title: Does diffusion-weighted MRI (DW-MRI) change treatment strategy in pediatric cholesteatoma?
abstract: CONCLUSIONS
  This review highlights the currently limited and contradictory evidence on the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the management of pediatric cholesteatoma patients. Available data confirm the need for prospective DW-MRI studies of a larger number of pediatric patients. Factors such as patient compliance, adhesion to follow-up or local logistic circumstances should also be considered.
  
  
  OBJECTIVE
  This systematic review aimed to collect and analyze the body of evidence on the usefulness of DW-MRI in first-stage tympanoplasty and in replacing second-look surgery in children with cholesteatoma.
  
  
  METHODS
  A comprehensive search of medical databases was conducted. The keywords used were pediatric/paediatric, magnetic resonance imaging, MRI, DW-MRI, cholesteatoma, child, and all meaningful combinations of them.
  
  
  RESULTS
  Only one study with 17 patients primarily fulfilled all criteria. Sensitivity, specificity, and positive and negative predictive values were 62%, 88%, 89%, and 58%, respectively. A second study retrospectively analyzed a subset of younger patients (n = 21) of a larger population. Sensitivity, specificity, and positive and negative predictive values were 100%. One additional study described 1 child and 11 adolescents among 32 cases. In all cases the correlation between imaging and surgery findings was 100%. There were no randomized controlled trials and power calculations were not performed.
authors.affiliation: Division Pediatric Otorhinolaryngology and Otology, Department of Otorhinolaryngology, Olgahospital, Klinikum Stuttgart, Bismarckstrasse 8, Stuttgart, Germany. a.koitschev@klinikum-stuttgart.de
authors.forename: Assen
authors.initials: A
authors.lastname: Koitschev
authors.forename: Pia
authors.initials: P
authors.lastname: Behringer
authors.forename: Dorothee
authors.initials: D
authors.lastname: Bögner
authors.forename: Peter
authors.initials: P
authors.lastname: Amrhein
authors.forename: Peter
authors.initials: P
authors.lastname: Winkler
authors.forename: Thekla
authors.initials: T
authors.lastname: von Kalle
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002781:Cholesteatoma / Q000175:diagnosis* / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D018579:Patient Selection; D024162:Second-Look Surgery; D014433:Tympanoplasty