Limitations of Non-Echo Planar Diffusion Weighted Magnetic Resonance Imaging (Non-Epi MRI) in Cholesteatoma Surveillance after Ossicular Chain Reconstruction. A Prospective Study.

Objective: Non-echo planar diffusion weighted magnetic resonance imaging is a reliable surveil-lance tool of residual cholesteatoma nowadays. It is not known whether the material of the os-sicular chain prosthesis modifies the sensitivity and specificity of MRI in these cases. The aim of the study was to compare the sensitivity, specificity and a localization-specific accuracy of non-EPI DW MRI sequences for residual cholesteatoma in the following 3 subgroups: patients with titanium ossicular prosthesis (group T), with autologous cortical bone columella (group A) or without any reconstruction (group WR) of hearing bones. Methods: This prospective study covered 28 cases with cholesteatoma of the middle ear under-gone second-look surgery, who had preoperative PROPELLER DW-MRI. Surgical findings were compared to the results of the DWI-MRI. Results: The overall sensitivity, specificity, positive predictive value (PPV) and negative pre-dictive value (NPV) were: 0.76-0.8-0.76-0.8. Group T, group A and group WR sensitivity was 0.83-0.6-1, specificity: 0.75-0.75-0.85, PPV: 0.83-0.75-0.66, NPV: 0.75-0.6-1. Overall accuracy was 0.78. Size of missed cholesteatoma was 2-4 mm (mean: 2.66 +/- 1.15). Conclusions: Various materials are suitable for ossicular chain reconstruction. The poor de-tectability of residual or recurrent cholesteatoma in the middle ears reconstructed with autolo-gous bony prosthesis may still claim second-look surgery instead of the usage of non-EPI DWI sequences independently in these patients. (C) 2020 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.