{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T12:52:39Z","timestamp":1767703959982,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T00:00:00Z","timestamp":1745625600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Surgical removal is the treatment of choice for cholesteatoma control. Depending on the size, the surgery involves partial resection of the ossicular chain and, if necessary, the bony skull base. Titanium foreign materials (prostheses, meshes) can be used to restore sound transmission and to cover larger defects of the skull base. After the operation, recurrence and residual control are necessary. This can be achieved by means of second-look surgery or an MRI examination with a non-EPI DWI sequence. Similarly to other metal implants, artifacts may occur in the image due to the titanium used. In this study, we assessed the magnitude of the MRI hardware differences induced by titanium prostheses and meshes and whether these differences could obscure cholesteatoma detection. Methods: 28 MRI examinations (T1-, T2-, non-EPI DWI sequences) in 14 males and 14 females (5.2\u201392.4 years) after cholesteatoma surgery and single-staged implantation of a PORP, TORP, or titanium mesh were considered. The size of the respective artifacts was measured, and the mean artifact sizes of the respective prosthesis types were compared. A second look surgery was performed in all cases due to the MRI result or clinical findings. Both were also compared. Results: Artifacts occurred in all titanium foreign bodies depending on the used MRI sequence (PORP, TORP, Mesh). We found a positive association between the size of the prosthesis and the size of the artifact. All subsequent second-look surgeries confirmed the MRI examinations according to a positive control for the presence of cholesteatoma. The detection rate was 82.1%. All false results were false negatives, and there were no positive results. Conclusions: Titanium material-related artifacts might influence the MRI detectability of recurrent cholesteatoma. Small cholesteatoma might be missed by an MRI-based follow-up. This finding supports the reevaluation of single-stage versus staged reconstruction modern approaches.<\/jats:p>","DOI":"10.3390\/jcm14092995","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T06:23:32Z","timestamp":1745821412000},"page":"2995","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Titanium Artifacts on Cholesteatoma in Magnetic Resonance Imaging After Reconstruction of the Middle Ear"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1624-0367","authenticated-orcid":false,"given":"Christoph J.","family":"Pfeiffer","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Klinikum Bielefeld Mitte, Bielefeld University, Teutoburger Str. 50, 33604 Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denis","family":"Mihailovic","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical School OWL, Klinikum Bielefeld Mitte, Bielefeld University, Teutoburger Str. 50, 33604 Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Bj\u00f6rn","family":"Gehl","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical School OWL, Klinikum Bielefeld Mitte, Bielefeld University, Teutoburger Str. 50, 33604 Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars-Uwe","family":"Scholtz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Klinikum Bielefeld Mitte, Bielefeld University, Teutoburger Str. 50, 33604 Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Kilgue","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Klinikum Bielefeld Mitte, Bielefeld University, Teutoburger Str. 50, 33604 Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conrad","family":"Riemann","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Klinikum Bielefeld Mitte, Bielefeld University, Teutoburger Str. 50, 33604 Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7579-7144","authenticated-orcid":false,"given":"Dina","family":"Voeltz","sequence":"additional","affiliation":[{"name":"Biostatistics and Medical Biometrics, Medical School OWL, Bielefeld University, Universit\u00e4tsstr. 25, 33615 Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4161-8304","authenticated-orcid":false,"given":"Ingo","family":"Todt","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Klinikum Bielefeld Mitte, Bielefeld University, Teutoburger Str. 50, 33604 Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.ijporl.2016.01.008","article-title":"Analysis of histopathological aspects and bone destruction characteristics in acquired middle ear cholesteatoma of pediatric and adult patients","volume":"82","author":"Erdag","year":"2016","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1258\/0022215021910960","article-title":"Staging and management of primary cerebellopontine cholesteatoma","volume":"116","author":"Moffat","year":"2002","journal-title":"J. Laryngol. Otol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Cucu, A.I., Patrascu, R.E., Cosman, M., Costea, C.F., Vonica, P., Blaj, L.A., Hartie, V., Istrate, A.C., Prutianu, I., and Boisteanu, O. (2023). Cerebellar Abscess Secondary to Cholesteatomatous Otomastoiditis-An Old Enemy in New Times. Diagnostics, 13.","DOI":"10.3390\/diagnostics13233566"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1097\/MAO.0000000000004172","article-title":"Outcomes of Soft Versus Bony Canal Wall Reconstruction with Mastoid Obliteration","volume":"45","author":"Vesole","year":"2024","journal-title":"Otol. Neurotol."