title: Imaging for evaluation of cholesteatoma: current concepts and future directions.
abstract: OBJECTIVE
  To examine the rationale and utility of imaging in patients with known or suspected cholesteatoma, with emphasis on high-resolution computed tomography (HRCT) and diffusion-weighted MRI (DW-MRI).
  
  
  RESULTS
  The initial diagnosis of cholesteatoma is largely based on patient history and clinical findings. HRCT scan can be a useful adjunct to define the presence of pathologic soft tissue in the temporal bone, and the extent of bony erosion, and inform the otologic surgeon about expected findings at the time of surgery. Although MRI has not traditionally been used in the evaluation of cholesteatoma given its poor resolution of bone anatomy, recent advances in DW-MRI sequences allow for high sensitivity and specificity in identifying the presence of cholesteatoma. More specifically, non-echo-planar DW-MRI is superior in the detection of residual or recurrent cholesteatoma compared to delayed-contrast MRI and echo-planar DW-MRI.
  
  
  CONCLUSIONS
  HRCT and DW-MRI offer complementary anatomic information that can be used effectively in the management of cholesteatoma. DW-MRI imaging has proven to be a reliable method for detecting residual or recurrent cholesteatomas down to 3 mm in size, and allows radiologic differentiation between cholesteatoma and other soft tissue. As more centers implement DW-MRI imaging for detecting residual or recurrent cholesteatoma, there will likely be less need for second-look surgery, thereby potentially decreasing associated morbidity and surgical costs.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California 94305, USA.
authors.forename: C Eduardo
authors.initials: CE
authors.lastname: Corrales
authors.forename: Nikolas H
authors.initials: NH
authors.lastname: Blevins
mesh_terms: D016477:Artifacts; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis*; D054893:Cone-Beam Computed Tomography; D003952:Diagnostic Imaging / Q000639:trends; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D024162:Second-Look Surgery; D012680:Sensitivity and Specificity; D013701:Temporal Bone / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*