Routine non-EPI DWI MRI at 12 to 24 months detects cholesteatoma recurrence in postoperative patients

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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Published June 3, 2026 Medically reviewed June 3, 2026 Study authors: Wolfovitz Amit, Segal Ella, Murad Havi, Agay Nirit, Tessler Idit PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider routine non-EPI DWI MRI at 12 to 24 months for postoperative cholesteatoma patients.

This meta-analysis examines non-EPI DWI MRI follow-up timing for patients with postoperative cholesteatoma. The analysis included 1187 patients and assessed MRI positivity rates for cholesteatoma recidivism over a follow-up period of 1 to 60 months. No specific setting or funding information was reported for this synthesis. The study does not report adverse events or tolerability data. The authors note that causality was not reported in the source data. The certainty of the findings is not explicitly stated in the provided text.

MRI positivity rates varied by time point. At 1 month, the rate was 12%. At 6 months, it was 19%. At 12 months, it was 15%. At 24 months, it was 22%. At 36 months, it was 12%. At 48 months, it was 21%. At 60 months, it was 13%. These percentages represent the MRI positivity rate for cholesteatoma recidivism at each interval.

Procedure type and age group influenced detection rates. At 12 months, the rate was 22% for canal wall up versus 7% for obliteration. At 36 months, the rate was 18% for canal wall up versus 9% for obliteration. At 12 months by age group, the rate was 16% in adults versus 20% in children. The 95% CI for adults was 6%-38% and for children was 7%-47%.

The practice relevance supports performing the first routine non-EPI DWI MRI at 12 to 24 months postoperatively. Follow-up imaging can be performed at 2-year intervals thereafter in patients with a negative initial scan, yet continued for at least 5 years.

Study Details

Study typeMeta analysis

Sample sizen = 1,187

EvidenceLevel 1

Follow-up1.0 mo

PublishedJun 2026

PMID41904979

View Original Abstract ↓

OBJECTIVE: Non-echo-planar diffusion-weighted imaging (non-EPI DWI) magnetic resonance imaging (MRI) has revolutionized postoperative cholesteatoma follow-up, shifting from surgical to radiological evaluation. Yet, the timing for postoperative imaging remains contentious. This meta-analysis assesses the optimal follow-up interval for postoperative MRI in detecting cholesteatoma recidivism. DATA SOURCES: PubMed, Embase, and Cochrane. REVIEW METHODS: We conducted a meta-analysis systematic review of PubMed, Embase and Cochrane between 2013 and 2024 following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The positive MRI rate over time was estimated for each study separately and then pooled across studies using weighted averages of the ears studied. Data were plotted against time with a smoothed curve and 95% confidence intervals. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS: We identified 525 studies, of which 16 studies met the inclusion criteria, comprising 1187 patients. The pooled MRI positivity rates at standardized follow-up intervals were 12% at 1 month, 19% at 6 months, and 15% at 12 months. Positivity increased to 22% at 24 months, then declined to 12% at 36 months, followed by a secondary peak of 21% at 48 months, and 13% at 60 months. Canal wall up procedure demonstrated significantly higher MRI positive rates than obliteration procedures at both 12 months (22% vs 7%) and 36 months (18% vs 9%). At 12 months, the pooled MRI positivity rate was 16% (95% CI: 6%-38%, I = 91%) in adults and 20% (95% CI: 7%-47%, I = 88%) in children. CONCLUSION: Our findings support performing the first routine non-EPI DWI MRI at 12 to 24 months postoperatively. Given the slow-growing nature of cholesteatoma and stable recurrence rates beyond this period, follow-up imaging can be performed at 2-year intervals thereafter in patients with a negative initial scan, yet continued for at least 5 years.