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• W3026825934 abstract "Abstract Background Cholesteatoma and otitis media are common middle ear pathologies. They may cause serious complication such as hearing loss, facial nerve paralysis or intra-cranial complications in advanced cases. They are mainly diagnosed by otoscope yet CT examination is essential to confirm the diagnosis in some cases as well as assess its extensions for proper surgical excision. However, CT is poor in differentiation of cholesteatoma from other middle ear pathologies. Between the two diseases, there are a grey zone. Depending on CT images in differentiation between cholestatoma and otitis media, radiologist will be susptable for misdiagnosis. Objective To determine the diagnostic accuracy of DWI and the difference between the ADCs of middle ear cleft cholestatoma and those of non-cholesteatomatous tissue especially recurrent otitis media on single-shot echo planar DW images. In a case of cholestatoma, the results will be confirmed by intra-operative findings and histopathological data. In a case of otitis media, we will follow up the patients clinically if signs and symptoms resolve or not; or follow up by CT examination. Methods This study was conducted on patient with suspected cholesteatoma suspected clinically or by CT examination or known patients and patient also with suspected otitis media recurrence who underwent already surgery or preparing to that; at Ain Shams university hospitals. The patients referred from the otolaryngology department at Ain Shams university hospitals and from other private clinics. The patients was investigated using magnetic resonance imaging (MRI). Results MRI examination was advocated to differentiate between cholesteatoma from other middle ear pathologies. Delayed post contrast T1 images were used but showed low sensitivity for smaller lesions as well as patient inconvenience due to delayed imaging after 30-45 minutes. In recent years, diffusion weighted sequences have been used in diagnosis of cholesteatoma due to its bright signal on DWIs. In our study we used thin cut multi-shot EPI diffusion weighted images in the assessment of cholesteatoma and otitis media suspected clinically or by CT examination or known patients. It showed very good sensitivity and excellent specificity in detection of diffusion restriction of cholestatoma compared to chronic otits media which appear as a facilitated diffusion. The use of multi-shot techniques improved its sensitivity compared to single shot images yet it is still relatively less than non-EPI techniques. Conclusion DWI is a beneficial tool in the evaluation of cholesteatoma and differentiate between it and otitis media with excellent specificity that reduces the need of second look surgeries in multiple cases. The use of multi-shot diffusion weighted techniques improved its sensitivity significantly compared to single shot techniques. It still could not detect lesions smaller than 4 mm." @default.
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• W3026825934 date "2020-03-01" @default.
• W3026825934 modified "2023-09-25" @default.
• W3026825934 title "Role of DWI in differentiation between cholestatoma and recurrent otitis media" @default.
• W3026825934 doi "https://doi.org/10.1093/qjmed/hcaa068.020a" @default.
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