HASTE diffusion-weighted MRI for the reliable detection of cholesteatoma

To assess the detection efficiency of Half-Fourier acquisition single-shot turbo spin-echo (HASTE) diffusion-weighted magnetic resonance imaging (MRI) for cholesteatoma. A total of 21 patients with suspected primary (n=16) or recurrent cholesteatoma (n=5) underwent MRI in a 1.5 Tesla scanner using an adapted protocol for cholesteatoma detection that included a coronal HASTE diffusion-weighted MRI sequence. The cholesteatoma diagnosis was based on evidence of a hyperintense lesion at b-1000 on diffusion-weighted images. The imaging findings were correlated with findings from surgery or clinical evaluations in all patients. HASTE diffusion-weighted MRI successfully detected 11 primary and 5 recurrent lesions out of 17 cholesteatomas (sensitivity, 94.1%). One primary cholesteatoma with a diameter of 4-5 mm was missed. MRI of patients without cholesteatoma were correctly interpreted as negative for cholesteatoma (specificity, 100%). The positive and negative predictive values for the HASTE diffusion-weighted MRI in detecting cholesteatoma were 100% and 80%, respectively. HASTE diffusion-weighted MRI offers great promise for cholesteatoma screening. The addition of this sequence to the posterior fossa MRI protocol may preclude unnecessary cholesteatoma surgery.