Cholesteatoma Imaging by diffusion and 3D T2 heavily weighed sequences: Role of fused images in localizing the white pearl.

BACKGROUND The most popular and successful technique for diagnosing preoperative cholesteatomas is diffusion imaging. In spite of its limited capacity to distinguish anatomical features. In order to create thin-section cross-sectional imaging images, attempts were undertaken to merge diagnostic diffusion images with corresponding anatomical images.PATIENTS AND METHODS: We studied MR images of 30 patients having CSOM. Imaging techniques included thin-section “Non-EPI” diffusion and “MRI-fluid-sensitive- cisternography”. The “Fused images” were then generated by dedicated software. A cholesteatomatous “white pearl” is ascribed a certain location of oto-mastoid cavity. Fused and non-fused images are compared by inter-observer agreement. RESULTS: Cholesteatomas were most frequently seen in the "attic" section (60%) and the "mastoid cavity" (20%), then the "tympanic cavity; other than attic (10%), and finally the mastoid antrum (10%). When comparing fused images to non-fused images, all of the accuracy numbers were greater. CONCLUSIONS: “In order to effectively delineate the cholesteatomas pearl, fused images—which are produced by over-riding thin-section non-echo-planar diffusion and heavily T2W 3D ultra-thin sequences—can replace other thick-section anatomical images, which are unable to override thin-section diffusion images and may overlook minute pearls.