Survey of the Use of Diffusion-Weighted Imaging for Cholesteatoma in the United Kingdom

Background: Non-echoplanar diffusion-weighted MRI (DWMRI) has a role in the surgical planning for cholesteatoma. Aims/Objectives: The aim of the study was to assess the use of DWMRI in the management of cholesteatoma across the UK, and measure clinicians' confidence in the use of DWMRI. Materials and Methods: Telephone survey in 139 Otolaryngology Departments in the United Kingdom between March 2017 and July 2017, and asking radiology delegates at the British Society of Head and Neck Imaging 2017 meeting. Results: The response rate was 101 out of 139 Trusts (73%). Of those respondents who did have DWMRI available, 68/88 respondents (77%) use it for cholesteatoma. The mean confidence (+/- standard deviation) of the respondents with DWMRI in identifying cholesteatoma presence was 7.3 +/- 2.1, in identifying volume of cholesteatoma was 6.8 +/- 1.8, and in identifying subsites of cholesteatoma was 4.6 +/- 2.1. Conclusions and Significance: DWMRI has a well-defined role in the follow-up of patients after cholesteatoma surgery, and those primary cases of cholesteatoma where the diagnosis is in question. The use of DWMRI for cholesteatoma is variable across the UK, but there are certain clinical scenarios where there is not enough awareness regarding the benefits of imaging (such as petrous apex cases of cholesteatoma).