Magnetic resonance imaging at one year for detection of postoperative residual cholesteatoma in children: Is it too early?

Objective: To compare the residual cholesteatoma detection accuracy of diffusion-weighted (DW) and T1 delayed sequences for magnetic resonance at one year postoperative with second-look surgery in pediatric patients who have undergone primary middle ear surgery for cholesteatoma. Methods: This was a prospective monocentric consecutive study conducted in a tertiary academic referral center. Children were referred for MR imaging (MRI) one year after surgery. A 1.5 T MRI was utilized, using nonecho-planar DW images and delayed gadolinium-enhanced T1-weighted images. Accuracy of magnetic resonance imaging was assessed by two radiologists before surgery. Interobserver and intraobserver agreements were assessed using the it test. Magnetic resonance imaging data were compared with surgery, which was considered as the gold standard. Results: Twenty-four consecutive unselected pediatric patients were included. Sensitivity, specificity, positive predictive value, and negative predictive value for the first observer were of 40%, 86%, 67%, and 67%, respectively, and those for the second observer were 30%, 86%, 60%, and 63%, respectively. The only two cholesteatoma with a size superior to 3 mm were diagnosed before surgery, but the majority of small cholesteatoma were not detected. Conclusions: MRI is a key examen to diagnosed the residual cholesteatoma but is limited by the size of the lesion under 3 mm. Delaying the realization of MRI during follow-up could increase sensitivity, thus avoiding misdiagnosis as well as unnecessary second look surgery. (C) 2015 Elsevier Ireland Ltd. All rights reserved.