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

Authors: NURSEL YURTTUTAN, NAGİHAN BİLAL, BETÜL KIZILDAĞ, ADEM DOĞANER

Abstract: 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 pre- operatively (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.

Keywords: Histogram analysis, temporal bone, computed tomography, cholesteatoma

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