title: Evaluating the utility of non-echo-planar diffusion-weighted imaging in the preoperative evaluation of cholesteatoma: a meta-analysis.
abstract: OBJECTIVE
  To describe the accuracy of non-echo-planar diffusion-weighted magnetic resonance imaging (DW MRI) in identifying middle ear cholesteatoma.
  
  
  METHODS
  A meta-analysis of the published literature.
  
  
  METHODS
  A systematic review of the literature was performed to identify studies in which patients suspected of having middle ear cholesteatoma underwent DW MRI scans prior to surgery. A meta-analysis of the included studies was performed.
  
  
  RESULTS
  Ten published articles (342 patients) met inclusion criteria. Cholesteatoma was confirmed in 234 patients, of which 204 were detected by DW MRI (true positives) and 30 were not (false negatives). One hundred eight patients did not have cholesteatoma on surgical examination, and of these 100 were correctly identified by MRI (true negatives) whereas eight were not (false positives). The overall sensitivity of DW MRI in detecting cholesteatoma was 0.94 (confidence interval, 0.80-0.98) and specificity 0.94 (confidence interval, 0.85-0.98). DW MRI sequences could not reliably detect cholesteatomas under 3 mm in size.
  
  
  CONCLUSIONS
  Non-echo-planar DW MRI is highly sensitive and specific in identifying middle ear cholesteatoma. DW MRI may help to stratify patients into groups of who would benefit from early second-look surgery and those who could be closely observed.
  
  
  METHODS
  2a.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California 94305-5739, USA.
authors.forename: Peter M M C
authors.initials: PM
authors.lastname: Li
authors.forename: Eleni
authors.initials: E
authors.lastname: Linos
authors.forename: Richard K
authors.initials: RK
authors.lastname: Gurgel
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Fischbein
authors.forename: Nikolas H
authors.initials: NH
authors.lastname: Blevins
mesh_terms: D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D013506:Otologic Surgical Procedures; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D024162:Second-Look Surgery / Q000379:methods*