title: Magnetic resonance imaging at one year for detection of postoperative residual cholesteatoma in children: Is it too early?
abstract: OBJECTIVE
  To compare the residual cholesteatoma detection accuracy of diffusion-weighted (DW) and T1 delayed sequences for magnetic resonance at one year postoperative with second-look surgery in pediatric patients who have undergone primary middle ear surgery for cholesteatoma.
  
  
  METHODS
  This was a prospective monocentric consecutive study conducted in a tertiary academic referral center. Children were referred for MR imaging (MRI) one year after surgery. A 1.5T MRI was utilized, using nonecho-planar DW images and delayed gadolinium-enhanced T1-weighted images. Accuracy of magnetic resonance imaging was assessed by two radiologists before surgery. Interobserver and intraobserver agreements were assessed using the κ test. Magnetic resonance imaging data were compared with surgery, which was considered as the gold standard.
  
  
  RESULTS
  Twenty-four consecutive unselected pediatric patients were included. Sensitivity, specificity, positive predictive value, and negative predictive value for the first observer were of 40%, 86%, 67%, and 67%, respectively, and those for the second observer were 30%, 86%, 60%, and 63%, respectively. The only two cholesteatoma with a size superior to 3mm were diagnosed before surgery, but the majority of small cholesteatoma were not detected.
  
  
  CONCLUSIONS
  MRI is a key examen to diagnosed the residual cholesteatoma but is limited by the size of the lesion under 3mm. Delaying the realization of MRI during follow-up could increase sensitivity, thus avoiding misdiagnosis as well as unnecessary second look surgery.
authors.affiliation: Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France; Service de Neuroradiologie diagnostique, Fondation Rothschild, 25 rue Manin, 75019 Paris, France. Electronic address: alecler@fo-rothschild.fr.
authors.forename: A
authors.initials: A
authors.lastname: Lecler
authors.affiliation: Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Lenoir
authors.affiliation: Centre anticancéreux Léon Bérard, Oncologie Médicale, 28 rue Laennec, 69008 Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Peron
authors.affiliation: Service d'Oto-Rhino-Laryngologie pédiatrique, Hôpital Necker, Université Paris René Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Denoyelle
authors.affiliation: Service d'Oto-Rhino-Laryngologie pédiatrique, Hôpital Necker, Université Paris René Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France.
authors.forename: E N
authors.initials: EN
authors.lastname: Garabedian
authors.affiliation: Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France.
authors.forename: H Ducou le
authors.initials: HD
authors.lastname: Pointe
authors.affiliation: Service d'Oto-Rhino-Laryngologie, INSERM U1185, Hôpital Bicêtre, Université Paris Sud, Assistance Publique Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: J
authors.initials: J
authors.lastname: Nevoux
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D004432:Ear, Middle / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D008297:Male; D018365:Neoplasm, Residual; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D024162:Second-Look Surgery
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: DW imaging; MRI; Pediatric; Residual cholesteatoma