1
|
Molinari G, Reale M, Albera A, Russo FY, Di Lullo AM, Gaffuri M, Ralli M, Turri-Zanoni M, Simon F, Anschuetz L, Trecca EMC. Follow-up strategies in pediatric cholesteatoma: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08875-8. [PMID: 39097857 DOI: 10.1007/s00405-024-08875-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE The aim of this article was to systematically review the literature on the pediatric population surgically treated for cholesteatoma and describe the applied post-operative follow-up strategies. METHODS A systematic review was conducted following the Primary Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. After running the selected search string in PubMed, Scopus and Google Scholar, studies in English, reporting on surgically treated pediatric cholesteatoma patients (age younger or equal to 18 year-old) were retrieved. Both primary and revision cholesteatoma surgeries were included. Articles lacking specific data on post-surgical follow-up and case series with less than 10 patients were excluded. RESULTS Nineteen papers, published between 2000 and 2023, were included for final analysis. Fourteen studies were retrospective and five prospective, for a total of 1319 patients and 1349 operated ears. Male to female ratio was 1.8:1, with a mean age at surgery of 10.4 years (range 1-18). The mean length of the follow-up after surgery was 4.4 ± 1.7 years (range 1-6.9). Clinical follow-up was detailed in 9 studies (47%) with otomicroscopy being the most common evaluation. In most articles (n = 8, 50%), MRI alone was utilized for radiological follow-up, while in 3 studies (19%), CT scans were employed exclusively. In 5 studies (31%), MRI was combined with CT scans. The timing of radiological investigations varied widely (ranging from 6 months to 3 years). A second-look strategy was reported in 14 studies (74%). CONCLUSION This systematic review highlights the heterogeneity of the follow-up strategies applied to pediatric patients after cholesteatoma surgery, both in terms of timing and types of investigations.
Collapse
Affiliation(s)
- Giulia Molinari
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Marella Reale
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy.
- Department of Otorhinolaryngology, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Andrea Albera
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesca Yoshie Russo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Antonella Miriam Di Lullo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Otorhinolaryngology - Head and Neck Surgery Unit, Department of Mental and Physical Health and Preventive, Medicine, University of Campania Luigi Vanvitelli, 80131, Naples, Italy
- CEINGE- Advanced Biotechnology, Salvatore G. Street N.486, 80131, Naples, Italy
| | - Michele Gaffuri
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Massimo Ralli
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Mario Turri-Zanoni
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy
- Department of Otolaryngology Head and Neck Surgery, Department of Biotechnology and Life Sciences, ASST Lariana, Ospedale Sant'Anna, University of Insubria, San Fermo Della Battaglia, 22042, Como, Italy
| | - Francois Simon
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 75015, Paris, France
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
| | - Eleonora M C Trecca
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Otorhinolaryngology and Maxillofacial Surgery, IRCCS Research Hospital Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| |
Collapse
|
2
|
Fong JB, McCool RR. Titanium Implant Obscuring Residual Cholesteatoma on Magnetic Resonance Imaging: A Case Report. EAR, NOSE & THROAT JOURNAL 2024:1455613241241112. [PMID: 38587331 DOI: 10.1177/01455613241241112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Cholesteatomas are benign growths of squamous epithelial tissue in the middle ear resulting in conductive hearing loss and/or erosion of the structures of the middle ear space. These lesions are surgically removed but require postoperative surveillance due to risk of recurrence or residual disease. Second-look surgery remains the gold standard for diagnosis and treatment of residual or recurrent cholesteatoma; however, advanced imaging modalities such as non-echoplanar diffusion weighted magnetic resonance imaging (non-EPI DWI-MRI) offer a less invasive alternative for surveillance. As surgeons become more reliant on advanced imaging, it is important to understand the limitations of the technology. We present a case of a delay in diagnosis of residual cholesteatoma due to a false-negative finding on non-EPI DWI-MRI screening in the presence of a titanium implant.
