Nursel YURTTUTAN, Adem DOĞANER, Nagihan BİLAL, Betül KIZILDAĞ

Could computed tomography histogram analysis add value to the diagnosis of cholesteatoma?

Background/aim: To investigate the potential role of computed tomography (CT) histogram analysis in differentiating cholesteatoma (CHS) and non-cholesteatoma (NCHS). Materials and methods: We evaluated 77 temporal bone CT images (from November 2016 to February 2020) that were obtained preoperatively (mean age, 37.10±17.27 years in CHS; 36.72±16.08 years in NCHS group). Histogram analyses of the resulting XML files were conducted using the R Project 3.3.2 program. ROC analysis was used to find threshold values, and the diagnostic efficiency of these values in differentiating CHS-NCHS was determined. Results: The CT images of 41 CHS (53.25%) and 36 NHCS cases (46.75%) were evaluated. There was a statistically significant difference between the CHS and NCHS group in terms of the mean, maximum, and median values (p = 0.036, p = 0.006, p = 0.043). When examining the ROC curve obtained from the mean of these parameters, area under the curve (AUC) is determined as 0.638, and when the threshold value is selected as 42.55, the mean value was determined to have a sensitivity of 86.50% and specificity of 56.10% in differentiating CHS-NCHS. Conclusion: In cases with magnetic resonance imaging (MRI) contraindications, small-sized lesions may be difficult to detect and characterize due to a poor resolution; to reduce the rate of false positives/negatives in these situations, CT histogram analysis of previously taken images may provide the additional information.