},{"key":"ref_5","unstructured":"Brar, S., Watters, C., and Winters, R. (2024). Tympanoplasty, StatPearls."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1097\/SCS.0b013e31817bd83e","article-title":"Reconstruction of cranial bone defects using a quick-setting hydroxyapatite cement and absorbable plates","volume":"19","author":"Ascherman","year":"2008","journal-title":"J. Craniofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1002\/lary.23840","article-title":"Reconstruction of cranial base defects using the Medpor Titan implant: Cranioplasty applications in acoustic neuroma surgery","volume":"123","author":"Boghani","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s11547-019-01085-x","article-title":"Role of non-echo-planar diffusion-weighted images in the identification of recurrent cholesteatoma of the temporal bone","volume":"125","author":"Romano","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"D\u00edaz Zufiaurre, N., Calvo-Imirizaldu, M., Lorente-Piera, J., Dom\u00ednguez-Ech\u00e1varri, P., Fontova Porta, P., Manrique, M., and Manrique-Huarte, R. (2024). Toward Improved Detection of Cholesteatoma Recidivism: Exploring the Role of Non-EPI-DWI MRI. J. Clin. Med., 13.","DOI":"10.3390\/jcm13092587"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1055\/s-2003-36905","article-title":"Wie verhalten sich metallhaltige Mittelohrimplantate in der Kernspintomographie?","volume":"82","author":"Kwok","year":"2003","journal-title":"Laryngorhinootologie."},{"key":"ref_11","first-page":"1285","article-title":"Metallische Implantate im MRT\u2014Gefahren und Bildartefakte","volume":"193","author":"Peschke","year":"2021","journal-title":"Rofo"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1097\/MAO.0b013e3182001ef4","article-title":"Petrous bone cholesteatoma removal with hearing preservation","volume":"32","author":"Senn","year":"2011","journal-title":"Otol. Neurotol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1002\/lary.25591","article-title":"The disease recurrence rate after the canal wall up or canal wall down technique in adults","volume":"126","author":"Kerckhoffs","year":"2016","journal-title":"Laryngoscope"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1177\/0194599815613073","article-title":"A Systematic Review of Non-Echo Planar Diffusion-Weighted Magnetic Resonance Imaging for Detection of Primary and Postoperative Cholesteatoma","volume":"154","author":"Stegeman","year":"2016","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1111\/coa.12762","article-title":"Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: A systematic review and meta-analysis","volume":"42","author":"Muzaffar","year":"2017","journal-title":"Clin. Otolaryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"111172","DOI":"10.1016\/j.ijporl.2022.111172","article-title":"Post-operative MRI detection of residual cholesteatoma in pediatric patients\u2014The yield of serial scans over a long follow-up","volume":"158","author":"Yosefof","year":"2022","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1002\/ohn.398","article-title":"Performance of Non-EPI DW MRI for Pediatric Cholesteatoma Follow-Up","volume":"170","author":"Daoudi","year":"2024","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"221","DOI":"10.3174\/ajnr.A2052","article-title":"Neuroradiology of cholesteatomas","volume":"32","author":"Huber","year":"2011","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_19","first-page":"20180015","article-title":"Cholesteatoma: Multishot echo-planar vs non echo-planar diffusion-weighted MRI for the prediction of middle ear and mastoid cholesteatoma","volume":"1","author":"Dudau","year":"2019","journal-title":"BJR Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1007\/s00405-021-06958-4","article-title":"Impact of COVID-19 pandemic on the incidence of otitis media with effusion in adults and children: A multicenter study","volume":"279","author":"Iannella","year":"2022","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1017\/S0022215123000117","article-title":"Cartilage grafts mimicking cholesteatoma recurrence on diffusion-weighted magnetic resonance imaging: A case series","volume":"137","author":"Walters","year":"2023","journal-title":"J. Laryngol. Otol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1097\/MAO.0b013e31822e938d","article-title":"A systematic review of diffusion-weighted magnetic resonance imaging in the assessment of postoperative cholesteatoma","volume":"32","author":"Jindal","year":"2011","journal-title":"Otol. Neurotol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ferlito, S., La Mantia, I., Caruso, S., Cammaroto, G., Chiesa-Estomba, C.M., Iannella, G., Nocera, F., Ingrassia, A., Cocuzza, S., and Vicini, C. (2022). High Definition Three-Dimensional Exoscope (VITOM 3D) in E.N.T. Surgery: A Systematic Review of Current Experience. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133639"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/2995\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:22:05Z","timestamp":1760030525000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/2995"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,26]]},"references-count":23,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14092995"],"URL":"https:\/\/doi.org\/10.3390\/jcm14092995","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,4,26]]}}}