Abstract
Objectives
This study investigated the utility of temporal subtraction computed tomography (TSCT) obtained with temporal bone high-resolution computed tomography (HRCT) for the preoperative prediction of mastoid extension of middle ear cholesteatomas.
Methods
Twenty-eight consecutive patients with surgically proven middle ear cholesteatomas were retrospectively evaluated. The presence of black color in the mastoid region on TSCT suggested progressive changes caused by bone erosion. Enlarged width of the anterior part of mastoid on HRCT was interpreted as suggestive of mastoid extension. Fisher’s exact test was used to compare the widths and black color on TSCT for cases with and without mastoid extension. The diagnostic accuracy of TSCT and HRCT for detecting mastoid extension and interobserver agreement during the evaluation of black color on TSCT were calculated.
Results
There were 15 cases of surgically proven mastoid extension and 13 cases without mastoid extension. Patients with black color on TSCT were significantly more likely to have a mastoid extension (p < 0.001). The sensitivity and specificity of TSCT were 0.93 and 1.00, respectively. Patients in whom the width of the anterior part of the mastoid was enlarged were significantly more likely to have a mastoid extension (p = 0.007). The sensitivity and specificity of HRCT to detect the width of the anterior part of the mastoid were 0.80 and 0.77, respectively. Interobserver agreement during the evaluation of TSCT findings was good (k = 0.71).
Conclusions
This novel TSCT technique and preoperative evaluations are useful for assessing mastoid extension of middle ear cholesteatomas and making treatment decisions.
Key Points
•TSCT shows a clear black color in the mastoid region when the middle ear cholesteatoma is accompanied by mastoid extension.
•TSCT obtained with preoperative serial HRCT of the temporal bone is useful for assessing mastoid extension of middle ear cholesteatomas.
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Abbreviations
- CT:
-
Computed tomography
- DWI:
-
Diffusion-weighted imaging
- HRCT:
-
High-resolution CT
- MRI:
-
Magnetic resonance imaging
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Acknowledgements
We appreciate Mr. Tadashi Sugita and Ms. Maiko Minegishi (FUJIFILM Medical Co., Ltd.) for their technical contribution to the subtraction method. We also appreciate Dr. Masahiro Takahashi, Dr. Yuika Sakurai, Dr. Masaomi Motegi, Dr. Manabu Komori, and Dr. Kazuhisa Yamamoto for sharing their clinical dataset with us.
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The scientific guarantor of this publication is Hiroya Ojiri.
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•retrospective
•diagnostic study
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Baba, A., Kurokawa, R., Kurokawa, M. et al. Preoperative prediction for mastoid extension of middle ear cholesteatoma using temporal subtraction serial HRCT studies. Eur Radiol 32, 3631–3638 (2022). https://doi.org/10.1007/s00330-021-08453-0
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DOI: https://doi.org/10.1007/s00330-021-08453-0