Department of Otolaryngology, Russells Hall Hospital, Dudley, UK.
Otol Neurotol. 2011 Oct;32(8):1243-9. doi: 10.1097/MAO.0b013e31822e938d.
A systematic review to determine whether the diffusion-weighted (DW) magnetic resonance imaging scan can reliably detect residual or recurrent cholesteatoma after mastoid surgery.
A systematic review.
Databases including EMBASE, MEDLINE, CINAHL, Web of Science, and Cochrane Review were searched for studies published without language restriction from the start of the databases. Additional studies were identified from cited references.
Initial search identified 402 publications, of which 16 studies met the inclusion criteria for the systematic review. The DW imaging (DWI) scan was used to detect residual or recurrent cholesteatoma and subsequent second-look surgery was performed to correlate the findings.
Studies were assessed for their selection of patients for radiologic investigations, imaging parameters, and subsequent surgery. Outcome measures included sensitivity, specificity, positive and negative predictive values of the DWI, and the incidence and size of residual or recurrent cholesteatoma.
Two different modalities of DWI sequences have been described. Eight studies with 225 patients analyzed echo-planar imaging (EPI) and 8 studies with 207 patients described the "non-EPI" scanning techniques. Non-EPI parameters are more reliable in identifying residual or recurrent cholesteatoma with sensitivity, specificity, and positive and negative predictive values of 91%, 96%, 97%, and 85%, respectively.
The available evidence suggests that non-EPI such as half-Fourier acquisition single-shot turbo spin echo sequences are more reliable in identifying residual or recurrent cholesteatoma. This is a promising radiologic investigation; however, we think further studies are required with more patients and long-term results to establish its place as an alternative to a second-stage surgery after canal wall up surgery.
系统评价以确定磁共振弥散加权（DW）成像扫描是否能可靠地检测乳突手术后残余或复发性胆脂瘤。
系统评价。
从数据库开始，无语言限制地搜索 EMBASE、MEDLINE、CINAHL、Web of Science 和 Cochrane Review 等数据库，以查找已发表的研究。通过引用参考文献确定其他研究。
最初的搜索确定了 402 篇出版物，其中 16 项研究符合系统评价的纳入标准。DW 成像（DWI）扫描用于检测残余或复发性胆脂瘤，并进行后续的二次探查手术以对结果进行相关性分析。
评估了研究对象对影像学检查的选择、成像参数以及后续手术的情况。研究结果包括 DWI 的敏感性、特异性、阳性和阴性预测值，以及残余或复发性胆脂瘤的发生率和大小。
描述了两种不同的 DWI 序列模式。8 项研究（225 例患者）分析了平面回波成像（EPI），8 项研究（207 例患者）描述了“非 EPI”扫描技术。非 EPI 参数在识别残余或复发性胆脂瘤方面更可靠，敏感性、特异性、阳性和阴性预测值分别为 91%、96%、97%和 85%。
现有证据表明，非 EPI，如半傅里叶采集单次激发涡轮自旋回波序列，在识别残余或复发性胆脂瘤方面更可靠。这是一种有前途的影像学检查方法；然而，我们认为需要进一步的研究，以更多的患者和长期结果来确定其在鼓室成形术后二期手术中的替代地位。
