title: The value of non echo planar, diffusion-weighted magnetic resonance imaging for the detection of residual or recurrent middle-ear cholesteatoma.
abstract: OBJECTIVE
  To determine the value of non echo planar, diffusion-weighted magnetic resonance imaging for detection of residual and recurrent middle-ear cholesteatoma after combined-approach tympanoplasty.
  
  
  METHODS
  The magnetic resonance imaging findings after primary surgery for cholesteatoma were compared with intra-operative findings at 'second-look' surgery or with clinical follow-up findings.
  
  
  RESULTS
  Forty-eight magnetic resonance imaging studies were performed in 38 patients. Second-look surgery was performed 21 times in 18 patients. The remaining patients were followed up at the out-patient clinic. There were no false-positive findings with non echo planar, diffusion-weighted magnetic resonance imaging; however, there were four false-negative findings. The mean maximum diameter of recurrent cholesteatoma, as assessed using magnetic resonance imaging, was 11.7 mm (range, 4.4-25.3 mm). The sensitivity of non echo planar, diffusion-weighted magnetic resonance imaging for detecting cholesteatoma prior to second-look surgery was 0.76, with a specificity of 1.00. When clinical follow up of the non-operated ears was included in the analysis, sensitivity was 0.81 and specificity was 1.00.
  
  
  CONCLUSIONS
  Recurrent cholesteatoma can be accurately detected using non echo planar, diffusion-weighted magnetic resonance imaging. Our study, however, also showed some false-negative results. Therefore, strict out-patient follow up is mandatory for those considering using this technique instead of standard second-look surgery.
authors.affiliation: Department of Radiology,Diakonessenhuis Utrecht,The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Velthuis
authors.affiliation: Department of Radiology,Diakonessenhuis Utrecht,The Netherlands.
authors.forename: K J
authors.initials: KJ
authors.lastname: van Everdingen
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery,Diakonessenhuis Utrecht,The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Quak
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery,Diakonessenhuis Utrecht,The Netherlands.
authors.forename: D R
authors.initials: DR
authors.lastname: Colnot
mesh_terms: D000328:Adult; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results