MULTIMODAL IMAGING ASSESSMENT IN CHOLESTEATOMA: CT AND NON-EPI DWI MRI COMPARATIVE ANALYSIS

Alizada E.E.^1,2, Korobkin A.S.², Serova N.S.¹, Ternovoy S.K.¹

 

1 – I.M. Sechenov First Moscow State Medical University of the Ministry (Sechenov University).

2 – The National Medical Research Center for Otorhinolaryngology of the FMBA of Russia. Moscow, Russia.

Purpose. To compare the diagnostic accuracy of multislice computed tomography (MSCT) and non-EPI diffusion-weighted imaging (DWI) MRI in the preoperative assessment and postoperative monitoring of cholesteatoma with a focus on residual and recurrent disease.

Materials and methods. We conducted a retrospective analysis of 110 patients with cholesteatoma who underwent both preoperative and postoperative imaging, including non-EPI DWI MRI and MSCT. Diagnostic performance was evaluated based on surgical and follow-up findings.

Results. Preoperative evaluation of 110 patients using both MSCT and non-EPI DWI MRI identified right-sided cholesteatoma in 54 cases (49.1%), left-sided in 49 (44.5%), and bilateral involvement in 7 (6.4%). Postoperative MRI detected recurrent cholesteatoma in 15 patients (13.6%) and residual matrix in 7 (6.4%). Non-EPI DWI MRI demonstrated superior diagnostic accuracy (sensitivity 95.5%, specificity 96.6%) compared to MSCT (86.4% and 81.8%, respectively) for detecting recurrent and residual disease.

Discussion. While MSCT remains a standard tool for anatomical assessment, its utility in postoperative monitoring is limited due to difficulties in distinguishing cholesteatoma from inflammatory changes. Non-EPI DWI MRI, by contrast, provides superior soft-tissue contrast and reliably detects restricted diffusion – a key marker of cholesteatoma – even in early-stage or residual disease.

Conclusion. Non-EPI DWI MRI should be the preferred imaging modality for postoperative cholesteatoma surveillance, offering high sensitivity and specificity that directly influence clinical decision-making.

 

Keywords: cholesteatoma, temporal bone imaging, diffusion-weighted MRI, MSCT, recurrent cholesteatoma.

 

Corresponding author: Alizada E.E., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

For citation: Alizada E.E., Korobkin A.S., Serova N.S., Ternovoy S.K. Multimodal imaging assessment in cholesteatoma: CT and non-EPI DWI MRI comparative analysis. REJR 2025; 15(2):40-52. DOI: 10.21569/2222-7415-2025-15-2-40-52.

Received:        08.03.25 Accepted: 26.03.25