Collapse
Affiliation(s)
- Justin B Fong
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Ryan R McCool
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Surgery, Section of Otolaryngology, Audiology and Maxillofacial Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
3
|
Zaman SU, Rangankar VP, Krishnarjun M, Kalekar TM, Shah VP, Pawar R, Kulothungan G. Readout-Segmented Echoplanar (RESOLVE) Diffusion-Weighted Imaging on 3T MRI in Detection of Cholesteatoma-Our Experience. Indian J Radiol Imaging 2024; 34:16-24. [PMID: 38106850 PMCID: PMC10723965 DOI: 10.1055/s-0043-1776054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background Several research studies have demonstrated the utility of diffusion-weighted imaging (DWI) in detecting middle ear cholesteatomas, especially with the non-echoplanar imaging (non-EPI) DWI technique. REadout Segmentation Of Long Variable Echo trains (RESOLVE), a multishot-EPI DWI, has better spatial resolution at a thinner section acquisition with reduced image distortion compared to the single-shot-EPI DWI technique. Purpose In this study, we evaluated the diagnostic ability of RESOLVE -DWI in middle ear cholesteatomas with surgical and histopathological support. Patients and Methods Fifty patients with clinical suspicion of primary cholesteatoma or postoperative recurrence were subjected to routine sequences and RESOLVE-DWI on magnetic resonance imaging (MRI). Thirty-eight patients had unilateral disease, while 12 patients had bilateral disease. The bilateral temporal bones of 50 patients were evaluated on MRI. The results attained by RESOLVE-DWI were correlated with intraoperative and histopathological findings. Results RESOLVE-DWI truly detected 55 of the 58 surgically proven cholesteatomas. RESOLVE-DWI could not detect three cholesteatoma lesions due to their small size and falsely diagnosed one case each of impacted wax and non-cholesteatomatous otitis media as cholesteatoma. With a 95% confidence interval, RESOLVE-DWI showed 94.8% sensitivity, 95.2% specificity, 96% positive predictive value, 93% negative predictive value, and 95% diagnostic accuracy in cholesteatoma detection. Conclusion RESOLVE-DWI is a sensitive and specific DWI technique for detecting middle ear cholesteatoma. However, RESOLVE-DWI has limitations in the diagnosis of small (<3 mm) cholesteatomas.
Collapse
Affiliation(s)
- Sameeh Uz Zaman
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
| | - Varsha P. Rangankar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Muralinath Krishnarjun
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Tushar M. Kalekar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Viraj Pankaj Shah
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Rishikesh Pawar
- Seth A.J.B ENT Municipal Hospital, Mumbai, Maharashtra, India
| | - Gowtham Kulothungan
- Shri Sathya Sai Medical College and Hospital, Chengalpattu, Tamil Nadu, India
| |
Collapse
|
4
|
Daoudi H, Levy R, Baudouin R, Couloigner V, Leboulanger N, Garabédian EN, Belhous K, Boddaert N, Denoyelle F, Simon F. Performance of Non-EPI DW MRI for Pediatric Cholesteatoma Follow-Up. Otolaryngol Head Neck Surg 2024; 170:221-229. [PMID: 37313857 DOI: 10.1002/ohn.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To 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 DESIGN Retrospective study. SETTING Tertiary comprehensive hospital. METHODS Children 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. RESULTS Two 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). CONCLUSION However, 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.
