Diffusion-weighted magnetic resonance imaging in the detection of residual and recurrent cholesteatoma in children: A systematic review and meta-analysis

Bazzi, Khalil; Wong, Eugene; Jufas, Nicholas; Patel, Nirmal

doi:10.1016/j.ijporl.2018.12.031

Cited by 22 publications

(18 citation statements)

References 25 publications

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“…Unlike canal wall down mastoidectomy, visual inspection of canal wall up mastoidectomy can be challenging; hence, a reliable diagnostic imaging tool is desirable for accurate follow-up diagnosis and treatment. [5][6][7] Preoperative high-resolution CT is the method of choice for the detection of osseous disintegration and is sufficient for diagnosis; however, for recurrent cholesteatoma after surgery, its role may be more limited. 8 MR imaging is suitable for the assessment pre-and postsurgery using DWI and delayed postcontrast T1-weighted spin-echo imaging, which enable differentiation between keratinous debris and noncholesteatoma findings such as granulation tissue or scar.…”

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confidence: 99%

Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics

Wiesmueller

Wuest

May

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The high diagnostic value of DWI for cholesteatoma diagnostics is undisputed. This study compares the diagnostic value of readout-segmented echo-planar DWI and single-shot TSE DWI for cholesteatoma diagnostics. MATERIALS AND METHODS:Thirty patients with newly suspected cholesteatoma were examined with a dedicated protocol, including readout-segmented echo-planar DWI and single-shot TSE DWI at 1.5T. Acquisition parameters of both diffusion-weighted sequences were as follows: b=1000 s/mm, 2 axial and coronal section orientations, and section thickness of 3 mm. Image quality was evaluated by 2 readers on a 5-point Likert scale with respect to lesion conspicuity, the presence of susceptibility artifacts mimicking cholesteatomas, and overall subjective image quality. Sensitivity and specificity were calculated using histology results as the gold standard.RESULTS: Twenty-five cases of histologically confirmed cholesteatomas were included in the study group. Lesion conspicuity was higher and fewer artifacts were found when using TSE DWI (both P , .001). The overall subjective image quality, however, was better with readout-segmented DWI. For TSE DWI, the sensitivity for readers 1 and 2 was 92% (95% CI, 74%-99%) and 88% (95% CI, 69%-97%), respectively, while the specificity for both readers was 80% (95% CI, 28%-99%). For readout-segmented DWI, the sensitivity for readers 1 and 2 was 76% (95% CI, 55%-91%) and 68% (95% CI, 46%-85%), while the specificity for both readers was 60% (95% CI, 15%-95%). CONCLUSIONS:The use of TSE DWI is advisable for cholesteatoma diagnostics and preferable over readout-segmented DWI.ABBREVIATIONS: rsDWI ¼ readout-segmented echo-planar DWI; tseDWI ¼ TSE DWI C holesteatoma is a common non-neoplastic disease in otology,

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Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics

Wiesmueller

Wuest

May

et al. 2021

AJNR Am J Neuroradiol

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“…The higher rate of recidivism dictates second-look surgery after canal wall up mastoidectomy. Second-look surgery is not without its drawbacks, including the financial burden of the second surgery on patient and institution, risk of anesthesia, and challenges related to altered anatomical landmarks due to previous surgery [43]. Different surgical techniques have been performed to overcome the disadvantages of CWU (high recidivism rates) and CWD (cavity problems) mastoidectomy including reconstruction of canal using cartilage and cortical bone [4] and using endoscopes for superior exposure of hidden spots in middle ear especially sinus tympani which represents most common site of recidivism during cholesteatoma surgery [44].…”

Section: Discussionmentioning

confidence: 99%

Recidivism of childhood cholesteatoma and surgical techniques: a meta-analysis study

Shewel

Tawfik

Aaref

et al. 2020

Egypt J Otolaryngol

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Background There is a debate in the literature about surgical management of childhood cholesteatoma. We aimed to conduct a meta-analysis study about the recidivism of acquired cholesteatoma in children after two primary surgical procedures, namely canal wall up (CWU) and canal wall down (CWD) mastoidectomy. Main body of the abstract A Medline search of English language literature on PubMed and Cochrane Collaboration from their dates of inception until August 2019 was conducted using the following search terms: “pediatric or child and Cholesteatoma Surgery”. Twenty-eight full-text papers fulfilled the selection criteria and were included in this meta-analysis This analysis showed an odd risk of 1.72 for recidivism of childhood cholesteatoma in single-stage canal wall up procedure relative to canal wall down procedures. The 95% confidence interval (CI) for the overall odds ratio was 1.27–2.34. The I2 statistic was 37%, representing low heterogeneity. Comparing the rate of recidivism before and after the year 2000 showed that there was still increased risk of recidivism in the canal wall up versus canal wall down mastoidectomy (the odds ratio was 1.87 and 1.57 respectively). Short conclusion Single-stage canal wall up mastoidectomy was significantly associated with a higher risk of cholesteatoma recidivism compared to canal wall down technique in children with acquired cholesteatoma

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“…It has previously been reported that diffusion-weighted imaging can detect small cholesteatoma up to 2–3 mm in diameter; however, large cholesteatoma up to 5 mm may be missed because of the lack of necessary keratin needed to show restricted diffusion. 19–22…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have discussed the role of diffusion-weighted imaging for the differentiation of recurrent cholesteatoma from granulation tissue. 19–27 This paper describes the use of diffusion-weighted imaging and delayed contrast MRI in the evaluation of recurrent cholesteatoma. This study aimed to assess the reliability of diffusion-weighted imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy.…”

Section: Introductionmentioning

confidence: 99%

Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy

Razek

Ashraf

et al. 2019

J. Laryngol. Otol.

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ObjectiveTo assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy.MethodsA prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients.ResultsCholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ = 0.72, p = 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ = 0.57, p = 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ = 0.994, p = 0.001).ConclusionDiffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.

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Diffusion-weighted magnetic resonance imaging in the detection of residual and recurrent cholesteatoma in children: A systematic review and meta-analysis

Cited by 22 publications

References 25 publications

Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics

Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics

Recidivism of childhood cholesteatoma and surgical techniques: a meta-analysis study

Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy

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