Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis.

BACKGROUND: Diagnosis and management of recurrent or residual cholesteatoma can be problematic. Diffusion-weighted imaging magnetic resonance imaging (MRI) sequences have been used for follow-up of such lesions. More recent non-echoplanar imaging (non-EPI) sequences are thought to be superior to older echoplanar imaging (EPI) sequences.

OBJECTIVE OF REVIEW: Evaluate whether diffusion-weighted magnetic resonance imaging is useful in the diagnosis of recurrent or residual cholesteatoma.

TYPE OF REVIEW: Systematic review and meta-analysis.

SEARCH STRATEGY: MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Database were searched, with no limits on date or language.

STUDY SELECTION: Adults or children who had previously undergone tympanomastoid surgery by any method with confirmation of recurrence/residual disease by second-look/revision surgery.

EVALUATION METHODS: Two reviewers independently reviewed studies. Data extracted on 11 domains and rechecked.

DATA SYNTHESIS: Statistical analysis with SPSS.

RESULTS: A total of 575 studies were identified of which 27 met the inclusion criteria. These covered 727 patient episodes. For EPI studies: sensitivity (sd) 71.82 (24.5), specificity (sd) 89.36 (13.4), PPV (sd) 93.36 (8.1) and NPV (sd) 73.36 (15.8). For non-EPI studies: sensitivity 89.79 (12.1), specificity (sd) 94.57 (5.8), PPV (sd) 96.50 (4.2) and NPV 80.46 (20.2). Improved sensitivity of non-EPI sequences reached significance (P = 0.02).

CONCLUSIONS: Diffusion-weighted MRI is both sensitive and specific for the detection of recurrent or residual cholesteatoma following ear surgery. Non-EPI techniques are superior to EPI techniques.