CT and MR imaging after middle ear surgery

Apparent Diffusion Coefficient Values of Middle Ear Cholesteatoma Differ from Abscess and Cholesteatoma Admixed Infection

“…Cholesteatoma typically shows intermediate T1 signal intensity without significant enhancement after 30 to 45 minutes and hyperintense signal intensity on T2-weighted and diffusion-weighted (DW) images. [1][2][3][4][5] Cholesteatoma shows increased DW signal intensity for the same reason as a brain epidermoid cyst, another lesion containing epidermoid cells, as previously reported in the literature. 5 Although restricted diffusion does contribute to increased DW signal intensity, the increased signal intensity predominantly results from the effects of T2 shinethrough.…”

Accuracy of turbo spin-echo diffusion-weighted imaging signal intensity measurements for the diagnosis of cholesteatoma

“…Although the qualitative non-echoplanar methods have high diagnostic accuracy (as seen above), there are still instances where the high signal of diffusion-weighted images does not unequivocally represent CS. The false positive cases reported in the literature include cholesterol granuloma, abscess, inserted fat graft, bony cement as well as chronic inflammatory tissue (7,(10)(11)(12)(13)(14)30). The cholesterol granuloma can be differentiated by its T1 hyperintensity, while the abscess can be differentiated by its acute clinical presentation as well as its very low ADC value (10,12,18).…”

Comparison of Echo-Planar Diffusion-Weighted Imaging and Delayed Postcontrast T1-Weighted MR Imaging for the Detection of Residual Cholesteatoma

“…T1-and T2-weighted sequences associated with diffusion-weighted imaging (DWI) or delayed postcontrast T1 sequences (DPI), though not early postcontrast T1 sequences, seem able to detect residual cholesteatoma among other types of tissue. [8][9][10] Results of sensitivity, specificity, positive predictive value (PPV), and NPV vary among previous studies. 8,[11][12][13][14][15] One explanation for this discrepancy may be the different sizes of residual cholesteatomas studied in these series.…”