Diagnosis of cholesteatoma by the b1000 value DWI MRI according to the signal intensity

Objective: The cholesteatoma (CL) can be evaluated visually or numerically on an apparent diffusion coefficient (ADC) map, which obtained from at least two different b-valued diffusion-weighted imaging (DWI). In this study, we aimed to evaluate the signal intensity (SI) of the lesion both visually and numerically only on the DWI image without ADC. In case of positive results a second  ‘b’ value is not required, so this method could be shorten the duration of the MRI examination. Material and Methods: Between January 2017 and May 2018, we included patients with chronic otitis media (COM) with a clinical suspicion of primary CL who underwent DWI. Two radiologists and one ear, nose, throat specialist evaluated the radiological images and the pathology results. Results: The mean SI measurement was significantly higher in the CL group by both observers (observer LR; CL: 107.94 ± 53.36, COM: 37.34 ± 14.70, observer FC; CL: 108.56 ± 50.00, COM: 37.06 ± 15.44; p<0001). ROC analysis showed that a mean SI value of 48.6 was the cut-off value in predicting the diagnosis of CL. The mean SI was significantly higher in the CL group (p<0.001). Conclusion: We demonstrated a significant difference between CL and COM concerning the diagnosis by visual and numerical signal evaluation only via b1000 valuable images. In false-positive cases, ADC is still confirmatory for high diagnostic accuracy.