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World J Radiol. May 28, 2017; 9(5): 217-222
Published online May 28, 2017. doi: 10.4329/wjr.v9.i5.217
Diffusion weighted imaging for the detection and evaluation of cholesteatoma
Benjamin Henninger, Christian Kremser
Benjamin Henninger, Christian Kremser, Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
Author contributions: Henninger B wrote the paper; Kremser C performed proofreading and wrote the physical part.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Benjamin Henninger, PD, Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. benjamin.henninger@i-med.ac.at
Telephone: +43-512-50480914 Fax: +43-512-50422758
Received: October 28, 2016
Peer-review started: November 2, 2016
First decision: February 15, 2017
Revised: February 23, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: May 28, 2017
Processing time: 202 Days and 15.2 Hours
Abstract

Cholesteatoma is a collection of keratinous debris and stratified squamous epithelium. It is trapped in the middle ear and can lead to bony erosion. The disease is treated surgically often followed by a second-look procedure to check for residual tissue or recurrence. Cholesteatoma has specific signal-intensity characteristics on magnetic resonance imaging with very high signal intensity on diffusion weighted imaging (DWI). Various DWI techniques exist: Echo-planar imaging (EPI)-based and non-EPI-based techniques as well as new approaches like multi-shot EPI DWI. This article summarizes all techniques, discusses the significance in detecting cholesteatoma and mentions actual studies. Further recommendations for daily clinical practise are provided.

Keywords: Cholesteatoma; Diffusion weighted imaging; Computed tomography; Magnetic resonance imaging; Echo-planar imaging; Non-echo-planar imaging

Core tip: Imaging cholesteatoma is either performed by computed tomography (CT) or by magnetic resonance imaging (MRI). CT is the method of choice for detection and for assessing exact location and extent. MRI with diffusion weighted imaging (DWI) is a powerful tool for the detection of local recurrence or residual cholesteatoma. Many DWI-techniques are available today; this review article gives an overview of the different sequences and the diagnostic procedure when using DWI with a clinical focus.