The Value of Magnetic Resonance Imaging in the Diagnosis of Residual or Recurrent Acquired Cholesteatoma After Canal Wall-Up Tympanoplasty

Abstract

The value of magnetic resonance imaging (MRI) in the diagnosis of recurrent or residual cholesteatoma after canal wall-up tympanoplasty is studied in a retrospective cohort study at a tertiary referral center. A total of 31 patients, who underwent 32 canal wall-up tympanoplasty procedures with MRI before revision surgery, were included in the study. MRI examination, using both the conventional and echo-planar diffusion-weighted sequences, was performed, with additional spin echo diffusion-weighted MRI sequences in 4 patients. All patients were treated with a canal wall-up tympanoplasty. The presence of residual or recurrent cholesteatoma at revision surgery is matched with preoperative findings on MRI. MRI could correctly detect the residual disease in 54.5% of the surgically matched residual or recurrent cholesteatomas. MRI yielded a false-negative result in 45.5%. There was 1 false-positive result (10%). Sensitivity, specificity, and positive and negative predictive values of MRI were 54.4%, 90%, 92.3%, and 47.4%, respectively. Preoperative MRI could correctly detect residual or recurrent cholesteatoma in somewhat over half the cases. A high number of false-negative results were obtained. At thismoment, MRI cannot yet replace revision surgery.