This particular paper was part of a larger project on the value of diffusion-weighted imaging in the diagnosis of middle ear cholesteatoma.

It started in the period 2000–2001, when we investigated the use of echo-planar diffusion-weighted MRI in the evaluation of patients with middle ear cholesteatoma prior to first-stage and second-stage surgery.  The conclusions were that echo-planar diffusion-weighted MRI was unable to replace second-look surgery¹ as it misses cholesteatomas smaller than 5 mm.  In this particular paper in AJNR  we described a case of a patient scanned using both the echo-planar diffusion-weighted MR sequence as well as a non-echo-planar diffusion-weighted MR sequence (the HASTE diffusion or single-shot TSE diffusion sequence), concluding that the latter is highly superior in the detection of middle ear cholesteatoma.  These results were later confirmed in a larger group of patients prior to first-stage surgery,² as well as in a larger group of patients prior to second-stage surgery.³  This paper—using the combination of non-echo-planar diffusion-weighted MR sequences and delayed gadolinium-enhanced T1-weighted sequences—was the first paper ever stating that second-look surgery could be replaced by MRI using these sequences.

In 2010, I published a paper in Radiology⁴ in which I proved that the non-echo-planar diffusion-weighted sequence (HASTE diffusion or single-shot TSE diffusion) could perform as a standalone sequence in the diagnosis of cholesteatoma, and that the use of gadolinium was no longer needed.

All these papers and results have accumulated in the successful public defense of a PhD at the KUL (Catholic University of Leuven, Belgium) entitled “The Value of Magnetic Resonance Imaging in the Preoperative Evaluation and the Postoperative Follow-up of Middle Ear Cholesteatoma” on November 14, 2011.

This work has not only tremendously influenced my work but also has enormously influenced the approach to patients with a middle ear cholesteatoma.  Not only has the preoperative evaluation and extent been improved using this technique, but the number of second-look surgeries (to look for residual or left-behind cholesteatoma) has decreased significantly, as has the number of CT scans performed prior to second-look. Patients are now selected for second-look surgery based upon these  non-echo-planar diffusion-weighted MR sequences.

These findings have been confirmed and reconfirmed in numerous papers in the radiologic literature.

References

1. Vercruysse J-P, De Foer B, Pouillon M, et al. The value of diffusion-weighted MR imaging in the diagnosis of primary acquired and residual cholesteatoma: a surgical verified study of 100 patients. Eur Radiol 2006;16:1461–67. doi: 10.1007/s00330-006-0160-2
2. De Foer B, Vercruysse J-P, Bernaerts A, et al. The value of single-shot turbo spin-echo diffusion-weighted MR imaging in the detection of middle ear cholesteatoma. Neuroardiology 2007;49:841–48. doi: 10.1007/s00234-007-0268-3
3. De Foer B, Vercruysse J-P, Bernaerts A, et al. Detection of postoperative residual cholesteatoma with non-echo-planar diffusion-weighted magnetic resonance imaging. Otol Neurotol 2008;29:513–17. doi: 10.1097/MAO.0b013e31816c7c3b
4. De Foer B, Vercruysse J-P, Bernaerts A, et al. Middle ear cholesteatoma: non–echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging—value in detection. Radiology 2010;255:866–72. doi: 10.1148/radiol.10091140

 

Read this article at AJNR.org . . .