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lüll Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging--value in detection De Foer B; Vercruysse JP; Bernaerts A; Meersschaert J; Kenis C; Pouillon M; De Beuckeleer L; Michiels J; Bogaerts K; Deckers F; Somers T; Hermans R; Offeciers E; Casselman JWRadiology 2010[Jun]; 255 (3): 866-72PURPOSE: To retrospectively compare non-echo-planar (non-EP) diffusion-weighted (DW) imaging, delayed gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging, and the combination of both techniques in the evaluation of patients with cholesteatoma. MATERIALS AND METHODS: This institutional review board-approved study, for which the need to obtain informed consent was waived, included 57 patients clinically suspected of having a middle ear cholesteatoma without a history of surgery and 63 patients imaged before "second-look" surgery. Four blinded radiologists evaluated three sets of MR images: a set of delayed gadolinium-enhanced T1-weighted images, a set of non-EP DW images, and a set of both kinds of images. Overall sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV), as well as intra- and interobserver agreement, were assessed and compared among methods. To correct for the correlation between different readings, a generalized estimating equations logistic regression model was fitted. Results were compared with surgical results, which were regarded as the standard of reference. RESULTS: Sensitivity, specificity, NPV, and PPV were significantly different between the three methods (P < .005). Sensitivity and specificity, respectively, were 56.7% and 67.6% with the delayed gadolinium-enhanced T1-weighted images and 82.6% and 87.2% with the non-EP DW images. Sensitivity for the combination of both kinds of images was 84.2%, while specificity was 88.2%. The overall PPV was 88.0% for delayed gadolinium-enhanced T1-weighted images, 96.0% for non-EP DW images, and 96.3%for the combination of both kinds of images. The overall NPV was 27.0% for delayed gadolinium-enhanced T1-weighted images, 56.5% for non-EP DW images, and 59.6% for the combination of both kinds of images. CONCLUSION: MR imaging for detection of middle ear cholesteatoma can be performed by using non-EP DW imaging sequences alone. Use of the non-EP DW imaging sequence combined with a delayed gadolinium-enhanced T1-weighted sequence yielded no significant increases in sensitivity, specificity, NPV, or PPV over the use of the non-EP DW imaging sequence alone.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Child[MESH]|Cholesteatoma, Middle Ear/*diagnosis[MESH]|Contrast Media[MESH]|Diffusion Magnetic Resonance Imaging/methods[MESH]|Female[MESH]|Gadolinium DTPA[MESH]|Humans[MESH]|Magnetic Resonance Imaging/*methods[MESH]|Male[MESH]|Meglumine[MESH]|Middle Aged[MESH]|Organometallic Compounds[MESH]|Predictive Value of Tests[MESH]|Retrospective Studies[MESH]|Sensitivity and Specificity[MESH] |