3T MR Imaging of Postoperative Recurrent Middle Ear Cholesteatomas: Value of Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction Diffusion-Weighted MR Imaging

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Fig 1.
Recurrent cholesteatoma (white arrow). A, Unenhanced T1-weighted image with low signal intensity. B, Delayed contrast-enhanced T1-weighted image with no change in signal intensity; C and D, Echo-planar DWI (C) and PROPELLER DWI (D) show high signal intensity with more artifacts on the echo-planar DWI (C).
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Fig 2.
Patient 5 with a wrong diagnosis on delayed contrast-enhanced T1-weighted imaging. No recurrence of cholesteatoma was histologically proved (white arrow). A, Unenhanced T1-weighted image shows low signal intensity. B, Delayed contrast-enhanced T1-weighted image shows no change in signal intensity. C and D, Echo-planar DWI (C) and PROPELLER DWI (D) confirm no recurrence of cholesteatoma. Note the low signal intensity on DWI with more artifacts (C).
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Fig 3.
Recurrent cholesteatoma. A, Echo-planar DWI shows artifacts (double arrowhead) masking the recurrence. B, PROPELLER DWI shows small attical recurrent cholesteatoma (white arrow).

Sensitivity, specificity, PPV, NPV, and P value for the 3 observers

	Sensitivity (%)			Specificity (%)			PPV (%)			NPV (%)			P Value
	S1	S2	F	S1	S2	F	S1	S2	F	S1	S2	F	S1	S2	F
EPI	33.3	38.9	44.4	100.0	100.0	87.5	100.0	100.0	80.0	57.1	59.3	58.3	≤0.02	≤.01	≤.05
PROP	100.0	100.0	89.5	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	88.9	≤0.001	≤.001	≤.001
T1	94.1	88.2	88.2	93.7	68.7	81.2	94.1	75.0	83.3	93.7	84.6	86.7	≤0.001	≤.001	≤.001

Note:—EPI indicates ASSET echo-planar DWI; PROP, PROPELLER DWI; T1, T1-weighted imaging; S1, senior1; S2, senior2; F, fellow; PPV, positive predictive value; NPV, negative predictive value.