Apparent diffusion coefficients for predicting primary cholesteatoma risk of recurrence after surgical clearance. Issue 125 (April 2020)

• Record Type: Journal Article
• Authors: Russo, Camilla; Elefante, Andrea; Cavaliere, Michele; Di Lullo, Antonella M.; Motta, Gaetano; Iengo, Maurizio; Brunetti, Arturo
• Is Part Of: European journal of radiology. Issue 125(2020)
• Publication Date: 2020-04
• Subjects: MRI Magnetic Resonance Imaging -- DWI Diffusion Weighted Imaging -- EPI Echo-Planar Imaging -- MSH multi-shot -- SSH single-shot -- ADC Apparent Diffusion Coefficient -- nADC Normalized Apparent Diffusion Coefficient -- ROI Region Of Interest -- mADC Mean Apparent Diffusion Coefficient -- NAWM Normal Appearing White Matter; Cholesteatoma -- Magnetic resonance imaging -- Diffusion weighted imaging; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.108915
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Non-EPI DWI with relative ADC map is widely used to detect middle ear cholesteatoma. ADC is a useful tool for stratifying ear cholesteatoma risk of recurrence. mADC and nADC can be both used for estimate the risk of recurrence. A cut-off value of nADC = 1.3 or mADC = 1000 is proposed to distinguish between groups. Abstract: Purpose: Beside the well-known accuracy of non-EPI DWI techniques and relative ADC maps in detecting cholesteatomatous tissue, ADC can also represent a useful tool for stratifying cholesteatoma risk of recurrence. Aim of this study is to test the role of ADC in determining risk of recurrence for primary middle ear cholesteatoma, proposing stratification based on pre-operative mean (mADC) and normalized (nADC) ADC values. Methods: In this prospective study, 60 patients with primary unilateral middle ear cholesteatoma underwent a three-years-long follow-up to assess the presence of recurrent disease after macroscopically complete excisional surgery. Baseline MRI examination mADC and nADC values in the group with early evidence of recurrent cholesteatoma were compared to the group with no evidence of recurrence by using T statistics. Results: ADC values on pre-operative MRI examination were lower in cholesteatomas with early evidence of recurrence, and statistical significance was slightly higher for nADC compared to mADC measurements. We also determined a cut-off between the two groups, proposing stratification in high-risk of recurrence cholesteatomas (mADC≤ 1000 or nADC< 1.3) and low-risk cholesteatomas (mADC>1000 or nADC≥1.3). Conclusions: ADC values resulted discriminating in identifying cholesteatomas with higher risk of early recurrence, both for mean and normalized ADC, with optimized tissue characterization and outcome prediction.