PDF

___

1. Ayache D, Schmerber S, Lavieille JP, Roger G, Gratacap B. Middle ear cholesteatoma. Ann Otolaryngol Chir Cervicofac 2006; 123(3): 120-137 (in French). doi: 10.1016/s0003- 438x(06)76653-1
2. Ayache D, Darrouzet V, Dubrulle F, Vincent C, Bobin S et al; French Society of Otolaryngology Head and Neck Surgery (SFORL). Imaging of non-operated cholesteatoma: clinical practice guidelines. European Annals of Otorhinolaryngology Head and Neck Diseases 2012; 129(3): 148-152. doi: 10.1016/j. anorl.2011.09.005
3. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y et al; GRADE Working Group. Grading quality of evidence and strength of recommendations. British Medical Journal 2004; 19: 328(7454): 1490. doi: 10.1136/bmj.328.7454.1490
4. Castellano G, Bonilha L, Li LM, Cendes F. Texture analysis of medical images. Clinical Radiology 2004; 59(12): 1061-1069. doi: 10.1016/j.crad.2004.07.008
5. Gulati M, Gupta S, Prakash A, Garg A, Dixit R. HRCT imaging of acquired cholesteatoma: a pictorial review. Insights Imaging 2019; 10(1): 92. doi: 10.1186/s13244-019-0782-y
6. Juliano AF, Ginat DT, Moonis G. Imaging review of the temporal bone: part I. Anatomy and inflammatory and neoplastic processes. Radiology 2013; 269(1): 17-33. doi: 10.1148/ radiol.13120733
7. Banerjee A, Flood LM, Yates P, Clifford K. Computed tomography in suppurative ear disease: does it influence management? Journal of Laryngology & Otology 2003; 117(6): 454-458. doi: 10.1258/002221503321892280
8. Alzoubi FQ, Odat HA, Al-Balas HA, Saeed SR. The role of preoperative CT scan in patients with chronic otitis media. European Archives of Oto-Rhino-Laryngology 2009; 266(6): 807-809. doi: 10.1007/s00405-008-0814-6
9. Gaillardin L, Lescanne E, Morinière S, Cottier JP, Robier A. Residual cholesteatoma: prevalence and location. Follow-up strategy in adults. European Annals of Otorhinolaryngology Head and Neck Diseases 2012; 129(3): 136-140. doi: 10.1016/j. anorl.2011.01.009
10. Khemani S, Singh A, Lingam RK, Kalan A. Imaging of postoperative middle ear cholesteatoma. Clinical Radiology 2011; 66(8): 760-767. doi: 10.1016/j.crad.2010.12.019
11. Corrales CE, Blevins NH. Imaging for evaluation of cholesteatoma: current concepts and future directions. Current Opinion in Otolaryngology & Head and Neck Surgery 2013; 21(5): 461- 467. doi: 10.1097/MOO.0b013e328364b473
12. Wake M, Robinson JM, Witcombe JB, Bazerbachi S, Stansbie JM et al. Detection of recurrent cholesteatoma by computerized tomography after ‘closed cavity’ mastoid surgery. Journal of Laryngology & Otology 1992; 106(5): 393-395. doi: 10.1017/ s0022215100119644
13. Miles KA, Ganeshan B, Hayball MP. CT texture analysis using the filtration-histogram method: what do the measurements mean? Cancer Imaging 2013; 13(3): 400-406. doi: 10.1102/1470- 7330.2013.9045
14. Ganeshan B, Panayiotou E, Burnand K, Dizdarevic S, Miles K. Tumour heterogeneity in non-small cell lung carcinoma assessed by CT texture analysis: a potential marker of survival. European Radiology 2012; 22(4): 796-802. doi: 10.1007/ s00330-011-2319-8
15. Kurtul N, Yurttutan N, Baykara M. Investigation of the radiotherapy-related changes in the eye lens using computed tomography entropy analysis. Journal of X-Ray Science and Technology 2018; 26(5): 747-755. doi: 10.3233/XST-18373
16. Lubner MG, Smith AD, Sandrasegaran K, Sahani DV, Pickhardt PJ. CT Texture Analysis: Definitions, Applications, Biologic Correlates, and Challenges. Radiographics 2017; 37(5): 1483- 1503. doi: 10.1148/rg.2017170056
17. Park HJ, Lee SM, Song JW, Lee SM, Oh SY et al. Texture-Based Automated Quantitative Assessment of Regional Patterns on Initial CT in Patients With Idiopathic Pulmonary Fibrosis: Relationship to Decline in Forced Vital Capacity. American Journal of Roentgenology 2016; 207(5): 976-983. doi: 10.2214/ AJR.16.16054
18. Daginawala N, Li B, Buch K, Yu H, Tischler B et al. Using texture analyses of contrast enhanced CT to assess hepatic fibrosis. European Journal of Radiology 2016; 85(3): 511-517. doi: 10.1016/j.ejrad.2015.12.009
19. Baykara S, Baykara M, Mermi O, Yildirim H, Atmaca M. Magnetic resonance imaging histogram analysis of corpus callosum in a functional neurological disorder. Turkish Journal of Medical Sciences 2021;51(1): 140-147. doi: 10.3906/sag-2004-252
20. Galdino E. Valvassori, Mahmood F. Mafee, Barbara L. Carter. Imaging of the Head and Neck. 2005. 2nd ed. Michigan University, G. Thieme Verlag; 68-89.
21. Tok S, Altınkaya N, Ozer F. Comparison Of Middle Ear Soft Tissue Density Of Chronic Otitis Media With Cholesteatoma By CT. Ear Nose Throat Updates 2018; 8(2): 79-81. doi: 10.32448/entupdates.458964
22. Park MH, Rah YC, Kim YH, Kim JH. Usefulness of computed tomography Hounsfield unit density in preoperative detection of cholesteatoma in mastoid ad antrum. American Journal of Otolaryngology 2011; 32(3): 194-197. doi:10.1016/j. amjoto.2010.01.008
23. Levi C, Gray JE, McCullough EC, Hattery RR. The unreliability of CT numbers as absolute values. American Journal of Roentgenology 1982; 139(3): 443-447. doi: 10.2214/ ajr.139.3.443