Collapse
Affiliation(s)
- Hannah Daoudi
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Raphaël Levy
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Robin Baudouin
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Vincent Couloigner
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Leboulanger
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eréa-Noel Garabédian
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kahina Belhous
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Nathalie Boddaert
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Simon
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
5
|
Baudouin R, Simon F, Levy R, Breton S, Alciato L, Talab E, Leboulanger N, Couloigner V, Garabedian EN, Denoyelle F. Early Magnetic Resonance Imaging to Diagnose Residual Cholesteatoma in Children and Benefit of Radiological Rereview. Otolaryngol Head Neck Surg 2023; 169:1631-1638. [PMID: 37264987 DOI: 10.1002/ohn.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Non-echo-planar diffusion-weighted (DW) magnetic resonance imaging (non-EPI MRI) is the appropriate sequence to detect residual cholesteatoma. In the child, MRI may be clinically useful to determine the timing of the second-look procedure. The aim of this paper was to retrospectively evaluate the performance of early MRI (before the 18th postoperative month) in detecting residual cholesteatoma in children after review by experienced specialized neuroradiologists. STUDY DESIGN Retrospective study. SETTING One university center comparative cohort. METHODS All patients who had a 2-staged procedure for cholesteatoma with an MRI before the second stage from 2010 to 2020 were included and analyzed. Three pediatric neuroradiologists reviewed all the images blinded to the surgical result. RESULTS N = 141 cholesteatoma events (140 children) were included with a mean age at MRI of 10 (±4) years old. Non-EPI MRIs were performed 10.7 (±3.8) months after the first-stage surgery and 2.2 (±2.6) months before the second-stage procedure. Non-EPI MRI had a 0.57 sensitivity (SE) and 0.83 specificity (SP). MRI was reviewed in 112 cases. The diagnosis was corrected in 17 cases (15.1%) (3 true positives, 7 false negatives, and 7 false positives). SE = 0.63 (p = 0.1) and SP = 0.92 (p = 0.08) after rereading. CONCLUSION Early MRI's SE is poor but SP is excellent after rereading. Evidence does not support the use of early non-EPI MRI to modify the surgical strategy or to postpone the second look. If performed, early non-EPI MRI should be read by specialized experienced radiologists with all 3 sequences (T1, T2, and non-EPI DW) and apparent diffusion coefficient calculation, especially in cases of otitis media with effusion.
Collapse
Affiliation(s)
- Robin Baudouin
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - François Simon
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Raphaël Levy
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sylvain Breton
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Department of Radiology, Paris Imagerie 114, Paris, France
| | - Lauranne Alciato
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Elsa Talab
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Erea-Noël Garabedian
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| |
Collapse
|
6
|
Cheng TC, Ho CY, Wu JL. The role of planned two-stage surgery in the management of congenital cholesteatoma. Int J Pediatr Otorhinolaryngol 2023; 171:111641. [PMID: 37392478 DOI: 10.1016/j.ijporl.2023.111641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE The purpose of this study is to verify the role of "planned two-stage surgery" in the management of advanced congenital cholesteatoma regarding disease recurrence rates, complications and the need for salvage surgery. METHOD Retrospective review of all congenital cholesteatoma under the age of 18 years underwent surgery from October 2007 to December 2021 in a single tertiary referral center. Patients with Potsic stage I/II who had closed-type congenital cholesteatoma received one-stage surgery. Advanced cases or those with open-type infiltrative congenital cholesteatomas underwent planned two-stage surgery. The second stage of surgery was performed 6-10 months after the first stage of surgery. Ossiculoplasty would be performed in the second operation if a significant air-bone gap was detected in the preoperative pure-tone audiometry test. RESULTS Twenty-four patients were included in the series. Six patients received one-stage surgery and no recurrence was noted in this group. The remaining 18 underwent planned two-stage surgery. Residual lesions found in the second operative phase were observed in 39% of patients who received planned two-stage surgery. Except for one patient whose ossicular replacement prosthesis protruded and two patients who had perforated tympanic membranes, none of the 24 patients required salvage surgery during follow-up (mean, 77 months after surgery), and no major complications occurred. CONCLUSIONS Planned two-stage surgery for advanced-stage or open infiltrative congenital cholesteatoma could timely detect residual lesions to avoid extensive surgery and reduce complications.
Collapse
Affiliation(s)
- Tsun-Chih Cheng
- Department of Otolaryngology, An Nan Hospital, China Medical University, No.66, Sec. 2, Changhe Rd., Annan Dist., Tainan City, 709, Taiwan.
| | - Cheng-Yu Ho
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan.
| | - Jiunn-Liang Wu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan.
