Clinicoradiological Evaluation of Cholesteatoma: Integrating Clinical, CT, and MRI Diagnostics.

Abstract

Objectives: The common chronic disorder, otitis media (COM), can lead to cholesteatoma, a destructive lesion of the middle ear that could potentially have major consequences. Correct diagnosis at an early stage is crucial for effective management. In this study, histopathology is used as the gold standard to compare how well a clinicoradiological method that uses clinical observations, high-resolution computed tomography (HRCT), and echo-planar imaging diffusion-weighted magnetic resonance imaging (EPI-DWI) can diagnose cholesteatoma.

Methods: A prospective diagnostic accuracy study was conducted on 230 patients aged 15 to 50 years with COM and clinically-suspected cholesteatoma. All patients underwent clinical evaluation (history, otoscopy, and audiometry) followed by HRCT and EPI-DWI imaging. Imaging findings were interpreted independently by radiologists blinded to clinical and histopathological results. Surgical exploration and histopathological confirmation were performed in all cases.

Results: Of the 230 patients, histopathology confirmed cholesteatoma in 110 cases (47.8%). Diffusion-weighted magnetic resonance imaging (DW-MRI) demonstrated superior sensitivity (92.7%) and specificity (89.4%) compared with HRCT (sensitivity: 75.5%; specificity: 70.2%). The clinicoradiological approach combining clinical assessment with EPI-DWI and HRCT improved diagnostic accuracy, achieving a sensitivity of 95.5%, specificity of 90.7%, positive predictive value of 93.2%, and negative predictive value of 94.3%. Receiver operating characteristic analysis revealed an area under the curve of 0.96 for DW-MRI and 0.88 for the clinicoradiological approach. Cohen's kappa showed an excellent agreement between the clinicoradiological assessment and histopathology (κ = .85).

Conclusions: The integration of clinical findings with EPI-DWI and HRCT significantly enhances the diagnostic accuracy for cholesteatoma, making the clinicoradiological approach a valuable tool in the evaluation of patients with COM. EPI-DWI remains the preferred imaging modality for cholesteatoma diagnosis, while HRCT provides complementary information on middle ear anatomy and bone erosion.