The diagnostic value of diffusion-weighted magnetic resonance imaging in detecting a residual cholesteatoma.

In this evidence-based case report, we address the following clinical question: What is the predictive value of diffusion-weighted magnetic resonance imaging (DW MRI) for detecting a residual cholesteatoma in patients with chronic otitis media with cholesteatoma who have previously undergone a canal-wall-up procedure? We searched for relevant synonyms for the determinant, MRI, and for the outcome, cholesteatoma, and retrieved relevant publications in Embase, PubMed, Cinahl, and Web of Science by using search terms in the title and abstract fields. The search yielded 683 records, of which 11 were relevant and valid for our clinical question. We pooled the data of the MRI findings of the included studies by adding the two-by-two tables of the individual studies. For the eight echo planar imaging (EPI) DW MRI studies, this resulted in a pooled sensitivity, specificity, positive predictive value, and negative predictive value of 68 percent, 87 percent, 81 percent, and 78 percent, respectively. For the three non-echo planar (non-EPI) DW MRI studies, the sensitivity, specificity, positive predictive value, and negative predictive value were 97 percent, 97 percent, 97 percent, and 97 percent, respectively. DW MRI, especially the non-EPI DW MRI, appears to be a rather accurate method, as opposed to a standard second-look operation, for the follow-up of patients who have undergone a canal-wall-up procedure for a chronic otitis media with cholesteatoma and who have no clinical signs of recurrent cholesteatoma. 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.