| |
Collapse
|
7
|
Ismaeel AM, El-Tantawy AM, Eissawy MG, Gomaa MA, Rahman AA, Elkholy T, Hamead K. The Clinical Role of Diffusion-Weighted MRI for Detecting Residual Cholesteatoma in Canal Wall up Mastoidectomy. Indian J Otolaryngol Head Neck Surg 2022; 74:3911-3918. [PMID: 36742854 PMCID: PMC9895341 DOI: 10.1007/s12070-021-02744-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess the value of the diffusion MRI with the non-echoplanar imaging (Non-EPI) technique for follow-up the post-operative patients to detect residual cholesteatomas. STUDY DESIGN This prospective study was performed on 40 patients. All patients were at least one year after Canal Wall Up mastoidectomy surgery for cholesteatoma and scheduled for a second-look surgery. PATIENTS AND METHODS This prospective study was performed on 40 patients. All patients were subjected to Canal Wall Up surgery and planned for the second-look operation. After one year as removal of choleasteatoma is uncertain in first surgery. The study done at Tertiary referral centers (Ain shams, Mansoura, and Minia university hospitals), non-echoplanar diffusion MRI (NEP-DWI) technique for follow-up the post-operative patients to detect residual cholesteatomas, then second look surgery done 2 weeks after MRI. RESULTS Forty patients underwent MRI with Non-echoplanar diffusion-weighted imaging (NEP-DWI). Twenty-six patients had positive MRI results with the remaining 14 patients had negative results. These results were compared to operative findings. All positive MRI cases showed positive intra-operative findings. Ten of negative MRI cases showed negative intra-operative findings. Four of DWI-negative cases showed small cholesteatomas. CONCLUSION The use of NEP-DWI is a valuable tool in detecting residual cholesteatoma that could replace the second look surgery in many cases.
Collapse
Affiliation(s)
- Amr M. Ismaeel
- Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amir M. El-Tantawy
- Department of Radiology, Faculty of Medicine, Mansoura University, Dakahlya, Egypt
| | - Mohamed G. Eissawy
- Department of Radiology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mohammed A. Gomaa
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University Hospital, Minia University, Minia, 61111 Egypt
| | - Ahmed Abdel Rahman
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University Hospital, Minia University, Minia, 61111 Egypt
| | - Tawfeek Elkholy
- Department of Otorhinolaryngology, Faculty of Medicne, Azhar University, Cairo, Egypt
| | - Khalf Hamead
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University Hospital, Minia University, Minia, 61111 Egypt
| |
Collapse
|
8
|
Diffusion-weighted magnetic resonance imaging for diagnosis of post-operative paediatric cholesteatoma. J Laryngol Otol 2022; 137:484-489. [PMID: 36184898 DOI: 10.1017/s0022215122002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVES High rates of recidivism are reported after paediatric cholesteatoma surgery. Our practice has adapted to include non-echoplanar diffusion-weighted magnetic resonance imaging for the diagnosis of residual or recurrent cholesteatoma. This audit aimed to evaluate the performance of non-echoplanar diffusion-weighted magnetic resonance imaging in our paediatric population. METHODS A retrospective review was conducted of non-echoplanar diffusion-weighted magnetic resonance imaging scans performed to detect residual disease or recurrence after surgery for cholesteatoma in children from 1 January 2012 to 30 November 2017 in our centre. Follow-up diffusion-weighted magnetic resonance imaging scans were reviewed to 16 August 2019. RESULTS Thirty-four diffusion-weighted magnetic resonance imaging scans were included. The sensitivity and specificity values of diffusion-weighted magnetic resonance imaging for detecting post-operative cholesteatoma were 81 per cent and 72 per cent, respectively. Positive predictive and negative predictive values were 72 per cent and 81 per cent, respectively. CONCLUSION Use of diffusion-weighted magnetic resonance imaging is recommended as a replacement for routine second-look surgical procedures in the paediatric population. However, we would caution that patients require close follow up after negative diffusion-weighted magnetic resonance imaging findings.
