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Review
. 2023 Apr 5;8(3):627-635.
doi: 10.1002/lio2.1032. eCollection 2023 Jun.

The diagnostic utility of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography for cholesteatoma: A meta-analysis

Mengzhao Xun  1   2 , Xu Liu  1   2 , Yongfang Sha  1   2 , Xin Zhang  1   2 , Jian Ping Liu  1   2
Affiliations
Review

The diagnostic utility of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography for cholesteatoma: A meta-analysis

Mengzhao Xun et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objective: The purpose of this meta-analysis was to compare the efficiency of high-resolution computed tomography (HRCT) and diffusion-weighted magnetic resonance imaging (DWI) in guiding the diagnosis of middle ear cholesteatoma in clinical practice.

Materials and methods: Cochrane Library, Medline, Embase, PubMed, and Web of Science were searched for studies that evaluated the sensitivity and specificity of HRCT or DWI in detecting middle ear cholesteatoma. A random-effects model was used to calculate and summarize the pooled estimates of sensitivity, specificity, and diagnostic odds ratios. Postoperative pathological results were considered as the diagnostic gold standard for middle ear cholesteatoma.

Results: Fourteen published articles (860 patients) met the inclusion criteria. The sensitivity and specificity of DWI when diagnosing cholesteatoma (regardless of type) were 0.88 (95% confidence interval [CI], 0.80-0.93) and 0.93 (95% CI, 0.86-0.97), respectively, while those of HRCT were 0.68 (95% CI, 0.57-0.77) and 0.78 (95% CI, 0.60-0.90), respectively. Notably, the sensitivity and specificity levels of DWI were similar to those of HRCT (p = .1178 for sensitivity, p = .2144 for specificity; pair-sampled t tests). The sensitivity and specificity of DWI or HRCT for the diagnosis of primary cholesteatoma were 0.78 (95% CI, 0.65-0.88) and 0.84 (95% CI, 0.69-0.93), respectively, while that for recurrent cholesteatoma were 0.93 (95% CI, 0.61-0.99) and 0.94 (95% CI, 0.82-0.98), respectively.

Conclusion: DWI and HRCT have similar levels of high sensitivity and specificity in detecting various cholesteatomas. Also, the diagnostic efficiency of HRCT or DWI for recurrent cholesteatoma is identical to that of primary cholesteatoma. Therefore, HRCT may be used in clinical settings to reduce the use of DWI and save clinical resources.

Lay summary: Data on the use of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography in the diagnosis of cholesteatoma were obtained through a literature search. They were analyzed to guide the clinical diagnosis and treatment of cholesteatoma.

Level of evidence: NA.

Keywords: cholesteatoma; computed tomography; diffusion‐weighted; magnetic resonance imaging; meta‐analysis.

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Conflict of interest statement

The research was conducted without any commercial relationship that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Literature search disposition.
FIGURE 2
FIGURE 2
Sensitivity and specificity of DWI and HRCT in the diagnosis of all cholesteatomas. (A) The forest plot shows the pooled results of the analysis of DWI sensitivity and specificity. (B) The forest plot shows the pooled results of the analysis of HRCT sensitivity and specificity. DWI, diffusion‐weighted magnetic resonance imaging; HRCT, high‐resolution computed tomography.
FIGURE 3
FIGURE 3
SROC curves for DWI or HRCT in the diagnosis of all cholesteatomas. (A) The graph shows the SROC curve for DWI in diagnosing all cholesteatomas. (B) The graph shows the SROC curve for HRCT in diagnosing all cholesteatomas. DWI, diffusion‐weighted magnetic resonance imaging; HRCT, high‐resolution computed tomography; SROC, summary receiver operating characteristic.
FIGURE 4
FIGURE 4
Sensitivity and specificity of DWI or HRCT for first‐ and second‐look surgery cholesteatomas. (A) Forest plot shows the pooled analysis results of the sensitivity and specificity for first‐look surgery cholesteatomas. (B) Forest plot shows the pooled analysis results of the sensitivity and specificity for second‐look surgery cholesteatomas. DWI, diffusion‐weighted magnetic resonance imaging; HRCT, high‐resolution computed tomography.
FIGURE 5
FIGURE 5
Graphs showing the SROC curves of DWI or HRCT in diagnosing first‐ and second‐look surgery cholesteatomas. (A) SROC curve for DWI or HRCT in diagnosing first‐look surgery cholesteatomas. (B) SROC curve for DWI or HRCT in diagnosing second‐look surgery cholesteatomas. DWI, diffusion‐weighted magnetic resonance imaging; HRCT, high‐resolution computed tomography; SROC, summary receiver operating characteristic.
See this image and copyright information in PMC

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