Magnetic resonance imaging at one year for detection of postoperative residual cholesteatoma in children: Is it too early?

Lenoir, Marion; Péron, Julien; Denoyelle, Françoise; Garabédian, E. N.; Pointe, Hubert Ducou Le; Nevoux, J.

doi:10.1016/j.ijporl.2015.05.028

Cited by 22 publications

(19 citation statements)

References 24 publications

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“…There are many studies to date that have evaluated the performance of non-echoplanar DWI in detecting post-operative cholesteatoma [ 2 , 8 , 12 – 23 , 25 , 29 – 39 ]. They are all observational studies with some studies having mixed post-operative and primary cholesteatoma cases in their study samples.…”

Section: Diagnostic Performance In Detecting Post-operative Cholesteamentioning

confidence: 99%

“…Occasionally slightly larger cholesteatoma up to 5 mm can be missed, presumably due to the nature of the cholesteatoma (lack of necessary keratin to return high DWI signal or poor image quality (movement artefact) [ 3 , 18 , 38 ] . There are a few studies in the literature with lower reported sensitivities than expected, this being attributed to a larger proportion in their study sample of cholesteatoma less than 3 mm in size [ 17 , 29 ]. In addition, no difference was demonstrated between the performance using a 3T scanner [ 17 , 25 ] and a 1.5T scanner, both equally limited in reliably detecting cholesteatomas less than 2–3 mm.…”

Section: Pitfalls In Sensitivitymentioning

confidence: 99%

“…In addition, no difference was demonstrated between the performance using a 3T scanner [ 17 , 25 ] and a 1.5T scanner, both equally limited in reliably detecting cholesteatomas less than 2–3 mm. Other less common causes of false negative cases described in the current literature include auto-atticotomy (an epithelial lined sac) [ 8 , 23 , 29 , 32 ], aspiration of cholesteatoma on microsuction [ 23 ], and patient movement artefacts [ 37 ].

Fig.…”

Section: Pitfalls In Sensitivitymentioning

confidence: 99%

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Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl

et al. 2016

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Non-echoplanar diffusion weighted magnetic resonance imaging (DWI) has established itself as the modality of choice in detecting and localising post-operative middle ear cleft cholesteatoma. Despite its good diagnostic performance, there are recognised pitfalls in its radiological interpretation which both the radiologist and otologist should be aware of. Our article highlights the various pitfalls and provides guidance for improving radiological interpretation and navigating beyond many of the pitfalls. It is recommended radiological practice to interpret the diffusion weighted images together with the ADC map and supplement with the corresponding T1 weighted and T2 weighted images, all of which can contribute to and enhance lesion localisation and characterisation. ADC values are also helpful in improving specificity and confidence levels. Given the limitation in sensitivity in detecting small cholesteatoma less than 3 mm, serial monitoring with DWI over time is recommended to allow any small residual cholesteatoma pearls to grow and become large enough to be detected on DWI. Optimising image acquisition and discussing at a joint clinico-radiological meeting both foster good radiological interpretation to navigate beyond the pitfalls and ultimately good patient care.Teaching Points• Non-echoplanar DWI is the imaging of choice in detecting post-operative cholesteatoma.• There are recognised pitfalls which may hinder accurate radiological interpretation.• Interpret with the ADC map /values and T1W and T2W images.• Serial DWI monitoring is of value in detection and characterisation.• Optimising image acquisition and discussing at clinico-radiological meetings enhance radiological interpretation.

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Section: Diagnostic Performance In Detecting Post-operative Cholesteamentioning

confidence: 99%

Section: Pitfalls In Sensitivitymentioning

confidence: 99%

Fig.…”

Section: Pitfalls In Sensitivitymentioning

confidence: 99%

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Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl

et al. 2016

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“…Non-EPI-DWI MRI is a very helpful tool in monitoring the disease and trying to avoid unnecessary surgical revisions. Most authors would consider MRI at 1 year postoperatively, otherwise explorative tympanoplasty in recommended [32].…”

Section: Endoscopic Approach To Cholesteatomamentioning

confidence: 99%

Endoscopic Ear Surgery in Children

Zinis¹,

Nassif²

2020

The Human Auditory System - Basic Features and Updates on Audiological Diagnosis and Therapy

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Endoscopic assistance is gradually gaining recognition in otology not only for office examinations but also during surgery. The first endoscopic surgical procedure that was started in our institution was endoscopic ventilation tube placement to manage children with stenotic and curved canals. Following this, endoscopy was used in all type I tympanoplasty and stage I cholesteatoma removals with the advantage of avoiding a postauricular or endaural approach. The last application of endoscopic assistance was to better visualize round window and scala tympani via posterior tympanotomy during cochlear implantation. There are several advantages in using endoscopes: the wide view obtained and the possibility to observe areas behind the angle with less invasiveness and its excellent resolution, in addition to its intense light and higher magnification that facilitates teaching and tutoring. The limits of endoscopic surgery are that one hand is always needed to hold the endoscope and the lack of a third dimension. Until miniaturization of 3D systems allow the possibility to work in the narrow external ear canal, in order to overcome the limitation that one hand is dedicated to the endoscope, we will describe the use of an endoscope holder in otologic procedures.

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“…Most authors agree that imaging follow-up should not start ,12 months postsurgery, [5][6][7][8] to reduce the number of false-negatives due to residual cholesteatomas measuring ,2 mm. 9 Nevertheless, the optimal duration of follow-up necessary to exclude the existence of a residual cholesteatoma if the findings of the first MR imaging are considered normal is unclear.…”

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confidence: 99%

Optimal Duration of MRI Follow-up to Safely Identify Middle Ear Residual Cholesteatoma

Fourez¹,

Akkari²,

Gascou

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Previous studies have demonstrated the usefulness of non-EPI DWI for detection of residual cholesteatoma. However, limited data are available to determine the suitable duration of imaging follow-up after a first MR imaging with normal findings has been obtained. The present study aimed to determine the optimal duration of non-EPI DWI follow-up for residual cholesteatoma. MATERIALS AND METHODS:A retrospective, monocentric study was performed between 2013 and 2019 and included all participants followed up after canal wall up tympanoplasty with at least 2 non-EPI DWI examinations performed on the same 1.5T MR imaging scanner. MR images were reviewed independently by 2 radiologists. Sensitivity and specificity values were calculated as a function of time after the operation. Receiver operating characteristic curves were analyzed to determine the optimal follow-up duration. RESULTS:We analyzed 47 MRIs from 17 participants. At the end of the individual follow-up period, a residual cholesteatoma had been found in 41.1% of cases. The follow-up duration ranged from 20 to 198 months (mean, 65.9 [SD, 43.9] months). Participants underwent between 2 and 5 non-EPI DWI examinations. Analyses of the receiver operating characteristic curves revealed that the optimal diagnostic value of non-EPI DWI occurred 56 months after the operation when the first MR imaging performed a mean of 17.3 (SD, 6.8) months after the operation had normal findings (sensitivity ¼ 0.71; specificity ¼ 0.7, Youden index ¼ 0.43).CONCLUSIONS: Repeat non-EPI DWI is required to detect slow-growing middle ear residual cholesteatomas. We, therefore, recommend performing non-EPI DWI for at least the first 5 years after the initial operation.

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Magnetic resonance imaging at one year for detection of postoperative residual cholesteatoma in children: Is it too early?

Cited by 22 publications

References 24 publications

Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl

Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl

Endoscopic Ear Surgery in Children

Optimal Duration of MRI Follow-up to Safely Identify Middle Ear Residual Cholesteatoma

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