title: Comparing diffusion weighted MRI in the detection of post-operative middle ear cholesteatoma in children and adults.
abstract: BACKGROUND
  There is a limited evidence base for the use of diffusion weighted MRI (DWMRI) in the assessment of post-operative cholesteatoma in children. This is important to address as this technique is particularly relevant in a paediatric setting.
  
  
  METHODS
  We searched a prospectively collected database of patients undergoing DWMRI for the assessment of residual and recurrent cholesteatoma. Imaging findings were correlated with findings at revision surgery. 320 investigations were divided into paediatric and adult groups (90 in children, 230 in adults) and compared.
  
  
  RESULTS
  Operative findings were available for 158 cases, of which 54 were children. The accuracy of DWMRI in children was 96.3%, and in adults was 88.5%. There were no statistically significant differences in the sensitivity, specificity, positive or negative predictive values between adults and children.
  
  
  CONCLUSIONS
  An increasing number of patients are not undergoing confirmatory surgery after negative DWMRI scans. False negative results are commonly secondary to small foci of disease; false positives have several possible causes. Performing MRI on children can be challenging, but sedation may be helpful in younger children.
  
  
  CONCLUSIONS
  The performance of diffusion weighted MRI is similar in paediatric and adult settings. This study suggests that DWMRI may be used in clinical practice in a similar way in children and adults.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Nash
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom.
authors.forename: Phui Yee
authors.initials: PY
authors.lastname: Wong
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom.
authors.forename: Ali
authors.initials: A
authors.lastname: Kalan
authors.affiliation: Department of Radiology, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom. Electronic address: raviklingam@yahoo.co.uk.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Lingam
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Northwick Park Hospital & Central Middlesex Hospital, London Northwest Healthcare NHS Trust, Harrow, London HA1 3UJ, United Kingdom.
authors.forename: Arvind
authors.initials: A
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Cholesteatoma; Diffusion weighted MRI