Early Magnetic Resonance Imaging to Diagnose Residual Cholesteatoma in Children and Benefit of Radiological Rereview

Abstract Objective Non‐echo‐planar diffusion‐weighted (DW) magnetic resonance imaging (non‐EPI MRI) is the appropriate sequence to detect residual cholesteatoma. In the child, MRI may be clinically useful to determine the timing of the second‐look procedure. The aim of this paper was to retrospectively evaluate the performance of early MRI (before the 18th postoperative month) in detecting residual cholesteatoma in children after review by experienced specialized neuroradiologists. Study Design Retrospective study. Setting One university center comparative cohort. Methods All patients who had a 2‐staged procedure for cholesteatoma with an MRI before the second stage from 2010 to 2020 were included and analyzed. Three pediatric neuroradiologists reviewed all the images blinded to the surgical result. Results N = 141 cholesteatoma events (140 children) were included with a mean age at MRI of 10 (±4) years old. Non‐EPI MRIs were performed 10.7 (±3.8) months after the first‐stage surgery and 2.2 (±2.6) months before the second‐stage procedure. Non‐EPI MRI had a 0.57 sensitivity (SE) and 0.83 specificity (SP). MRI was reviewed in 112 cases. The diagnosis was corrected in 17 cases (15.1%) (3 true positives, 7 false negatives, and 7 false positives). SE = 0.63 ( p = 0.1) and SP = 0.92 ( p = 0.08) after rereading. Conclusion Early MRI's SE is poor but SP is excellent after rereading. Evidence does not support the use of early non‐EPI MRI to modify the surgical strategy or to postpone the second look. If performed, early non‐EPI MRI should be read by specialized experienced radiologists with all 3 sequences (T1, T2, and non‐EPI DW) and apparent diffusion coefficient calculation, especially in cases of otitis media with effusion.