Diffusion-weighted magnetic resonance imaging in the management of cholesteatoma.

Diffusion-weighted (DW) MRI has recently increasingly gained popularity in the diagnosis of post-operative cholesteatoma. The aim of this study is to prospectively evaluate the usefulness of echo-planar imaging (EPI) for the diagnosis of residual cholesteatoma. Fifty patients underwent DW-EPI before surgery. Fifteen patients had a scan before their first surgery and 35 patients underwent neuroimaging prior to their second look surgery. In the first preoperative group of 15 patients, DW-EPI confirmed cholesteatoma in all the patients. In the post-operative group DW-EPI identified or excluded cholesteatoma correctly in 29 out of 35 patients. Our study has demonstrated a sensitivity of 83% and specificity of 82% of DW-EPI for the diagnosis of residual cholesteatoma. DW-EPI can be a value imaging modality and may help the surgeon in selecting patients for revision surgery.