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Single-Shot, Turbo Spin-Echo, Diffusion-Weighted Imaging versus Spin-Echo-Planar, Diffusion-Weighted Imaging in the Detection of Acquired Middle Ear Cholesteatoma

B. De Foera, J.-P. Vercruyssec, B. Pileta, J. Michielsd, R. Vertriestb, M. Pouillona, T. Somersc, J.W. Casselmana,e and E. Offeciersc

a Department of Radiology, A.Z. Sint-Augustinus, Antwerp, Belgium
b Department of Otorhinolaryngology, A.Z. Sint-Augustinus, Antwerp, Belgium
c University Department of Otorhinolaryngology, A.Z. Sint-Augustinus, Antwerp, Belgium
d Siemens Medical Solutions, Anderlecht, Belgium
e Department of Radiology, A.Z. Sint-Jan AV, Bruges, Belgium


Figure 1
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  		Fig. 1. Axial high-resolution CT at the level of the lateral semicircular canal shows a nodular attical soft tissue lesion (white arrow) with erosion of the anterior limb of the lateral semicircular canal (black arrow), highly suggestive of a cholesteatoma with erosion of the anterior limb of the lateral semicircular canal. Note the loss of delineation of the body and short process of the incus suggesting an extensive erosion (small arrow).


Figure 2
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  		Fig. 2. Coronal reformation of an axial volume spiral CT shows the attical soft-tissue lesion (white arrow) with loss of delineation of the tegmen (black arrow). Invasion into the middle cranial fossa cannot be excluded based on these images. There is also suspicion of a fistulization to the lateral semicircular canal on this coronal reformation (small arrow).


Figure 3
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  		Fig. 3. Coronal thin section T2-weighted MR image centered on the left ear reveals a nodular slightly hyperintense lesion (large arrow) under the temporal lobe with hyperintense material (small arrow) laterally, suggesting the presence of a small cholesteatoma with surrounding inflammatory tissue.


Figure 4
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  		Fig. 4. Coronal late postgadolinium T1-weighted MR image shows the cholesteatoma as a nonenhancing nodular lesion (large arrow) under the temporal lobe surrounded by enhancing inflammatory tissue (small arrow) mainly on its lateral side.


Figure 5
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  		Fig. 5. Coronal EPI-DWI shows a bilateral curvilinear hyperintensity (white arrows) under the temporal lobe, compatible with a large susceptibility artifact. No nodular hyperintensity suggestive of cholesteatoma can be seen.


Figure 6
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  		Fig. 6. Coronal single-shot TSE-DWI shows no curvilinear interface artifact but clearly demonstrates a hyperintensity under the temporal lobe, indicating that a cholesteatoma is present (white arrow).





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X