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Case Report
In vivo and ex vivo interrogation of the spectral properties of a middle ear and mastoid cholesteatoma
1 MD, Physician, Department of Otolaryngology, New York University Langone Health, New York, NY, USA
2 MD, Physician, Department of Radiology, New York University Langone Health, New York, NY, USA
3 Senior Staff Scientist, Siemens Healthineers, Malvern, PA 19355, USA
4 Medical Student, Department of Otolaryngology, New York University Langone Health, New York, NY, USA
5 MD, Physician, Department of Pathology, New York University Langone Health, New York, NY, USA
6 MD, Department of Radiology, New York University Langone Health, New York, NY, USA
Address correspondence to:
Justin Cottrell
MD, Department of Otolaryngology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10010,
USA
Message to Corresponding Author
Article ID: 100020Z18JC2026
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How to cite this article
Cottrell J, Dogra S, O’Donnell T, Scudder M, Liu CZ, McMenomey S, Jethanamest D, Moonis G. In vivo and ex vivo interrogation of the spectral properties of a middle ear and mastoid cholesteatoma. J Case Rep Images Otolaryngol 2026;5(1):6–11.ABSTRACT
Introduction: We sought to compare in vivo and ex vivo spectral properties of a recurrent middle ear and mastoid cholesteatoma.
Case Report: A 25-year-old male with clinically suspected recurrent cholesteatoma four years after a canal wall up mastoidectomy was consented for the study. He underwent preoperative computed tomography (CT) imaging of the temporal bone on a Photon Counting CT scanner followed by right tympanomastoidectomy with cholesteatoma removal. The cholesteatoma specimen was separated into mastoid and middle ear samples that were packed in two centrifuge tubes and placed in a phantom to scan on a dual energy computed tomography (DECT) scanner. Following post-processing, regions-of-interest (ROIs) were placed on pre- and post-operative images and iodine densities were compared. On in vivo images, iodine densities were 0.9 mg/mL in a mastoid ROI, 0.3 mg/mL in an aditus ad antrum ROI, −0.7 mg/mL in a middle ear ROI and 0 mg/mL in a right cerebellar ROI (used as reference). On ex vivo images, iodine densities were 0.1 mg/mL in both the mastoid and tympanic specimens.
Conclusion: In vivo cholesteatoma iodine densities differed based on location. The mastoid iodine density was higher than ex vivo cholesteatoma iodine densities, which may reflect a combination of beam hardening artifact on in vivo images, sample rinsing before transfer to the centrifuge tubes, and different scanners used for in vivo and ex vivo images. Additional research is needed to better understand variations in in vivo and ex vivo findings to facilitate accurate dual energy spectral analysis.
Keywords: Cholesteatoma, Dual energy, Photon counting, Spectral properties
SUPPORTING INFORMATION
Author Contributions
Justin Cottrell - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Siddhant Dogra - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Thomas O’Donnell - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Michael Scudder - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Cheng Z Liu - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sean McMenomey - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Daniel Jethanamest - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Gul Moonis - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Justin Cottrell et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