Collapse
|
9
|
Yosefof E, Yaniv D, Tzelnick S, Sokolov M, Ulanovski D, Raveh E, Kornreich L, Hilly O. Post-operative MRI detection of residual cholesteatoma in pediatric patients - The yield of serial scans over a long follow-up. Int J Pediatr Otorhinolaryngol 2022; 158:111172. [PMID: 35526314 DOI: 10.1016/j.ijporl.2022.111172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 04/20/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Non-echo-planar diffusion weighted magnetic resonance imaging (Non-EPI DWI MRI) is commonly used for follow-up after cholesteatoma surgery. MRI has a critical role in the evaluation of residual disease, where physical examination will commonly demonstrate an intact tympanic membrane. The aim of our study was to assess the timing of residual cholesteatoma identification on serial MRI scans and the yield of MRI follow up after canal wall up tympano-mastoidectomy. METHODS A retrospective chart review of children that underwent canal wall up tympano-mastoidectomy due to cholesteatoma in Schneider Children's Medical Center during 2004-2016, and were followed up both clinically and with MRI. RESULTS Seventy-seven children (89 ears) were included, who altogether underwent 166 surgeries (77 revisions). Average follow-up was 66 ± 34.4 months. During follow up, 244 scans were performed; 19 cases of residual disease were diagnosed by MRI and confirmed in surgery. The mean time from surgery and an MRI positive for residual disease was 29.7 ± 16 months (range: 10-66). In 9/19 cases (47%), at least one negative MRI preceded the scan positive for residual disease, and in 4 cases at least two initial scans were negative. CONCLUSIONS MRI plays an important role in the diagnosis of residual disease after cholesteatoma surgery. In our cohort. Almost half of the cases diagnosed with residual disease had at least one negative scan prior to the positive one, emphasizing the importance of close radiological follow-up with serial scans after surgery.
Collapse
Affiliation(s)
- Eyal Yosefof
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Yaniv
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Tzelnick
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meirav Sokolov
- Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Ulanovski
- Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Raveh
- Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liora Kornreich
- Department of Imaging, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Baudouin R, Simon F, Levy R, Leboulanger N, Couloigner V, Garabedian EN, Denoyelle F. How Imaging Can Help Surgeons Prepare for Second-Look Cholesteatoma Surgery in Children. JAMA Otolaryngol Head Neck Surg 2022; 148:279-281. [PMID: 35024774 PMCID: PMC8759025 DOI: 10.1001/jamaoto.2021.3785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Robin Baudouin
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - François Simon
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Raphaël Levy
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Nicolas Leboulanger
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Vincent Couloigner
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Erea-Noël Garabedian
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Françoise Denoyelle
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| |
Collapse
|
11
|
Fourez AL, Akkari M, Gascou G, Lefevre PH, Duflos C, Kaderbay A, Mondain M, Venail F. Optimal Duration of MRI Follow-up to Safely Identify Middle Ear Residual Cholesteatoma. AJNR Am J Neuroradiol 2021; 42:1313-1319. [PMID: 33858822 DOI: 10.3174/ajnr.a7116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/15/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have demonstrated the usefulness of non-EPI DWI for detection of residual cholesteatoma. However, limited data are available to determine the suitable duration of imaging follow-up after a first MR imaging with normal findings has been obtained. The present study aimed to determine the optimal duration of non-EPI DWI follow-up for residual cholesteatoma. MATERIALS AND METHODS A retrospective, monocentric study was performed between 2013 and 2019 and included all participants followed up after canal wall up tympanoplasty with at least 2 non-EPI DWI examinations performed on the same 1.5T MR imaging scanner. MR images were reviewed independently by 2 radiologists. Sensitivity and specificity values were calculated as a function of time after the operation. Receiver operating characteristic curves were analyzed to determine the optimal follow-up duration. RESULTS We analyzed 47 MRIs from 17 participants. At the end of the individual follow-up period, a residual cholesteatoma had been found in 41.1% of cases. The follow-up duration ranged from 20 to 198 months (mean, 65.9 [SD, 43.9] months). Participants underwent between 2 and 5 non-EPI DWI examinations. Analyses of the receiver operating characteristic curves revealed that the optimal diagnostic value of non-EPI DWI occurred 56 months after the operation when the first MR imaging performed a mean of 17.3 (SD, 6.8) months after the operation had normal findings (sensitivity = 0.71; specificity = 0.7, Youden index = 0.43). CONCLUSIONS Repeat non-EPI DWI is required to detect slow-growing middle ear residual cholesteatomas. We, therefore, recommend performing non-EPI DWI for at least the first 5 years after the initial operation.
