Evaluating the utility of non–echo‐planar diffusion‐weighted imaging in the preoperative evaluation of cholesteatoma: A meta‐analysis

Objectives/Hypothesis To describe the accuracy of non–echo-planar diffusion-weighted magnetic resonance imaging (DW MRI) in identifying middle ear cholesteatoma. Study Design A meta-analysis of the published literature. Methods A systematic review of the literature was performed to identify studies in which patients suspected of having middle ear cholesteatoma underwent DW MRI scans prior to surgery. A meta-analysis of the included studies was performed. Results Ten published articles (342 patients) met inclusion criteria. Cholesteatoma was confirmed in 234 patients, of which 204 were detected by DW MRI (true positives) and 30 were not (false negatives). One hundred eight patients did not have cholesteatoma on surgical examination, and of these 100 were correctly identified by MRI (true negatives) whereas eight were not (false positives). The overall sensitivity of DW MRI in detecting cholesteatoma was 0.94 (confidence interval, 0.80–0.98) and specificity 0.94 (confidence interval, 0.85–0.98). DW MRI sequences could not reliably detect cholesteatomas under 3 mm in size. Conclusions Non–echo-planar DW MRI is highly sensitive and specific in identifying middle ear cholesteatoma. DW MRI may help to stratify patients into groups of who would benefit from early second-look surgery and those who could be closely observed. Level of Evidence 2a.