A Meta-Analysis on the Diagnostic Performance of Non-Echoplanar Diffusion-Weighted Imaging in Detecting Middle Ear Cholesteatoma: 10 Years On. Issue 4 (April 2017)

• Record Type: Journal Article
• Authors: Lingam, Ravi K.; Bassett, Paul
• Is Part Of: Otology & neurotology. Volume 38:Issue 4(2017)
• Publication Date: 2017-04
• Subjects: Cholesteatoma -- Diffusion weighted imaging -- Meta-analysis -- MRI -- Non-echo-planar; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000001353
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Objective: To describe via a meta-analysis of the published literature, the performance of non-echo-planar diffusion weighted imaging (DWI) in detecting middle ear cholesteatoma. Methodology: A systematic review of the published literature was performed to identify original studies evaluating the diagnostic performance of non-echo-planar DWI in detecting middle ear cholesteatoma. Only studies with surgical correlation were included. A bi-variate meta-analysis and hierarchical summary receiver operating characteristic model was performed. Results: A total of 26 studies (1, 152 patient episodes) were included. Pooled sensitivity and specificity of 0.91 (95% CI: 0.87–0.95) and 0.92 (95% CI: 0.86–0.96), respectively were obtained. Separate subgroup analysis performed for primary cholesteatoma, postoperative cholesteatoma, pediatric cases, and adult cases all showed high sensitivities (range, 0.86–0.93) and specificities (0.88–0.97). There was a statistically significant degree of heterogeneity in terms of sensitivity between all studies ( I 2 value 46%) and in the pediatric subgroup ( I 2 value 78%). There was no evidence of significant heterogeneity between the specificity measurements. Conclusions: Non-echo-planar DWI is highly sensitive and specific in detecting cholesteatoma. A large prospective multicentre randomized controlled study could validate the findings and evaluate the cost-effectiveness of DWI as an alternative for second-look surgery (control arm) in managing cases of postoperative cholesteatoma.