Value of Non Echo-Planar Diffusion-Weighted Magnetic Resonance Imaging in the Detection of Middle Ear Cholesteatoma

OBJECTIVE: This study was conducted to determine the clinical value of diffusion-weighted magnetic resonance imaging (MRI) (DWI) in detecting the presence of cholesteatoma. MATERIALS AND METHODS: Fifty-six patients (21 female and 35 male; mean age, 43 years old) who underwent middle ear surgery were referred to the Radiology Department for preoperative DWI study. MRI (1.5-T) was performed using fast advanced spin echo (FASE) DWI, T2-weighted spin echo imaging (T2WI), and T1-weighted spin echo imaging (T1WI). RESULTS: DWI identified 41 of 48 cholesteatomas involving the middle ear cavity (sensitivity, 85.4%). Seven patients with middle ear cholesteatoma who showed negative DWI findings (false-negative cases) had limited keratin accumulation due to simple atelectasis or meticulous evacuation of keratin debris before the MRI study. No false-positive cases were found in this study (specificity, 100%). The positive and negative predictive values were 100% and 53.3%, respectively. The minimum size of middle ear cholesteatoma detected by the current MRI system was 5mm. CONCLUSION: DWI was useful for the detection of middle ear cholesteatoma. Department of OtolaryngologyHead and Neck Surgery, Department of Radiology Miyazaki University School of Medicine, Miyazaki, Japan