A Lecler1, M Lenoir2, J Peron3, F Denoyelle4, E N Garabedian4, H Ducou le Pointe2, J Nevoux5. 1. Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France; Service de Neuroradiologie diagnostique, Fondation Rothschild, 25 rue Manin, 75019 Paris, France. Electronic address: alecler@fo-rothschild.fr. 2. Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France. 3. Centre anticancéreux Léon Bérard, Oncologie Médicale, 28 rue Laennec, 69008 Lyon, France. 4. Service d'Oto-Rhino-Laryngologie pédiatrique, Hôpital Necker, Université Paris René Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France. 5. Service d'Oto-Rhino-Laryngologie, INSERM U1185, Hôpital Bicêtre, Université Paris Sud, Assistance Publique Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
Abstract
OBJECTIVE: To compare the residual cholesteatoma detection accuracy of diffusion-weighted (DW) and T1 delayed sequences for magnetic resonance at one year postoperative with second-look surgery in pediatric patients who have undergone primary middle ear surgery for cholesteatoma. METHODS: This was a prospective monocentric consecutive study conducted in a tertiary academic referral center. Children were referred for MR imaging (MRI) one year after surgery. A 1.5T MRI was utilized, using nonecho-planar DW images and delayed gadolinium-enhanced T1-weighted images. Accuracy of magnetic resonance imaging was assessed by two radiologists before surgery. Interobserver and intraobserver agreements were assessed using the κ test. Magnetic resonance imaging data were compared with surgery, which was considered as the gold standard. RESULTS: Twenty-four consecutive unselected pediatric patients were included. Sensitivity, specificity, positive predictive value, and negative predictive value for the first observer were of 40%, 86%, 67%, and 67%, respectively, and those for the second observer were 30%, 86%, 60%, and 63%, respectively. The only two cholesteatoma with a size superior to 3mm were diagnosed before surgery, but the majority of small cholesteatoma were not detected. CONCLUSIONS: MRI is a key examen to diagnosed the residual cholesteatoma but is limited by the size of the lesion under 3mm. Delaying the realization of MRI during follow-up could increase sensitivity, thus avoiding misdiagnosis as well as unnecessary second look surgery.
OBJECTIVE: To compare the residual cholesteatoma detection accuracy of diffusion-weighted (DW) and T1 delayed sequences for magnetic resonance at one year postoperative with second-look surgery in pediatric patients who have undergone primary middle ear surgery for cholesteatoma. METHODS: This was a prospective monocentric consecutive study conducted in a tertiary academic referral center. Children were referred for MR imaging (MRI) one year after surgery. A 1.5T MRI was utilized, using nonecho-planar DW images and delayed gadolinium-enhanced T1-weighted images. Accuracy of magnetic resonance imaging was assessed by two radiologists before surgery. Interobserver and intraobserver agreements were assessed using the κ test. Magnetic resonance imaging data were compared with surgery, which was considered as the gold standard. RESULTS: Twenty-four consecutive unselected pediatric patients were included. Sensitivity, specificity, positive predictive value, and negative predictive value for the first observer were of 40%, 86%, 67%, and 67%, respectively, and those for the second observer were 30%, 86%, 60%, and 63%, respectively. The only two cholesteatoma with a size superior to 3mm were diagnosed before surgery, but the majority of small cholesteatoma were not detected. CONCLUSIONS: MRI is a key examen to diagnosed the residual cholesteatoma but is limited by the size of the lesion under 3mm. Delaying the realization of MRI during follow-up could increase sensitivity, thus avoiding misdiagnosis as well as unnecessary second look surgery.
Authors: A-L Fourez; M Akkari; G Gascou; P-H Lefevre; C Duflos; A Kaderbay; M Mondain; F Venail Journal: AJNR Am J Neuroradiol Date: 2021-04-15 Impact factor: 4.966