Objective: To describe via a meta-analysis of the published literature, the performance of non-echo-planar diffusion weighted imaging (DWI) in detecting middle ear cholesteatoma.
Methodology: A systematic review of the published literature was performed to identify original studies evaluating the diagnostic performance of non-echo-planar DWI in detecting middle ear cholesteatoma. Only studies with surgical correlation were included. A bi-variate meta-analysis and hierarchical summary receiver operating characteristic model was performed.
Results: A total of 26 studies (1,152 patient episodes) were included. Pooled sensitivity and specificity of 0.91 (95% CI: 0.87-0.95) and 0.92 (95% CI: 0.86-0.96), respectively were obtained. Separate subgroup analysis performed for primary cholesteatoma, postoperative cholesteatoma, pediatric cases, and adult cases all showed high sensitivities (range, 0.86-0.93) and specificities (0.88-0.97). There was a statistically significant degree of heterogeneity in terms of sensitivity between all studies (I value 46%) and in the pediatric subgroup (I value 78%). There was no evidence of significant heterogeneity between the specificity measurements.
Conclusions: Non-echo-planar DWI is highly sensitive and specific in detecting cholesteatoma. A large prospective multicentre randomized controlled study could validate the findings and evaluate the cost-effectiveness of DWI as an alternative for second-look surgery (control arm) in managing cases of postoperative cholesteatoma.