Diffusion-weighted magnetic resonance imaging in the detection of residual and recurrent cholesteatoma in children: A systematic review and meta-analysis

Khalil Bazzi; Eugene Wong; Nicholas Jufas; Nirmal Patel

doi:10.1016/j.ijporl.2018.12.031

Diffusion-weighted magnetic resonance imaging in the detection of residual and recurrent cholesteatoma in children: A systematic review and meta-analysis

Int J Pediatr Otorhinolaryngol. 2019 Mar:118:90-96. doi: 10.1016/j.ijporl.2018.12.031. Epub 2018 Dec 26.

Authors

Khalil Bazzi¹, Eugene Wong², Nicholas Jufas³, Nirmal Patel³

Affiliations

¹ School of Medicine, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, NSW, Australia. Electronic address: khalil.bazzi@outlook.com.
² Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, NSW, Australia.
³ Kolling Deafness Research Centre, Royal North Shore Hospital and Macquarie University, Sydney, Australia; Discipline of Surgery, Sydney Medical School, University of Sydney, Australia; Sydney Endoscopic Ear Surgery (SEES) Research Group, Australia; Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

PMID: 30599286
DOI: 10.1016/j.ijporl.2018.12.031

Abstract

Objective: To examine the performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of residual and recurrent cholesteatoma in children.

Methods: A systematic review and meta-analysis was conducted as per PRISMA guidelines using the following databases from their date of inception: MEDLINE, PubMed, Embase, Cochrane Library, Web of Science. Bivariate meta-analysis using a random effects model was used to calculate summarized pooled estimates of sensitivity, specificity, and diagnostic odds ratios, using second-look surgery as the gold standard comparison.

Results: A total of ten articles (141 cases) were included for qualitative and quantitative analysis. Pooled sensitivity and specificity of non-echo planar imaging (non-EPI) DW-MRI were 89.4% (95%CI 51.9%-98.5%) and 92.9% (95%CI 81.4%-97.5%) respectively. DW-MRI appears limited in its ability to detect lesions less than 3 mm in size.

Conclusion: Non-EPI DW-MRI is highly specific but carries uncertain sensitivity in the detection of residual and recurrent cholesteatoma in children. Further research is warranted to determine the specific role of DW-MRI in this patient group, namely when and how often children should be referred for imaging and in which cases the method can be used to completely replace second-look surgery.

Keywords: Cholesteatoma; Diffusion weighted imaging; Echo-planar; Magnetic resonance imaging; Non echo-planar; Pediatric.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Child
Cholesteatoma, Middle Ear / diagnostic imaging*
Cholesteatoma, Middle Ear / surgery
Diffusion Magnetic Resonance Imaging* / methods
Humans
Recurrence
Second-Look Surgery
Sensitivity and Specificity