Role of Diffusion-Weighted Magnetic Resonance Imaging with 1.5 and 3 Tesla Scanners in Cholesteatoma Diagnosis and Follow-up

Objective: Diffusion-weighted magnetic resonance imaging (DWMRI) is a valuable imaging technique that has gained widespread use in recent years, particularly for evaluating cholesteatoma. Our study aimed to evaluate the effectiveness of DWMRI for the primary diagnosis and follow-up of recurrent or residual cholesteatoma in chronic otitis media and to compare the efficacy of two different DWMRI protocols obtained using 1.5 and 3 Tesla scanners.Material and Methods: We conducted a retrospective review of all patients who underwent surgery at a University Hospital's Department of Otorhinolaryngology for cholesteatoma, confirmed by clinical findings or pathology, and had accessible preoperative imaging in the hospital database between May 2018 and August 2022.Results: Forty-two ears were included in our study. In our study group, the sensitivity of DWMRI in detecting cholesteatoma was 82.8%, whereas the specificity was 84.6%. The positive predictive value was 92.3%, and the negative predictive value was 68.8%. When evaluating the effectiveness of DWMRI separately in six postoperative ears, the sensitivity was 83.3%, and the positive predictive value was 100%. In the group of 30 ears examined with 1.5 Tesla, DWMRI sensitivity reached 100%, with a positive predictive value of 90.5%, specificity of 81.8%, and a negative predictive value of 100%. In the 3 Tesla group with 12 ears, the sensitivity was 50%, while the positive predictive value was 100%, specificity was 100%, and the negative predictive value was 28.6%. When comparing these results, imaging with 1.5 Tesla proved to be statistically more effective regarding sensitivity and negative predictive value.Conclusions: This study underscores the important role of diffusion-weighted magnetic resonance imaging in the evaluation of cholesteatoma and indicates that imaging protocols using a 1.5 Tesla scanner may yield favorable diagnostic performance. However, given the limited sample size in the 3T cohort, these findings should be interpreted cautiously, and further studies with larger and more balanced groups are needed to draw definitive conclusions.