A patient who underwent canal wall up mastoidectomy for cholesteatoma is planned for a second-look procedure at 12 months. Which imaging modality is currently preferred to detect residual cholesteatoma before surgery?

• A High-resolution CT temporal bone
• B T2-weighted conventional MRI
• C Non-echo-planar diffusion-weighted MRI ✓
• D PET-CT of the temporal bone

Explanation

Keratin within cholesteatoma shows restricted diffusion, so non-echo-planar diffusion-weighted MRI demonstrates residual cholesteatoma as a focus of high signal with high sensitivity and specificity, allowing avoidance of unnecessary second-look surgery. High-resolution CT cannot distinguish residual cholesteatoma from granulation tissue or effusion. Conventional T2 images show all soft tissue as bright and are non-specific. PET-CT has no established role in temporal bone cholesteatoma surveillance.

Reference: Scott-Brown's Otorhinolaryngology and Head and Neck Surgery, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.