Collapse
Affiliation(s)
- A-L Fourez
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - M Akkari
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - G Gascou
- Neuroradiology (G.G., P.-H.L.), University Hospital Gui de Chauliac
| | - P-H Lefevre
- Neuroradiology (G.G., P.-H.L.), University Hospital Gui de Chauliac
| | - C Duflos
- Department of Medical Information and Biostatistics (C.D.), University Hospital La Colombière, University of Montpellier, Montpellier, France
| | - A Kaderbay
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - M Mondain
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - F Venail
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
- Institute for Neurosciences de Montpellier (F.V.), Institut National de la Santé et de la Recherche Médicale U1051 and University of Montpellier, Montpellier, France
| |
Collapse
|
12
|
Hermann R, Blanc J, Fieux M, Desternes G, Coudert A, Truy E. Multi-operated cholesteatoma: when two surgeries are not enough. Eur Arch Otorhinolaryngol 2020; 278:665-673. [PMID: 32535859 DOI: 10.1007/s00405-020-06104-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Most studies regarding residual and recurrent cholesteatoma focus on single relapse. This study examines patients who had to undergo at least three surgeries for complete eradication of their cholesteatoma, with the aim of bringing to light risk factors and assessing the functional impact of multiple surgeries on hearing. METHOD We include 27 patients who underwent 3 consecutive surgeries for cholesteatoma between 2006 and 2016. This population represented 3.1% of all cholesteatoma operated on during that same period (868 patients). RESULTS Cases of multi-residual and/or recurrent cholesteatoma (RRC) were significantly younger (13.1 years old), than single-RRC or cases with No-RRC (respectively, 28.0 and 38.5 years old) (p < 0.01). Furthermore, there was a significant difference in cholesteatoma location especially for combined attical and mesotympanic location between the three groups (no-RCC 26%; single-RRC 34% and multi-RRC 66%) (p < 0.01). There was also a significant difference in ossicular erosion of the malleus, incus and stapes between the three groups (p < 0.01). In our study, the type of surgery did not influence multi-RRC rates. We did not observe any significant impact on hearing between the first and third surgeries. Mean duration between the first and second surgeries was significantly shorter for multi-RRC (14.5 months SD 8.3) than for single-RRC (23.3 months SD 18.1) (p < 0.05). CONCLUSION Special care should be given in case of combined attical and mesotympanic extension, ossicular erosion and young children. Delaying the realization of MRI, and/or of second-look surgery, could decrease the risk of multi-RRC.
Collapse
Affiliation(s)
- Ruben Hermann
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,University Claude Bernard Lyon 1, Lyon, France.
| | - Jacques Blanc
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Maxime Fieux
- University Claude Bernard Lyon 1, Lyon, France.,Department of Otology and Otoneurology, Lyon Sud Hospital, Hospice Civils de Lyon, Lyon, France
| | - Gauvain Desternes
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Aurélie Coudert
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Eric Truy
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,University Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
13
|
