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Non-echoplanar diffusion-weighted MRI in children and adolescents with cholesteatoma: reliability and pitfalls in comparison to middle ear surgery

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Abstract

Background

Currently, there is only limited and contradictory evidence of the role of diffusion-weighted MRI (DW-MRI) in the management of children with cholesteatoma.

Objective

To provide surgically controlled data that may allow to replace second-look surgery by non-echoplanar DW-MRI in children.

Materials and methods

Fifty-five children and adolescents with a median age of 8.6 years (2.2-17.7 years) underwent 61 preoperative half-Fourier acquisition single-shot turbo spin-echo (HASTE) DW-MRI of their petrous bone. Surgical interventions followed within 24 h (79%), within 5 months (20%) or at 18 months (1 case).

Results

Surgery detected a cholesteatoma or retraction pocket in 41 of 61 cases (67%). In 49 cases (80%), the MR result was confirmed by surgical findings. Two MR findings were false-positive and 10 false-negative (including cholesteatomas <4 mm). HASTE DW-MRI alone had a sensitivity of 76% and a specificity of 90%. The positive predictive value was 94%, the negative predictive value 64%. In combination with preoperative otoscopy, sensitivity was 90% and negative predictive value 82%.

Conclusion

DW-MRI correctly detected the majority of lesions but could not reliably exclude small cholesteatomas and empty retraction pockets. We would therefore not generally recommend MR as a substitute for second-look surgery.

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Acknowledgments

We thank Peter Ainslie for linguistic advice.

Conflicts of interest

None

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Authors and Affiliations

  1. Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, Kriegsbergstr. 62, D-70174, Stuttgart, Germany

    Thekla von Kalle

  2. Division of Pediatric Otorhinolaryngology and Otology, Department of Otorhinolaryngology, Olgahospital Klinikum Stuttgart, Kriegsbergstr. 62, D-70174, Stuttgart, Germany

    Peter Amrhein & Assen Koitschev

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  1. Thekla von Kalle
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  2. Peter Amrhein
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  3. Assen Koitschev
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Correspondence to Thekla von Kalle.

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von Kalle, T., Amrhein, P. & Koitschev, A. Non-echoplanar diffusion-weighted MRI in children and adolescents with cholesteatoma: reliability and pitfalls in comparison to middle ear surgery. Pediatr Radiol 45, 1031–1038 (2015). https://doi.org/10.1007/s00247-015-3287-y

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  • DOI: https://doi.org/10.1007/s00247-015-3287-y

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