T2 imaging is routinely performed for detection of cholesteatoma in the middle ear. In this patient a hyperintense signal is demonstrated in the previous resection area and left middle ear, suggesting the presence of inflammation or tumor (cholesteatoma, cholesterol granuloma).
TSE DWI imaging (b-value 1000) shows hyperintense foci in the left middle ear and resection area, which is suggestive of cholesteatoma. These findings are to be correlated with the ADC map.
The TSE DWI is more time consuming than the EPI DWI but is much less susceptible to artifacts and allows detection of cholesteatomas as small as 2 mm.
Image fusion of both the T2 and DWI sequences allows for a more precise anatomic description of the recurrent cholesteatoma. The largest lesion is proximate to the tegmen.