Proposal of a magnetic resonance imaging follow-up protocol after cholesteatoma surgery: a prospective study

Abstract

Background

Non-echo planar (EPI) diffusion-weighted (DW) MRI has become an effective tool for the follow-up after cholesteatoma surgery and decreased the rate of second-look surgeries.

Objectives

To shed light on the optimal imaging follow-up protocol to detect postoperative residual or recurrent cholesteatoma.

Materials and methods

64 patients were included in this prospective study. Three different surgical procedures were considered: canal-wall-up (26 patients), canal-wall-down (20 patients), and obliterative (18 patients). The imaging follow-up protocol included non-EPI DW MRI during the following postoperative periods: 1 month, 6 months, and 1, 3, 5, and 7 years after the primary surgery.

Results

MRI-positive lesions were present in 18.75% of patients. 50% of the MRI-positive findings occurred at the 1-month follow-up. The other peak of MRI positivity occurred at the 3-year follow-up. The last MRI-positive finding appeared at the 5-year follow-up.

Conclusions

The timing for the imaging protocol proposed by this prospective study to detect recidivism after cholesteatoma surgery stressed the importance of performing non-EPI DW MRI for detecting residual, though rare, disease. Likewise, extending the follow-up to a least 5 years after primary surgery was also recommended to detect any recurrent cholesteatoma that would appear unlikely to be present beyond this time set.

Chinese Abstract

背景：非回波平面 (EPI) 弥散加权 (DW) MRI 已成为胆脂瘤手术后的随访的有效工具, 它降低了二次手术的发生率。

目的：阐明最佳影像学随访方案, 以便检测术后残留的或复发的胆脂瘤。

材料与方法：本前瞻性研究共纳入 64 例患者。考虑了三种不同的手术方式：耳道-壁-上（26 名患者）、耳道-壁-下（20 名患者）和闭塞的（18 名患者）。影像学随访方案, 包括非 EPI DW MRI, 在以下术后时期进行：初次手术后 1 个月、6 个月和 1、3、5 和 7 年。

结果：18.75% 的患者出现 MRI 阳性病变。 50% 的 MRI 阳性结果出现于随访 1 个月。 MRI 阳性的另一个高峰出现在 术后3 年的随访中。最后一次 MRI 阳性发现出现在术后 5 年的随访中。

结论：这项前瞻性研究提出的用于检测胆脂瘤手术后复发的成像方案的时间强调了进行非 EPI DW MRI 检测残留（虽然罕见）胆脂瘤的重要性。同样, 还建议将随访时间延长至初次手术后至少 5 年, 以检测任何复发性胆脂瘤。超出此时间段后, 复发性胆脂瘤似乎不太可能发生。

Keywords:

• Cholesteatoma
• MRI
• non-EPI
• follow-up
• recurrence
• residual

Disclosure statement

No potential conflict of interest was reported by the author(s).