Denoyelle F, Simon F, Chang KW, Chan KH, Cheng AG, Cheng AT, Choo DI, Daniel SJ, Farinetti A, Garabedian EN, Greinwald JH, Hoff SR, Hone S, Licameli GR, Papsin BC, Poe DS, Pransky S, Smith RJH, Triglia JM, Walton J, Zalzal G, Leboulanger N. International Pediatric Otolaryngology Group (IPOG) Consensus Recommendations: Congenital Cholesteatoma. Otol Neurotol 2020; 41:345-351. [DOI: 10.1097/mao.0000000000002521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Ide S, Ganaha A, Tono T, Goto T, Nagai N, Matsuda K, Azuma M, Hirai T. Value of DW-MRI in the preoperative evaluation of congenital cholesteatoma. Int J Pediatr Otorhinolaryngol 2019; 124:34-38. [PMID: 31158569 DOI: 10.1016/j.ijporl.2019.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/19/2019] [Accepted: 05/16/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study evaluated the clinical value of diffusion-weighted magnetic resonance imaging (DW-MRI) in the diagnosis and staging of congenital cholesteatoma (CC). PATIENTS AND METHODS We retrospectively reviewed 24 patients with CC. All the patients underwent computed tomography (CT) and DW-MRI preoperatively; thereafter, surgery was performed. DW-MRI examination was performed with a 3 T MRI system using three-dimensional reversed fast imaging with steady-state precession and diffusion-weighted magnetic resonance sequence. The preoperative and operative CT and DW-MRI findings were compared. RESULTS Using DW-MRI, cholesteatoma was successfully detected in 17 (71%) of the 24 patients with CC. Among the seven patients with false-negative results, the cholesteatoma mass diameter was <5 mm in six patients and ≥5 mm in one patient. One of these patients had open type congenital cholesteatoma (OTCC). The detection rates for closed type cholesteatoma and OTCC were 85% (17/20) and 0% (0/4), respectively, using DW-MRI. Using CT and DW-MRI, the correct stage was identified in 88% (15/17) and 59% (10/17) of the patients with aeration around the CC and in 0% (0/7) and 100% (7/7) of those without aeration around the CC, respectively. CONCLUSION CT is the primary imaging tool for evaluating suspected CC in patients with aeration around the CC. However, CT is unreliable for the detection of the extension and staging of CC when the middle ear is filled with nonspecific imaging. DW-MRI is useful for the preoperative diagnosis and staging of CC > 5 mm in diameter with or without surrounding granulation tissue. Thus, we recommend using DW- MRI at least when CT fails to localize CC as a soft tissue mass because of non-specific tissue filling the middle ear and the mastoid.
Collapse
Affiliation(s)
- Shinsuke Ide
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Akira Ganaha
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Tetsuya Tono
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Takashi Goto
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Noriaki Nagai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Keiji Matsuda
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan.
| | - Minako Azuma
- Department of Radiology, University of Miyazaki, Miyazaki, Japan.
| | - Toshinori Hirai
- Department of Radiology, University of Miyazaki, Miyazaki, Japan.
| |
Collapse
|
15
|
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; 118:90-96. [PMID: 30599286 DOI: 10.1016/j.ijporl.2018.12.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 01/03/2023]
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.
Collapse
|
16
|
Garin A, Benoudiba F, Ducreux D. [Techniques and progress in the imaging of the ear]. Presse Med 2017; 46:1097-1105. [PMID: 29097036 DOI: 10.1016/j.lpm.2017.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022] Open
Abstract
Ear and temporal bone imaging is essential for the diagnostic and preoperative management of middle ear lesions. The scanner is the exam of choice to analyze the walls and the contents of the middle ear. MRI is used to characterize the opacities of the middle ear and to evaluate possible neurological complications. Modern imaging techniques allow intraoperative guidance in otological surgery. Hearing implants are not always a contraindication to MRI but require precautions according to the type of implant.
Collapse
Affiliation(s)
- Antoine Garin
- AP-HP, hôpital Bicêtre, service d'oto-rhino-laryngologie et de chirurgie cervicofaciale, 94270 Le Kremlin-Bicêtre, France; Université Paris-Saclay, faculté de médecine, 94275 Le Kremlin-Bicêtre, France.
