Clinical Radiology

Volume 73, Issue 1, January 2018, Pages 35-44
Clinical Radiology

Review
MRI in otology: applications in cholesteatoma and Ménière's disease

https://doi.org/10.1016/j.crad.2017.09.002Get rights and content

Imaging of middle-ear cholesteatoma with diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI), and inner-ear endolymphatic hydrops (in Ménière's disease) with post-gadolinium high-resolution MRI, are reviewed. DWI MRI provides for a more specific diagnosis of tympano-mastoid cholesteatoma. There is an established and increasing role of DWI MRI in detecting both primary and postoperative cholesteatoma, localising disease, and planning surgery. The contemporary diagnostic accuracy of DWI is reviewed, pitfalls in interpretation are described, and potential future developments are highlighted. High-resolution post-gadolinium MRI of the inner ear is being explored for diagnosing endolymphatic hydrops. There is now increasing data to validate the application of three-dimensional (3D)-fluid attenuated inversion recovery (FLAIR) sequences, performed at 4 hours post-intravenous gadolinium, in the setting of potential Ménière's disease. The clinical context and the evolution of these MRI techniques are discussed. Current MRI-based grading schemes for endolymphatic hydrops are described, together with the available data on their clinical implications.

Introduction

This article explores two different otological conditions in which MRI has an increasing role in diagnosis and patient management. The first clinical scenario is that of cholesteatoma imaging, where diffusion-weighted (DWI) MRI of the middle ear and mastoid is now a well-established imaging technique. Secondly, we review the imaging of Ménière's disease (MD), where delayed gadolinium enhanced imaging of the inner ear is evolving as a method for diagnosing endolymphatic hydrops (EH); however, this is yet to be widely practiced.

Section snippets

Imaging middle-ear cholesteatoma with DWI

Since the initial application of non-echoplanar DWI to the detection of cholesteatoma,1, 2 there has been significant development, progress, and understanding of its role in the management of both primary and postoperative middle-ear cholesteatoma.

Imaging endolymphatic hydrops in Meniere's disease

MD is a disorder of the inner ear that is characterised by episodic attacks of vertigo, tinnitus, fluctuating hearing loss, sensation of fullness in the ear, and progressive loss of audiovestibular function. MD usually only affects one ear, although over time both ears may become involved.33, 34 The disease usually presents between the ages of 40–60 years and females are more commonly affected than males.35 There is an unpredictable clinical course with the symptoms varying in severity from a

References (72)

  • F. Dubrulle et al.

    Diffusion-weighted MR imaging sequence in the detection of postoperative recurrent cholesteatoma

    Radiology

    (2006)
  • F. Más-Estellés et al.

    Contemporary non-echo-planar diffusion-weighted imaging of middle-ear cholesteatomas

    RadioGraphics

    (2012)
  • R.K. Lingam et al.

    Non-echoplanar diffusion weighted imaging in the detection of postoperative middle-ear cholesteatoma: navigating beyond the pitfalls to find the pearl

    Insights Imaging

    (2016)
  • D. Le Bihan et al.

    Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging

    Radiology

    (1988)
  • M. Jindal et al.

    A systematic review of diffusion-weighted magnetic resonance imaging in the assessment of postoperative cholesteatoma

    Otol Neurotol

    (2011)
  • J. Muzaffar et al.

    Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis

    Clin Otolaryngol

    (2016)
  • R.K. Lingam et al.

    Apparent diffusion coefficients for detection of postoperative middle-ear cholesteatoma on non-echo-planar diffusion-weighted images

    Radiology

    (2013)
  • S.C. Khemani et al.

    Radiological imaging of cholesteatoma

    Otorhinolaryngol

    (2010)
  • J. Tomlin et al.

    Surgical technique and recurrence in cholesteatoma: a meta- analysis

    Audiol Neurotol

    (2013)
  • J.H. Kim et al.

    Clinical results of attico-antrotomy with attic reconstruction or attic obliteration for patients with an attic cholesteatoma

    Clin Exper Otorhinolaryngol

    (2009)
  • B. De Foer et al.

    Middle-ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging—value in detection

    Radiology

    (2010)
  • P.M. Li et al.

    Evaluating the utility of non-echo-planar diffusion-weighted imaging in the preoperative evaluation of cholesteatoma: a meta-analysis

    Laryngoscope

    (2013)
  • S.L. van Egmond et al.

    A systematic review of non-echo planar diffusion-weighted magnetic resonance imaging for detection of primary and postoperative cholesteatoma

    Otolaryngol Head Neck Surg

    (2016)
  • R.K. Lingam et al.

    A Meta-analysis on the diagnostic performance of non-echo-planar diffusion-weighted imaging in detecting middle-ear cholesteatoma: 10 years on

    Otol Neurotol

    (2017)
  • S. Khemani et al.

    The value of non-echo planar HASTE diffusion-weighted MR imaging in the detection, localisation and prediction of extent of postoperative cholesteatoma

    Clin Otolaryngol

    (2011)
  • F.B. Pizzini et al.

    HASTE diffusion-weighted 3-Tesla magnetic resonance imaging in the diagnosis of primary and relapsing cholesteatoma

    Otol Neurotol

    (2010)
  • S. Steens et al.

    Repeated postoperative follow-up diffusion-weighted magnetic resonance imaging to detect residual or recurrent cholesteatoma

    Otol Neurotol

    (2016)
  • R. Nash et al.

    The role of diffusion-weighted magnetic resonance imaging in assessing residual/recurrent cholesteatoma after canal wall down mastoidectomy

    Clin Otolaryngol

    (2016)
  • A. Majithia et al.

    Staging primary middle-ear cholesteatoma with non-echoplanar (half-Fourier-acquisition single-shot turbo spin- echo) diffusion-weighted magnetic resonance imaging helps plan surgery in 22 patients: our experience

    Clin Otolaryngol

    (2012)
  • L. Migirov et al.

    Non-EPI DW MRI in planning the surgical approach to primary and recurrent cholesteatoma

    Otol Neurotol

    (2014)
  • P.Y. Wong et al.

    Monitoring progression of 12 cases of non-operated middle-ear cholesteatoma with non-echoplanar diffusion weighted magnetic resonance imaging: our experience

    Otol Neurotol

    (2016)
  • I. Plouin-Gaudon et al.

    Fusion of MRIs and CT scans for surgical treatment of cholesteatoma of the middle ear in children

    Arch Otolaryngol Head Neck Surg

    (2010)
  • K. Yamashita et al.

    High-resolution three-dimensional diffusion-weighted MRI/CT image data fusion for cholesteatoma surgical planning: a feasibility study

    Eur Arch Otorhinolaryngol

    (2015)
  • G.D. Locketz et al.

    Fusion of computed tomography and PROPELLER diffusion-weighted magnetic resonance imaging for the detection and localization of middle-ear cholesteatoma

    JAMA Otolaryngol Head Neck Surg

    (2016)
  • T. Watanabe et al.

    The efficacy of color mapped fusion images in the diagnosis and treatment of cholesteatoma using transcanal endoscopic ear surgery

    Otol Neurotol

    (2015)
  • R. Gurkov et al.

    Ménière's disease? A contemporary re-evaluation of endolymphatic hydrops

    J Neurol

    (2016)

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