Turbo spin non echo-planar diffusion weighted MRI for cholesteatoma in revision mastoidectomy: a prospective study of diagnostic accuracy and clinical impact

Paul Paddle, Guillermo Hurtado, Stacy Goergen, Sharon Hong, Malcolm Baxter, Bridget Copson

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Background: Non-echo planar diffusion weighted MRI (NEDWI MRI) is accurate in detecting cholesteatoma in the post-operative ear but the effect on surgical decision-making in the setting of revision mastoid surgery using surgical histopathology as the gold standard has not been investigated.
Methods: A blinded diagnostic accuracy study of pre-operative NEDWI MRI was conducted for consecutive patients requiring revision mastoid surgery. The operating surgeon completed a pre-operative survey without knowledge of the MRI results and post-operative survey after knowledge of the MRI results to determine impact on clinical decision making.
Results: Non-EPI DWI MRI demonstrated overall sensitivity of 45.45% (95% CI: 16.75–76.62), specificity of 88.24% (95% CI: 63.56–98.54%), in detecting recurrent cholesteatoma in 28 operations. In 65.22% of cases the operating surgeon would have proceeded with second look surgery regardless of the MRI result.
Conclusions: Negative NEDWI has the potential to reduce unnecessary surgery in patients who have no indication for surgery other than disease surveillance.
Original languageEnglish
Article number12
Number of pages9
JournalAustralian Journal of Otolaryngology
Issue number3
Publication statusPublished - 16 Mar 2018

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