Clinical Utility of MRI for Cholesteatoma Recurrence

Diffusion-weighted magnetic resonance imaging (DWI) has recently been proposed as an alternative to surgical exploration for suspected recurrent or residual cholesteatoma. A second-look surgery is often planned for extensive disease in ears where the posterior canal wall has been left intact. Alternatively, granulation tissue with chronic otorrhea in a patient with a history of cholesteatoma is highly suspicious for recurrence. Computerized tomography imaging is excellent for showing bony definition details of the temporal bone but cannot differentiate between soft tissue types. Cholesteatoma has unique signaling characteristics on DWI that can help distinguish between inflammatory tissue and residual or recurrent disease.