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Research ArticleHead and Neck Imaging

Comparison of the Utility of High-Resolution CT-DWI and T2WI-DWI Fusion Images for the Localization of Cholesteatoma

X. Fan, C. Ding and Z. Liu
American Journal of Neuroradiology July 2022, 43 (7) 1029-1035; DOI: https://doi.org/10.3174/ajnr.A7538
X. Fan
aFrom the Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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C. Ding
aFrom the Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Z. Liu
aFrom the Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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  • FIG 1.
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    FIG 1.

    TSE-DWI images (A and E) were fused with HRCT (B) and T2WI fat-suppression images (F), respectively, to generate CT-DWI (C) and T2WI-DWI (G) fusion images, converting the colors to increase the visibility of the lesion (blue arrow) (D and H).

  • FIG 2.
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    FIG 2.

    Left middle ear mastoid region. A, CT-DWI fusion image of a cholesteatoma in red (blue arrowhead) and inflammatory tissue in gray (green arrow). B, T2WI-DWI fusion image of cholesteatoma in red (blue arrowhead) and inflammatory tissue in gray (green arrow).

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    FIG 3.

    Subjective evaluation of CT-DWI and T2WI fusion image quality.

  • FIG 4.
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    FIG 4.

    Pathologically confirmed cholesteatoma. The attic and mastoid antrum are filled with cholesteatoma during the operation. A, TSE-DWI: a high signal intensity area (blue arrow) is seen in the mastoid of the left middle ear with clear borders and poorly displayed semicircular canal. B, HRCT: a soft-tissue density shadow is seen within the middle ear mastoid cavity (blue arrow), and the anterior and posterior pedicles of the horizontal semicircular canal are clearly displayed (yellow arrow). CT-DWI fusion image (C) shows the cholesteatoma exceeding the posterior branch of the horizontal semicircular canal, involving the mastoid antrum. D, T2WI shows a nonspecific high-intensity-signal shadow in the mastoid process of the left middle ear. E, T2WI-DWI: the horizontal semicircular canal is clear, the cholesteatoma shows yellow changes, and the lesion involves the attic and mastoid antrum.

  • FIG 5.
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    FIG 5.

    Surgical confirmation of a cholesteatoma in the tympanic cavity. A, TSE-DWI: a clear high-intensity-signal area (blue arrow) with a clear border in the right middle ear. B, HRCT: soft-tissue density shadow (blue arrow) in the middle ear with an unclear border and clear cochlear structures (yellow arrows). CT-DWI fusion image (C) clearly shows the cholesteatoma in the tympanic cavity. D, T2WI shows a nonspecific high-intensity-signal shadow in the mastoid process of the right middle ear. E, T2WI-DWI shows a clear cochlea with the cholesteatoma, localized in the tympanic cavity with reddish-yellow changes.

Tables

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    Table 1:

    Subjective evaluation of fusion image quality

    ScoreOverall Quality of the Fusion ImageSemicircular Canal DisplayClarity of the LesionDiagnostic Confidence
    1UnacceptableDifficult to identify edgesSevere blurring of contoursVery poor
    2Poor, evaluation moderately limitedBlurred edges, but identifiableBlurred contoursPoor
    3Moderate, evaluation mildly limitedMargins recognizableContours recognizableModerate
    4Good, evaluation less limitedEdges visible, no distortionContour edges visibleGood
    5Very goodClear edgesClear contoursVery good
    • View popup
    Table 2:

    Comparison of subjective evaluation agreement between CT-DWI and T2WI-DWI fusion imagesa

    CT-DWI, Interobserver κ (95% CI)T2WI-DWI, Interobserver κ (95% CI)
    Overall quality of fusion image0.82 (0.71–0.93)0.87 (0.73–1.00)
    Semicircular canal display0.88 (0.77–0.98)0.81 (0.70–0.92)
    Clarity of the lesion0.94 (0.88–0.99)0.93 (0.88–0.99)
    Diagnostic confidence0.93 (0.86–0.99)0.91 (0.85–0.97)
    • ↵a κ indicates weighted κ coefficients.

    • View popup
    Table 3:

    Diagnostic efficacy of middle ear mastoid localization in CT-DWI fusion and T2WI-DWI fusion images

    SensitivitySpecificityAUCAUC 95% CIP Value
    Attic.32
     CT-DWI0.980.750.870.76–0.94
     T2WI-DWI1.000.750.880.77–0.95
    Tympanic cavity.30
     CT-DWI0.840.860.850.74–0.93
     T2WI-DWI0.840.720.780.66–0.88
    Mastoid antrum.70
     CT-DWI0.760.870.820.70–0.90
     T2WI-DWI0.790.870.830.71–0.91
    Mastoid cavity.16
     CT-DWI0.750.850.800.68–0.89
     T2WI-DWI0.820.820.850.74–0.93
    • Note:—AUC indicates area under the curve.

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American Journal of Neuroradiology: 43 (7)
American Journal of Neuroradiology
Vol. 43, Issue 7
1 Jul 2022
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Cite this article
X. Fan, C. Ding, Z. Liu
Comparison of the Utility of High-Resolution CT-DWI and T2WI-DWI Fusion Images for the Localization of Cholesteatoma
American Journal of Neuroradiology Jul 2022, 43 (7) 1029-1035; DOI: 10.3174/ajnr.A7538

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CT-DWI vs. T2WI-DWI for Cholesteatoma Localization
X. Fan, C. Ding, Z. Liu
American Journal of Neuroradiology Jul 2022, 43 (7) 1029-1035; DOI: 10.3174/ajnr.A7538
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