Evaluation of magnetic resonance imaging to detect cholesteatoma in clinical healthcare

Figures & data

Figure 1. Flow chart of all subject episodes grouped according to the index test and reference standard. Group names are marked in bold.

Table 1. Contingency table with otosurgery as the reference standard and non-EPI DW MRI as the index test.

	Otosurgery
Non-EPI DW MRI	Cholesteatoma	Not Cholesteatoma	Total
Cholesteatoma	14	5	19
Not cholesteatoma	14	15	29
Equivocal	3	1	4
Total	31	21	52

Data presented are number of cases. Non-EPI DW MRI: Non-Echo Planar Imagining Diffusion Weighed Magnetic Resonance Imaging.

Figure 2. Total number of executed non-EPI DW MRI per year separated into each radiological diagnosis. non- EPI DW MRI: Non-Echo Planar Imagining Diffusion Weighed Magnetic Resonance Imaging.

Figure 3. Time to otosurgery from the date of non-EPI DW MRI for all operated groups. non- EPI DW MRI: Non-Echo Planar Imagining Diffusion Weighed Magnetic Resonance Imaging.

Table 2. Sex, type of disease and follow-up for all operated groups.

	Sex	Cholesteatoma		Follow-up
Group	Male/female (n)	Primary (n)	Residual/Recurrent (n)	Still clinically monitored.(n)	Discharged from follow up. (n)	Not conducted as planned. (n)	Unknown (n)
True positive n = 14	12/2	6	8	9	3	2	0
False positive n = 5	3/2	–	–	2	3	0	0
True negative n = 15	9/6	–	–	8	5	1	1
False negative n = 14	10/4	7	7	12	1	1	0
Equivocal- cholesteatoma n = 3	1/2	2	1	3	0	0	0
Equivocal-Not cholesteatoma n = 1	1/0	–	–	1	0	0	0

Table 3. Sensitivity, specificity, predictive values, and likelihood ratios for non-EPI DW MRI to detect cholesteatoma.

	Sensitivity	Specificity	PPV	NPV	LR+	LR-
Primary radiological interpretation	0.50 (0.32, 0.68)	0.75 (0.54, 0.90)	0.74 (0.52, 0.90)	0.52 (0.34, 0.69)	2.00 (0.86, 4.65)	0.67 (0.43, 1.04)
Primary	0.46 (0.22, 0.72)	0.75 (0.54, 0.90)	0.55 (0.27, 0.81)	0.68 (0.48, 0.85)	1.85 (0.71, 4.82)	0.72 (0.41, 1.26)
Recurrent/ Residual	0.53 (0.29, 0.77)	0.75 (0.54, 0.90)	0.62 (0.35, 0.84)	0.68 (0.48, 0.85)	2.13 (0.87, 5.22)	0.62 (0.34, 1.13)
Re-examined	0.66 (0.47, 0.81)	0.80 (0.60, 0.93)	0.83 (0.64, 0.94)	0.62 (0.42, 0.79)	3.28 (1.31, 8.18)	0.43 (0.25, 0.75)
EAONO/JOS	0.57 (0.36, 0.77)	0.74 (0.56, 0.88)	0.63 (0.41, 0.82)	0.69 (0.51, 0.84)	2.20 (1.05, 4.61)	0.58 (0.34, 1.00)
Re-examined + EAONO/JOS	0.74 (0.54, 0.89)	0.77 (0.59, 0.90)	0.74 (0.54, 0.89)	0.77 (0.59, 0.90)	3.20 (1.52, 6.73)	0.34 (0.17, 0.70)

non-EPI DW MRI: Diffusion Weighed Magnetic Resonance Imaging; PPV: positive predictive value; NPV: negative predictive value; LR+: Positive likelihood ratio; LR-: Negative likelihood ratio. 95% confidence intervals are in parentheses.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [EK], upon reasonable request.