|Beitragstitel||Utility of non-echoplanar diffusion-weighted magnetic resonance imaging in the diagnosis of recurrent or residual cholesteatoma|
We aimed to determine the value of non-echoplanar diffusion weighted magnetic resonance imaging (NEP DW-MRI) in diagnosing residual or recurrent middle ear cholesteatoma before second look surgery.
In a monocentric retrospective study, we studied patients previously operated for cholesteatoma who underwent NEP DWI-MRI prior to second look surgery by a single surgeon.
34 patients met the inclusion criteria. 18 patients (51,42%) presented with recurrent or residual cholesteatoma, of which 12 were detected upon DWI-MRI (true positives) and 6 were not (false negatives). 17 had no cholesteatoma, of which 13 were correctly excluded on MRI (true negatives) and 4 were incorrectly diagnosed with disease (false positives). Overall sensitivity was 66,6% and specificity was 76,4%.
In our setting MRI cannot at this time effectively replace second look surgeries for all patients but contributes to individualized decision-making.
Second look surgery remains indicated for high risk cases (extensive cholesteatoma, low surgeon confidence in total removal), positive or changing MRI findings, clinically suspicious cases and patients undergoing second stage surgery. Watchful waiting & follow up imaging should be reserved for low risk cases with negative MRIs. NEP DW-MRI sequences remain up to date superior to other MRI sequences and other imaging modalities, but they require experienced radiologists and surgeons, thus training should be encouraged.