Efficacy of Diffusion‐Weighted Magnetic Resonance Imaging in Middle Ear Cholesteatoma

Abstract

Objective: Evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis of middle ear cholesteatoma. Method: We performed DWI on 73 patients suspected of having middle ear cholesteatoma, including 21 revision cases. Magnetic resonance imaging was performed with 1.5 T units using diffusion-weighted spin-echo-type echo planar imaging. Results: Of 73 participants, 59 had cholesteatoma. Positive DWI findings were observed in 42 subjects and negative findings in 31 subjects. The sensitivity, specificity, and positive and negative predictive values of DWI for cholesteatoma were 69.4%, 92.8%, 97.5%, and 41.9%, respectively. In the case of 34 patients who were positive for cholesteatoma on both otoscopic and CT examinations, 33 were diagnosed with cholesteatoma. Of the remaining 39 subjects with one or both negative results for cholesteatoma, the sensitivity, specificity, positive predictive value, and negative predictive value of DWI were 57.6%, 92.3%, 93.7%, and 52.1%, respectively. Conclusion: Since DWI clearly showed high specificity and positive predictive value, it is useful for diagnosing middle ear cholesteatoma, including postoperative recurrent cholesteatoma of 5 mm diameter or larger. DWI could sufficiently detect cholesteatoma with one or both negative results on otoscopic and CT examinations.