title: Non-echoplanar diffusion-weighted MRI in children and adolescents with cholesteatoma: reliability and pitfalls in comparison to middle ear surgery.
abstract: BACKGROUND
  Currently, there is only limited and contradictory evidence of the role of diffusion-weighted MRI (DW-MRI) in the management of children with cholesteatoma.
  
  
  OBJECTIVE
  To provide surgically controlled data that may allow to replace second-look surgery by non-echoplanar DW-MRI in children.
  
  
  METHODS
  Fifty-five children and adolescents with a median age of 8.6 years (2.2-17.7 years) underwent 61 preoperative half-Fourier acquisition single-shot turbo spin-echo (HASTE) DW-MRI of their petrous bone. Surgical interventions followed within 24 h (79%), within 5 months (20%) or at 18 months (1 case).
  
  
  RESULTS
  Surgery detected a cholesteatoma or retraction pocket in 41 of 61 cases (67%). In 49 cases (80%), the MR result was confirmed by surgical findings. Two MR findings were false-positive and 10 false-negative (including cholesteatomas <4 mm). HASTE DW-MRI alone had a sensitivity of 76% and a specificity of 90%. The positive predictive value was 94%, the negative predictive value 64%. In combination with preoperative otoscopy, sensitivity was 90% and negative predictive value 82%.
  
  
  CONCLUSIONS
  DW-MRI correctly detected the majority of lesions but could not reliably exclude small cholesteatomas and empty retraction pockets. We would therefore not generally recommend MR as a substitute for second-look surgery.
authors: Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, Kriegsbergstr. 62, D-70174, Stuttgart, Germany, t.vonkalle@klinikum-stuttgart.de.
authors: Thekla
authors: T
authors: von Kalle
authors: Peter
authors: P
authors: Amrhein
authors: Assen
authors: A
authors: Koitschev
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D004432:Ear, Middle / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity