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

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