title: Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis.
abstract: BACKGROUND
  Diagnosis and management of recurrent or residual cholesteatoma can be problematic. Diffusion-weighted imaging magnetic resonance imaging (MRI) sequences have been used for follow-up of such lesions. More recent non-echoplanar imaging (non-EPI) sequences are thought to be superior to older echoplanar imaging (EPI) sequences.
  
  
  OBJECTIVE
  Evaluate whether diffusion-weighted magnetic resonance imaging is useful in the diagnosis of recurrent or residual cholesteatoma.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Database were searched, with no limits on date or language.
  
  
  METHODS
  Adults or children who had previously undergone tympanomastoid surgery by any method with confirmation of recurrence/residual disease by second-look/revision surgery.
  
  
  METHODS
  Two reviewers independently reviewed studies. Data extracted on 11 domains and rechecked.
  
  
  RESULTS
  Statistical analysis with SPSS.
  
  
  RESULTS
  A total of 575 studies were identified of which 27 met the inclusion criteria. These covered 727 patient episodes. For EPI studies: sensitivity (sd) 71.82 (24.5), specificity (sd) 89.36 (13.4), PPV (sd) 93.36 (8.1) and NPV (sd) 73.36 (15.8). For non-EPI studies: sensitivity 89.79 (12.1), specificity (sd) 94.57 (5.8), PPV (sd) 96.50 (4.2) and NPV 80.46 (20.2). Improved sensitivity of non-EPI sequences reached significance (P = 0.02).
  
  
  CONCLUSIONS
  Diffusion-weighted MRI is both sensitive and specific for the detection of recurrent or residual cholesteatoma following ear surgery. Non-EPI techniques are superior to EPI techniques.
authors.affiliation: Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: J
authors.identifier: http://orcid.org/0000-0003-3065-0269
authors.initials: J
authors.lastname: Muzaffar
authors.affiliation: Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Metcalfe
authors.affiliation: Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Colley
authors.affiliation: Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Coulson
mesh_terms: D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D013506:Otologic Surgical Procedures; D012008:Recurrence