Diffusion-Weighted MRI in the Diagnosis of Cholesteatomas

Objective: The diagnosis of a cholesteatoma can be difficult in cases with an intact tympanic membrane. The aim of our study was to examine whether diffusion-weighted MRI can confirm the diagnosis of a cholesteatoma. Study Design: A preoperative diffusion-weighted MRI (echo-planar imaging) scan of the temporal bone was performed in 31 patients with clinically suspected cholesteatoma. The diagnosis was confirmed by pathohistological examination in 18 cases, while the majority of the remaining patients showed chronic otitis media without cholesteatoma. Results: In 3 out of 18 patients with histologically confirmed cholesteatoma, diffusion-weighted imaging produced a hyperintense signal. Another 4 of the 18 cases had a questionable positive result. No increased signal was observed in 11 of these 18 patients. Of 12 patients without a cholesteatoma, 2 showed a positive signal while a questionable hyperintense signal was observed in 5 patients. Conclusions: According to our present findings, diffusion-weighted MRI (echo-planar imaging) can - with a low sensitivity and specificity - be helpful in individual cases in provisionally diagnosing a cholesteatoma in association with standard MRI and high-resolution CT, even though the lack of a hyperintense signal in diffusion-weighted MRI does not exclude a cholesteatoma. Copyright (C) 2009 S. Karger AG, Basel