Diffusion weighted imaging for the detection and evaluation of cholesteatoma

Figure 1 Thirty-nine-year-old male patient with clinically suspected cholesteatoma in the right middle ear. A: Axial CT of the temporal bone with soft-tissue mass in the tympanic space adjacent to malleolus and incus (white arrow); B: Axial T2-weighted MR depicts fluid-like signal in the tympanic space (white arrow); C: Fused axial T2-weighted image and axial EPI DWI RESOLVE without any sign of restriction. Therefore there is no evidence of cholesteatoma; the findings are consistent with chronic otitis media. CT: Computed tomography; DWI: Diffusion weighted imaging; EPI: Echo-planar imaging; RESOLVE: Readout-segmented echo-planar.

Figure 2 Thirty-one-year-old female after surgery for cholesteatoma. A, B: CT show a soft-tissue mass in the tympanic space adjacent to malleolus and scutum with suspected bony erosion (white arrow); C-E: Axial T2 weighted image shows fluid-like signal (white arrow) that has no restriction in EPI DWI RESOLVE (axial in D and coronal in E). There was no sign of recurrent cholesteatoma on follow-up surgery. CT: Computed tomography; DWI: Diffusion weighted imaging; EPI: Echo-planar imaging; RESOLVE: Readout-segmented echo-planar.

Figure 3 Twenty-three-year-old male patient with a typical cholesteatoma detected with diffusion weighted imaging. A, D: T2 weighted images (A and D) show a fluid-like mass in the left middle ear (white arrow); B, C, E, F: EPI DWI RESOLVE (B and E) depict a hyperintense signal (white arrow) consistent with restriction due to a small cholesteatoma that is better demonstrated on fused images (C and F). DWI: Diffusion weighted imaging; EPI: Echo-planar imaging; RESOLVE: Readout-segmented echo-planar.