Presented at the 7th International Conference on Cholesteatoma and Ear Surgery, The Hague, The Netherlands, June 22–26, 2004.
Usefulness of Delayed Postcontrast Magnetic Resonance Imaging in the Detection of Residual Cholesteatoma after Canal Wall-Up Tympanoplasty†
Version of Record online: 3 JAN 2009
Copyright © 2005 The Triological Society
Volume 115, Issue 4, pages 607–610, April 2005
How to Cite
Ayache, D., Williams, M. T., Lejeune, D. and Corré, A. (2005), Usefulness of Delayed Postcontrast Magnetic Resonance Imaging in the Detection of Residual Cholesteatoma after Canal Wall-Up Tympanoplasty. The Laryngoscope, 115: 607–610. doi: 10.1097/01.mlg.0000161360.66191.29
- Issue online: 3 JAN 2009
- Version of Record online: 3 JAN 2009
- Manuscript Accepted: 23 NOV 2004
- middle ear;
- chronic otitis media;
- postoperative ear
Objectives/Hypothesis: Imaging takes an increasing place in the follow-up of patients who have undergone surgery for cholesteatoma, with computed tomography (CT) as the first line imaging technique. However, in case of complete opacity of the tympanomastoid cavities, CT is not able to differentiate residual cholesteatoma from postoperative scar tissue. The aim of this study was to assess the usefulness of magnetic resonance imaging (MRI) using delayed postcontrast T1-weighted images for the detection of residual cholesteatoma after canal wall-up tympanoplasty (CWU) in cases where CT was not conclusive.
Study Design: Prospective study.
Methods: MRI, with delayed postcontrast T1-weighted images (30–45 minutes after contrast injection), was performed before revision surgery in 41 consecutive patients who had undergone CWU for cholesteatoma and presenting with a nonspecific complete opacity of the mastoid bowl on CT. In all the cases, imaging results were compared with operative findings at surgical revision.
Results: A residual cholesteatoma was found in 19 of 41 patients at revision surgery and was correctly detected on MRI in 17 patients. In the two remaining cases, cholesteatoma pearls smaller than 3 mm were not seen. There was no false-positive case. Statistics were as follows: sensitivity 90%; specificity 100%; positive predictive value 100%; negative predictive value 92%.
Conclusion: When postoperative CT is not conclusive because of complete opacity of the tympanomastoid cavities, MRI with delayed postcontrast T1-weighted images is a reliable additional technique for the detection of a residual cholesteatoma when its diameter is at least 3 mm.