Accuracy of Non-Echo Planar Diffusion Weighed Magnetic Resonance Imaging
to detect Cholesteatoma in routine clinical healthcare: A Diagnostic
Study
Abstract
Objectives: To determine the accuracy of Non-Echo-Planar Diffusion
Weighed Magnetic Resonance Imaging (non-EPI DW MRI) in diagnosing
cholesteatoma in routine clinical healthcare - a comparison to
otosurgery outcome. Method: A retrospective diagnostic study including
all subjects examined with middle ear non-EPI DW MRI in two regions in
northern Sweden between October 2010, when the use of non-EPI DW MRI
began, and March 2019 when the search was made. Examinations not
performed as non-EPI DW MRI were excluded. Sensitivity, specificity,
positive predictive value, negative predicative value, and likelihood
ratios were calculated using non-EPI DW MRI as the index test and
diagnosis from otosurgery as the reference standard. Results: Fifty-two
subjects with suspicion of cholesteatoma underwent non-EPI DW MRI and
subsequent otosurgery after examination. Non-EPI DW MRI had a
sensitivity of 0.50, specificity of 0.75, positive predictive value of
0.74, negative predictive value of 0.52, positive likelihood ratio of
2.0, and negative likelihood ratio of 0.67. Discussion: The diagnostic
accuracy of non-EPI DW MRI does not reach acceptable levels to be
reliable in the existing everyday clinical setting. The accuracy of the
examination increases when interpreted by an experienced radiologist and
when using the definition of cholesteatoma recommended by The European
Academy of Otology and Neurotology and The Japanese Otological Society.