Diagnostic Accuracy of Fusion Technique of Computed Tomography and Diffusion-weighted Imaging in Preoperative Localization of Cholesteatoma

Saeed, Abdelrahman Ahmed; Mohammed, Wesam Roshdy; Elseddik, Mohamed Abobakr

doi:10.21608/arcmed.2025.359627.1094

	Diagnostic Accuracy of Fusion Technique of Computed Tomography and Diffusion-weighted Imaging in Preoperative Localization of Cholesteatoma
ARCADEs of MEDICINE
Articles in Press, Accepted Manuscript, Available Online from 06 July 2025
Document Type: Original Research
DOI: 10.21608/arcmed.2025.359627.1094
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Authors
Abdelrahman Ahmed Saeed ¹; Wesam Roshdy Mohammed²; Mohamed Abobakr Elseddik³
¹Diagnostic and Interventional Radiology Department, Armed forces college of medicine, Cairo, Egypt.
²Otorhinolaryngology department, Armed Foreces College of Medicine, Egypt
³Radiodiagnosis department, Armed forces college of Medicine, Cairo, Egypt
Abstract
Background: diffusion-weighted magnetic resonance imaging (DW-MRI) has emerged as a powerful tool in detecting cholesteatoma preoperatively, but it lacks anatomical localization of cholesteatoma. So, the fusion technique of Computed Tomography (CT) and DWI has been recently preferred in the pre-operative localization of cholesteatoma by integrating the detailed bony structures visualized through high-resolution CT (HRCT) with the soft tissue detection capabilities of DW-MRI. The objective of our study is to measure the sensitivity, specificity, and diagnostic accuracy of the fusion technique. Methods: A total of 25 cases were included in our study, 60% (n=15) were males and 40% (n=10) were females. The mean age of the patients was 32.7 ± 20.7 years. Pre-operative HRCT temporal bone and DW-MRI were done. CT-DWI fused images were used to localize cholesteatoma and then compared with intraoperative localization. Results: The evaluation of cholesteatoma localization revealed the most accurate results in lesions of the mastoid cells and the external auditory canal (diagnostic accuracy = 100%) on fusion technique, followed by the attic and mastoid antrum (diagnostic accuracy =96%), and finally the tympanic cavity (diagnostic accuracy = 84%). Conclusions: The fusion technique of HRCT and DW-MRI can be regarded as a precise method for localizing cholesteatoma in different areas of the middle ear and determining the most suitable surgical approach, and better decision-making leading to optimal post-operative outcome for the patient and preventing unnecessary operations.
Keywords
CT-DWI; diffusion-weighted imaging; fusion technique; cholesteatoma


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