| | - Farida Benoudiba
- AP-HP, hôpital Bicêtre, service de neuroradiologie, 94270 Le Kremlin-Bicêtre, France
| | - Denis Ducreux
- Université Paris-Saclay, faculté de médecine, 94275 Le Kremlin-Bicêtre, France; AP-HP, hôpital Bicêtre, service de neuroradiologie, 94270 Le Kremlin-Bicêtre, France; CNRS UMR 8081, IR4M, Le Kremlin-Bicêtre, France
| |
Collapse
|
17
|
A Meta-Analysis on the Diagnostic Performance of Non-Echoplanar Diffusion-Weighted Imaging in Detecting Middle Ear Cholesteatoma: 10 Years On. Otol Neurotol 2017; 38:521-528. [DOI: 10.1097/mao.0000000000001353] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
18
|
Lingam RK, Nash R, Majithia A, Kalan A, Singh A. Non-echoplanar diffusion weighted imaging in the detection of post-operative middle ear cholesteatoma: navigating beyond the pitfalls to find the pearl. Insights Imaging 2016; 7:669-78. [PMID: 27558789 PMCID: PMC5028345 DOI: 10.1007/s13244-016-0516-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Abstract Non-echoplanar diffusion weighted magnetic resonance imaging (DWI) has established itself as the modality of choice in detecting and localising post-operative middle ear cleft cholesteatoma. Despite its good diagnostic performance, there are recognised pitfalls in its radiological interpretation which both the radiologist and otologist should be aware of. Our article highlights the various pitfalls and provides guidance for improving radiological interpretation and navigating beyond many of the pitfalls. It is recommended radiological practice to interpret the diffusion weighted images together with the ADC map and supplement with the corresponding T1 weighted and T2 weighted images, all of which can contribute to and enhance lesion localisation and characterisation. ADC values are also helpful in improving specificity and confidence levels. Given the limitation in sensitivity in detecting small cholesteatoma less than 3 mm, serial monitoring with DWI over time is recommended to allow any small residual cholesteatoma pearls to grow and become large enough to be detected on DWI. Optimising image acquisition and discussing at a joint clinico-radiological meeting both foster good radiological interpretation to navigate beyond the pitfalls and ultimately good patient care. Teaching Points • Non-echoplanar DWI is the imaging of choice in detecting post-operative cholesteatoma. • There are recognised pitfalls which may hinder accurate radiological interpretation. • Interpret with the ADC map /values and T1W and T2W images. • Serial DWI monitoring is of value in detection and characterisation. • Optimising image acquisition and discussing at clinico-radiological meetings enhance radiological interpretation.
Collapse
Affiliation(s)
- Ravi K Lingam
- Department of Radiology, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK.
| | - Robert Nash
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| | - Anooj Majithia
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| | - Ali Kalan
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| | - Arvind Singh
- Department of Otolaryngology, Head & Neck Surgery, Northwick Park and Central Middlesex Hospitals, London Northwest Healthcare NHS Trust, London, England, UK
| |
Collapse
|
19
|
Nash R, Wong PY, Kalan A, Lingam RK, Singh A. Comparing diffusion weighted MRI in the detection of post-operative middle ear cholesteatoma in children and adults. Int J Pediatr Otorhinolaryngol 2015; 79:2281-5. [PMID: 26547234 DOI: 10.1016/j.ijporl.2015.10.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/17/2015] [Accepted: 10/21/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is a limited evidence base for the use of diffusion weighted MRI (DWMRI) in the assessment of post-operative cholesteatoma in children. This is important to address as this technique is particularly relevant in a paediatric setting. METHODS We searched a prospectively collected database of patients undergoing DWMRI for the assessment of residual and recurrent cholesteatoma. Imaging findings were correlated with findings at revision surgery. 320 investigations were divided into paediatric and adult groups (90 in children, 230 in adults) and compared. RESULTS Operative findings were available for 158 cases, of which 54 were children. The accuracy of DWMRI in children was 96.3%, and in adults was 88.5%. There were no statistically significant differences in the sensitivity, specificity, positive or negative predictive values between adults and children. DISCUSSION An increasing number of patients are not undergoing confirmatory surgery after negative DWMRI scans. False negative results are commonly secondary to small foci of disease; false positives have several possible causes. Performing MRI on children can be challenging, but sedation may be helpful in younger children. CONCLUSION The performance of diffusion weighted MRI is similar in paediatric and adult settings. This study suggests that DWMRI may be used in clinical practice in a similar way in children and adults.
Collapse
Affiliation(s)
- Robert Nash
- Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom
| | - Phui Yee Wong
- Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom
| | - Ali Kalan
- Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom
| | - Ravi K Lingam
- Department of Radiology, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom.
| | - Arvind Singh
- Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom
| |
Collapse
|