Back ground: Diffusion weighted imaging was introduced to improve the detection of middle ear cholesteatomas. By computed tomography, difficulty was found as cholesteatoma shows middle ear opacity similar to chronic otitis media in cases with no bone erosion,
Objectives: Purpose of this study to clarify the role of diffusion-weighted imaging in the diagnosis of cholesteatoma and differentiating it from chronic otitis media.
Methods: Cross sectional study of 20 patients, All patient treated medically, followed, surgery was done in those not responding to medical treatment after one month. T2WI and DWI and ADC map were done, results assessed by SPSS system version 20 and Chi square test. Sensitivity, specificity, positive and negative predictive vales assessed.
Results: 20 patients (9 males and 11 females), ages 15-35 and mean age = ± 25 year, 10 of them showed middle ear hyperintense signal intensity lesion in T2 weighted image, restricted diffusion, and low apparent diffusion coefficient values, mean value was about = ± 0.75 ± 0.26 x10^-3 mm²/s,11 patients were confirmed cholesteatoma. 10 patients showed hyperintense signal intensity lesion in T2WI, facilitated diffusion and high apparent diffusion coefficient values, mean value = ± 1.75 ± 0.14 x10^-3 mm²/s, 9 confirmed otitis media by complete resolution after antibiotic treatment and follow up. Sensitivity of diffusion-weighted imagining 90.0%, specificity 88.9%, positive and negative predictive value 90.9% and 88.9%.
Conclusion: Diffusion-weighted imagining has a high sensitivity and diagnostic accuracy in differentiation of cholesteatoma from otitis media in overlapping cases.