Performance of Non‐EPI DW MRI for Pediatric Cholesteatoma Follow‐Up

AbstractObjectiveTo evaluate the accuracy, sensitivity, and specificity of nonecho planar (non‐EPI) diffusion‐weighted (DW) magnetic resonance imaging (MRI) to detect residual cholesteatoma in children.Study DesignRetrospective study.SettingTertiary comprehensive hospital.MethodsChildren operated on for a first‐stage cholesteatoma procedure from 2010 to 2019 were included. MRIs were performed with non‐EPI DW sequences. Initial reports were collected, indicating the presence or absence of hyperintensity suggestive of cholesteatoma. Three hundred twenty‐three MRIs were correlated with the subsequent surgery (66%) or year‐later MRI (21%), or were considered accurate if performed 5 years or more after the last surgery (13%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging procedure for the detection of cholesteatoma were calculated.ResultsTwo hundred twenty‐four children with mean age of 9 ± 4 years old presented with cholesteatoma. MRIs were performed 27 ± 24 months after surgery. Residual cholesteatoma was diagnosed in 35%. The sensitivity, specificity, PPV, and NPV of MRI were 62%, 86%, 74%, and 78%, respectively. Accuracy, sensitivity, and specificity increased significantly over time (multivariate analysis). The mean delay after last surgery was of 30 ± 2.0 months for accurate MRI (true positive or negative) versus 17 ± 2.0 months for nonaccurate (false positive or negative) MRIs (p < .001).ConclusionHowever, long the delay after the last surgery, the sensitivity of non‐EPI diffusion sequence MRI in children has limitations for the detection of residual cholesteatoma. Surveillance for residual cholesteatoma should incorporate findings at primary surgery, surgeon experience, a low threshold for second‐look procedures, and routine imaging.