Detection of cholesteatoma: 2D BLADE turbo gradient- and spin-echo imaging versus readout-segmented echo-planar diffusion-weighted imaging

Purpose This study is to compare the accuracy of 2D BLADE turbo gradient- and spin-echo imaging (TGSE BLADE) diffusion-weighted imaging (DWI) with that of readout-segmented echo-planar (RESOLVE) DWI in the detection of primary and residual/recurrent temporal bone cholesteatoma. Methods The prospective study population consisted of 58 patients who were underwent magnetic resonance (MR) imaging for the evaluation of suspected temporal bone cholesteatoma. Two radiologists independently evaluated the two sequences. Kappa ( k ) statistics, the intra-class correlation coefficient (ICC), and a paired t test were used for statistical analysis. Results Of the 58 patients included, all had histo-pathologically confirmed cholesteatomas. In ≤ 3 mm group ( n = 13), TGSE BLADE sequence correctly identified all cases except one that was recorded as equivocal on both sequences because of high signal intensity on T1WI; while on RESOLVE sequences, 6 were positive, 4 were equivocal, and 3 were false negative. For > 3 mm group ( n = 45), detection performance was similar between the two sequences. The mean ADC of cholesteatoma on TGSE BLADE DWI was 0.923 × 10 –3 mm 2 /s, and the mean ADC of cholesteatoma on RESOLVE DWI was 0.949 × 10 –3 mm 2 /s, with no significant difference in the mean ADC values of cholesteatoma measured on the two sequences ( p = 0.9216). Conclusion TGSE BLADE outperforms RESOLVE in the detection of small temporal bone cholesteatoma ≤ 3 mm.