ISSN: 1899-0967
Polish Journal of Radiology
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vol. 87
Head and neck radiology
Original paper

The value of different diffusion-weighted magnetic resonance techniques in the diagnosis of middle ear cholesteatoma. Is there still an indication for echo-planar diffusion-weighted imaging?

Alina Piekarek
Tomasz Zatoński
Mateusz Kolator
Joanna Bladowska
Marek Sąsiadek
Anna Zimny

Department of Radiology, Wroclaw Medical University, Wroclaw, Poland
Department of Otolaryngology, Wroclaw Medical University, Wroclaw, Poland
Pol J Radiol 2022; 87: e51-e57
Online publish date: 2022/01/20
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The aim of the study was to analyse the value of 2 different diffusion-weighted imaging (DWI) techniques (echo-planar imaging [EPI] and on-echo-planar imaging [non-EPI]) in the diagnosis of cholesteatoma.

Material and methods
Our material consisted of 32 subjects suspected of cholesteatoma, who underwent magnetic resonance imaging of the temporal bone using both EPI and non-EPI DWI. Two independent readers retrospectively analysed magnetic resonance images. Intra- and interobserver agreements as well sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of both DWI sequences were assessed.

Using non-EPI DWI all cholesteatomas were correctly diagnosed by both readers with no false negative nor inconclusive cases and with only one false positive result. Non-EPI DWI revealed high interobserver agreement (κ = 1) and high correlation with histopathological results (r = 0.895). EPI DWI misdiagnosed 27-31% of cholesteatomas (false negative results), showing also significantly low interobserver agreement (κ = 0.373) and low correlation with histopathological results (r = 0.328 for reader 1 and r = 0.267 for reader 2). Non-EPI DWI revealed very high sensitivity (100%), specificity (83.3%), NPV (100%), and PPV (96.3%) in comparison to EPI DWI, which showed lower sensitivity (69.2%), specificity (66.6-83.3%), NPV (33.3-38.4%), and PPV (90.0-94.7%).

Non-EPI DWI with high sensitivity, specificity, and interobserver agreement is a very reliable technique in detecting middle ear cholesteatoma regardless of the pre- or postoperative state of the ear, and it should entirely replace EPI DWI in clinical practice.


cholesteatoma, diffusion weighted imaging, EPI DWI, non-EPI DWI

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