PT  - JOURNAL ARTICLE
AU  - Benson, J.C.
AU  - Carlson, M.L.
AU  - Lane, J.I.
TI  - Non-EPI versus Multishot EPI DWI in Cholesteatoma Detection: Correlation with Operative Findings
AID  - 10.3174/ajnr.A6911
DP  - 2020 Dec 17
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2020/12/17/ajnr.A6911.short
4100  - http://www.ajnr.org/content/early/2020/12/17/ajnr.A6911.full
AB  - BACKGROUND AND PURPOSE: Although multishot EPI (readout-segmented EPI) has been touted as a robust DWI sequence for cholesteatoma evaluation, its efficacy in disease detection compared with a non-EPI (eg, HASTE) technique is unknown. This study sought to compare the accuracy of readout-segmented EPI with that of HASTE DWI in cholesteatoma detection.MATERIALS AND METHODS: A retrospective review was completed of consecutive patients who underwent MR imaging for the evaluation of suspected primary or recurrent/residual cholesteatomas. Included patients had MR imaging examinations that included both HASTE and readout-segmented EPI sequences and confirmed cholesteatomas on a subsequent operation. Two neuroradiologist reviewers assessed all images, with discrepancies resolved by consensus. The ratio of signal intensity between the cerebellum and any observed lesion was noted.RESULTS: Of 23 included patients, 12 (52.2%) were women (average age, 47.8 [SD, 25.2] years). All patients had surgically confirmed cholesteatomas: Six (26.1%) were primary and 17 (73.9%) were recidivistic. HASTE images correctly identified cholesteatomas in 100.0% of patients. On readout-segmented EPI sequences, 16 (69.6%) were positive, 5 (21.7%) were equivocal, and 2 (8.7%) were falsely negative. Excellent interobserver agreement was noted between reviews on both HASTE (κ = 1.0) and readout-segmented EPI (κ = 0.9) sequences. The average signal intensity ratio was significantly higher on HASTE than in readout-segmented EPI, facilitating enhanced detection (mean difference 0.5; 95% CI, 0.3–0.8; P = .003).CONCLUSIONS: HASTE outperforms readout-segmented EPI in the detection of primary cholesteatoma and disease recidivism.MSmultishotRESOLVEreadout-segmented EPI