title: Non-echo planar diffusion-weighted MRI increases follow-up accuracy after one-step step canal wall-down obliteration surgery for cholesteatoma.
abstract: CONCLUSIONS
  Non-echo planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) increases the number of detected cholesteatoma after one-step canal wall-down (CWD) obliteration surgery for cholesteatoma compared with clinical evaluation alone.
  
  
  OBJECTIVE
  To evaluate the use of DW-MRI for detection of cholesteatoma after surgical treatment using a CWD obliteration technique.
  
  
  METHODS
  Thirty-eight adult patients (41 ears) treated with an identical one-step CWD obliteration surgical technique were included in a prospective and blinded study. All patients were investigated with non-EPI and EPI DW-MRI 1-9 months after the clinical examination. Follow-up time after primary surgery varied between 10 and 234 months. DW-MRI was assessed by two neuroradiologists and compared with clinical results. Inter-rater agreement was calculated. Positive non-EPI DW-MRI cases underwent revision surgery within 18-159 days after imaging.
  
  
  RESULTS
  Seven of 41 cases were evaluated as positive for cholesteatoma on non-EPI DW-MRI. Since one patient refused surgery six of these seven cases underwent surgical revision and all were verified. There was agreement between clinical and non-EPI findings in five of eight cases. EPI findings correlated poorly with non-EPI and clinical findings. Inter-rater agreement (Cohen's kappa) was 0.91 for non-EPI DW-MRI (p < 0.001) and -0.062 for EPI DW-MRI (p = 0.43).
authors.affiliation: Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden. lennart.edfeldt@akademiska.se
authors.forename: Lennart
authors.initials: L
authors.lastname: Edfeldt
authors.forename: Karin
authors.initials: K
authors.lastname: Strömbäck
authors.forename: Niklas
authors.initials: N
authors.lastname: Danckwardt-Lillieström
authors.forename: Helge
authors.initials: H
authors.lastname: Rask-Andersen
authors.forename: Shahin
authors.initials: S
authors.lastname: Abdsaleh
authors.forename: Johan
authors.initials: J
authors.lastname: Wikström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence