Twenty-seven patients with chronic middle ear infection were prospectively studied with pre- and post-contrast magnetic resonance (MR) images to assess the role of MR imaging in the recognition of middle ear tissue abnormalities. The findings were correlated with computed tomographic (CT) scans and surgical and pathologic data. Granulation tissue constantly appeared enhanced on studies done with gadolinium diethylenetriaminepentaacetic acid (DTPA), unlike cholesteatoma, cholesterol granuloma, or brain herniation into the middle ear cavities. Evaluation of extension and thickness of the inflammatory tissue with MR imaging was in accordance with surgical findings. In six cases, isolated granulation tissue misdiagnosed as either a cholesteatoma or herniated brain on CT scans was accurately evaluated on postcontrast MR images. When granulation tissue was associated with other soft-tissue masses, Gd-DTPA-enhanced MR images allowed accurate definition of the site and the extension of each lesion. Furthermore, abnormal meningeal enhancement was precisely depicted by MR images in two cases.