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Background Several research studies have demonstrated the utility of diffusion-weighted imaging (DWI) in detecting middle ear cholesteatomas, especially with the non-echoplanar imaging (non-EPI) DWI technique. REadout Segmentation Of Long Variable Echo trains (RESOLVE), a multishot-EPI DWI, has better spatial resolution at a thinner section acquisition with reduced image distortion compared to the single-shot-EPI DWI technique. Purpose In this study, we evaluated the diagnostic ability of RESOLVE -DWI in middle ear cholesteatomas with surgical and histopathological support. Patients and Methods Fifty patients with clinical suspicion of primary cholesteatoma or postoperative recurrence were subjected to routine sequences and RESOLVE-DWI on magnetic resonance imaging (MRI). Thirty-eight patients had unilateral disease, while 12 patients had bilateral disease. The bilateral temporal bones of 50 patients were evaluated on MRI. The results attained by RESOLVE-DWI were correlated with intraoperative and histopathological findings. Results RESOLVE-DWI truly detected 55 of the 58 surgically proven cholesteatomas. RESOLVE-DWI could not detect three cholesteatoma lesions due to their small size and falsely diagnosed one case each of impacted wax and non-cholesteatomatous otitis media as cholesteatoma. With a 95% confidence interval, RESOLVE-DWI showed 94.8% sensitivity, 95.2% specificity, 96% positive predictive value, 93% negative predictive value, and 95% diagnostic accuracy in cholesteatoma detection. Conclusion RESOLVE-DWI is a sensitive and specific DWI technique for detecting middle ear cholesteatoma. However, RESOLVE-DWI has limitations in the diagnosis of small (<3 mm) cholesteatomas.
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OBJECTIVE: To evaluate the significance of Eustachian tube (ET) angles and ET pretympanic diameter on high resolution computed tomography (HRCT) Temporal bone in patients with chronic otitis media (COM). METHODS: A retrospective study was carried out at Tertiary care centre. Group A included 92 ears with COM (38 patients with bilateral COM and 16 with unilateral COM); and Group B included 108 normal ears (54 patients with bilateral normal ears). Reid plane-ET angle, Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone, and compared in the two groups. Patients with chronic otitis media (Group A) were subdivided into Group A1 (Blocked ET) and Group A2 (Patent ET). The parameters were evaluated and compared in the subgroups too. RESULTS: The mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41 ± 2.57 and 148.12 ± 3.43 respectively; whereas in Group B it was 27.56 ± 3.62 and 145.14 ± 4.34 respectively. Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients. ET pretympanic diameter was (5.37 ± 2.10) mm in Group A and (6.47 ± 2.40) mm in Group B. It was significantly less in patients with COM. A significant correlation was found between the ET patency and the two ET parameters (Reid plane-ET angle and pretympanic diameter). CONCLUSIONS: Eustachian tube angles in adults may play a significant role in the etiology of chronic otitis media. Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.
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INTRODUCTION: Doppler ultrasound is cost-effective and accurate noninvasive method for evaluation of peripheral arterial disease. However, there is difficulty in detection of aortoiliac lesions due to inadequate visualization of aortoiliac arteries in many patients. The Doppler waveform changes occurring distal to significant stenosis or occlusion are well documented. Accordingly, common femoral artery (CFA) Doppler waveform analysis may be used to predict haemodynamically significant proximal aortoiliac lesions. AIM: To evaluate the accuracy of Doppler waveform analysis at the CFA for diagnosing haemodynamically significant aortoiliac stenosis or occlusion in patients of peripheral arterial disease. MATERIALS AND METHODS: A total of 67 patients (114 aortoiliac segments) with suspected peripheral arterial disease were retrospectively evaluated and labeled as normal or abnormal by analysing the Doppler waveform of CFA. The triphasic waveform with normal reversal pattern was categorized as normal, while low velocity biphasic or monophasic waveform were labeled as abnormal and indirect diagnosis of normal or diseased (>50% stenosis or occlusion) aortoiliac segment was made. The results were compared to intra-arterial angiography, considered as the gold standard. RESULTS: The Doppler waveform analysis of CFA was abnormal in 41 out of 114 common femoral arteries, while intra-arterial angiography showed significant stenosis (21 arteries) or occlusion (26 arteries) in 47 (41%) of 114 aortoiliac segments in 67 patients. Out of 67 normal aortoiliac segments seen on angiography, the CFA waveform analysis was interpreted as normal in 62 segments. An abnormal CFA waveform could diagnose significant aortoiliac lesion with 87% sensitivity, 92% specificity, 89% Positive Predictive Value (PPV), 91% Negative Predictive Value (NPV) and 90% accuracy using angiography as the gold standard. The low velocity monophasic waveform which was seen in 38 (33%) of 114 segments was reliable predictor of significant aortoiliac disease with 93% positive predictive value. CONCLUSION: CFA Doppler waveform pattern analysis is a sensitive and accurate technique for the prediction of haemodynamically significant aortoiliac stenosis or occlusion.
