Introduction:

The detection of residual or recurrent cholesteatoma has traditionally required second-look surgery. Non-echo-planar diffusion-weighted magnetic resonance imaging (non-EPI DWI-MRI) is emerging as a noninvasive and accurate alternative. The objective of this study was to describe the usefulness of this diagnostic tool through two clinical cases.

Methodology:

This was a retrospective descriptive study. Two cases of adult patients evaluated with computed tomography (CT) and 1.5-T magnetic resonance imaging (MRI), including a non-EPI DWI sequence and apparent diffusion coefficient (ADC) maps, are presented. MRI diagnosis was based on diffusion restriction, defined as hyperintensity on DWI b=1000 and corresponding hypointensity on the ADC map, in a blinded and independent analysis performed by an expert otolaryngologist and imaging specialist.

Results:

In both cases, CT showed nonspecific middle-ear opacification. Non-EPI DWI-MRI was decisive in demonstrating diffusion restriction, establishing the diagnosis of cholesteatoma, which was subsequently confirmed by surgery and histopathology.

Conclusion:

In this case series, non-EPI DWI-MRI was a decisive diagnostic tool, supporting its usefulness as a noninvasive alternative to second-look surgery.

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