title: Cholesteatoma imaging using modified echo-planar diffusion-weighted magnetic resonance imaging.
abstract: BACKGROUND
  Imaging of cholesteatomas can be useful especially in cases of recurrent disease. Computed tomography scans have been recommended before primary surgery, but cholesteatoma tissue looks similar to inflammatory tissue. Diffusion-weighted magnetic resonance imaging is both sensitive and specific in detecting cholesteatoma, which appears as a bright signal on a dark background. Non-echo-planar diffusion-weighted magnetic resonance imaging is superior to routine echo-planar diffusion-weighted magnetic resonance imaging as it minimises susceptibility artefacts; however, the addition of this facility involves expensive magnetic resonance scanner upgrading.
  
  
  METHODS
  To avoid the cost of such upgrading, we modified our echo-planar diffusion-weighted magnetic resonance imaging parameters and then scanned 15 consecutive cases of suspected cholesteatoma or suspected recurrent cholesteatoma.
  
  
  RESULTS
  Imaging results correlated well with clinical and/or operative findings.
  
  
  CONCLUSIONS
  These results indicate that software adjustments can enable echo-planar diffusion-weighted magnetic resonance imaging to detect cholesteatomas reliably, and as effectively as non-echo-planar diffusion-weighted magnetic resonance imaging. This discovery has the potential to facilitate reliable delayed post-operative screening of canal wall up mastoidectomies, avoiding the need for a 'second look' procedure.
authors.affiliation: ENT Department, Hope Hospital, Salford, UK. edflook@yahoo.com
authors.forename: E
authors.initials: E
authors.lastname: Flook
authors.forename: S
authors.initials: S
authors.lastname: Izzat
authors.forename: A
authors.initials: A
authors.lastname: Ismail
mesh_terms: D016477:Artifacts; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D017352:Echo-Planar Imaging / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D012680:Sensitivity and Specificity; D014584:User-Computer Interface