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 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)=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.