title: MRI for the diagnosis of recurrent middle ear cholesteatoma in children--can we optimize the technique? Preliminary study.
abstract: BACKGROUND
  Recurrent cholesteatoma after surgical excision occurs frequently in children. Until recently, a surgical second look was mandatory and considered as standard reference. MRI including a delayed T1 sequence after gadolinium injection and diffusion-weighted imaging (DWI) has proved its efficiency but has been evaluated mainly in adults.
  
  
  OBJECTIVE
  Our purpose was to evaluate the accuracy of DWI to diagnose recurrence of cholesteatoma in children.
  
  
  METHODS
  We evaluated prospectively with MRI 20 ears in 18 children who had had surgery for cholesteatoma. We compared DWI and delayed T1-weighted images following gadolinium administration with intraoperative or follow-up findings. We calculated the sensitivity and specificity of each sequence for the diagnosis of recurrent cholesteatoma.
  
  
  RESULTS
  Sensitivity to diagnose recurrent cholesteatoma was 87% for both DWI and delayed post-gadolinium sequences, specificity was 71% and 83%, respectively. Adding both sequences, the sensitivity was 87%, the specificity 100%. There was one false negative probably due to small size recurrence.
  
  
  CONCLUSIONS
  In our series, DWI was reliable to diagnose recurrent cholesteatoma in children and allows avoiding surgery when negative. However, because small recurrences less than 5 mm may be missed, follow-up must be prolonged (5 years).
authors.affiliation: Fondation Lenval, 57 avenue de la Californie, 06200, Nice, France. a.geoffray@lenval.com
authors.forename: Anne
authors.initials: A
authors.lastname: Geoffray
authors.forename: Myriam
authors.initials: M
authors.lastname: Guesmi
authors.forename: Jean François
authors.initials: JF
authors.lastname: Nebbia
authors.forename: Béatrice
authors.initials: B
authors.lastname: Leloutre
authors.forename: Sonanda
authors.initials: S
authors.lastname: Bailleux
authors.forename: Claude
authors.initials: C
authors.lastname: Maschi
mesh_terms: D000293:Adolescent; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010865:Pilot Projects; D015203:Reproducibility of Results; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D016896:Treatment Outcome