A Case of Congenital Open-Type Cholesteatoma Diagnosed by Diffusion-Weighted MRI Using the PROPELLER Technique

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  • PROPELLER拡散強調画像による側頭部MRIが診断に有効であったOpen型先天性真珠腫例
  • PROPELLER カクサン キョウチョウ ガゾウ ニ ヨル ソクトウブ MRI ガ シンダン ニ ユウコウ デ アッタ Openガタ センテンセイ シンジュ シュレイ

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Abstract

<p>Congenital cholesteatoma in the tympanic cavity can be divided into two types - the closed-type cholesteatoma, which takes the form of a keratotic cyst, and the open-type cholesteatoma, characterized by a flat surface of the epidermis on the middle ear mucosa. Closed-type cholesteatoma is usually identified as a globular white mass through a normal tympanic membrane; whereas the tympanic membrane appears normal in open-type cholesteatomas. Therefore, it is difficult to diagnose open-type cholesteatomas, which are often identified accidentally during exploratory tympanotomy for preoperative diagnoses such as conductive hearing loss. Herein, we report a case of open-type cholesteatoma, in which the diagnosis was suspected from the findings of diffusion-weighted MRI examination using the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique.</p><p>An 18-year-old male presented to our hospital with the complaint of right hearing loss, which was suspected at a previous ENT clinic to be caused by a congenital ossicular anomaly. Otoscopic examination failed to reveal any abnormalities. Pure-tone audiometry showed moderate conductive hearing loss in the right ear. Computed tomography of the temporal bone revealed a defect of the long process of the incus and superstructure of the stapes, with a surrounding shadow that appeared to be soft tissue. On the basis of these findings, we suspected an open-type cholesteatoma with a defect of the ossicles. Diffusion-weighted MRI examination using the PROPELLER technique showed a high-intensity in the temporal bone, suggestive of a cholesteatoma. We performed exploratory tympanotomy, and found the open-type cholesteatoma in the middle ear. The cholesteatoma was removed without ossiculoplasty, and until now, nine months after the surgery, there has been no sign of recurrence.</p><p>Our case showed the usefulness of diffusion-weighted MRI using the PROPELLER technique for the diagnosis of the open-type cholesteatoma. The possibility of open-type cholesteatoma should be borne in mind in patients diagnosed preoperatively as having a congenital ossicular anomaly, and diffusion-weighted MRI with the PROPELLER technique is indicated in such patients towards confirming the diagnosis.</p>

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