Abstract
We present two cases of cholesteatoma and one false positive finding in non-EP DW MRI in order to highlight the differential diagnosis in imaging and emphasize the need to discuss the findings with the otologic surgeon. The first case demonstrates different MRI signal patterns encountered in a patient with cholesteatoma. The second report is a rare case of supralabyrinthine cholesteatoma with atypical clinical presentation. The third case presents a rare but important false positive finding in non-EP DW MRI. Clinical and imaging findings are discussed taking into account the current literature.
Highlights
A simple definition of cholesteatoma is “wrong skin at the wrong place with retention of keratin”
The expansive characteristics of the keratinizing squamous epithelium lead to sharp bony erosions that are appreciated on computed tomography (CT) scans
We present three cases to highlight the differential diagnosis in imaging and emphasize the need to discuss the findings with the otologic surgeon
Summary
A simple definition of cholesteatoma is “wrong skin at the wrong place with retention of keratin”. CT cannot confirm the true presence of a cholesteatoma mass since it differentiates poorly between soft tissue lesions. Non-echo planar diffusion-weighted MR imaging (non-EP DW MRI) has gained much attention due to its short acquisition time and high sensitivity and specificity for detecting even small cholesteatomas of 2 - 3 mm in size [1]. Whereas this fast sequence may be sufficient to screen for residual cholesteatoma in canal wall-up procedures, we encourage using additional T2-. T1-weighted sequences in cases of primary diagnosis of a soft tissue lesion within the temporal bone. We present three cases to highlight the differential diagnosis in imaging and emphasize the need to discuss the findings with the otologic surgeon
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