A patient underwent combined approach tympanoplasty for attic cholesteatoma two years ago. The surgeon wishes to detect residual cholesteatoma in the middle ear before offering a second-look procedure. Which imaging modality is currently preferred for this purpose?
- A Non-echo-planar diffusion-weighted MRI of the temporal bone ✓
- B High-resolution computed tomography of the temporal bone
- C T2-weighted MRI with gadolinium contrast
- D Fluorodeoxyglucose positron emission tomography scan
Correct answer: A. Non-echo-planar diffusion-weighted MRI of the temporal bone
Explanation
Keratin within cholesteatoma shows restricted diffusion. Non-echo-planar diffusion-weighted sequences such as HASTE give high spatial resolution without the distortion seen with conventional echo-planar DWI, allowing detection of even small residual pearls and avoiding unnecessary second-look surgery. HRCT detects bony erosion but cannot reliably distinguish recurrent cholesteatoma from granulation tissue or fluid, and contrast-enhanced T2 images show enhancement of inflammatory tissue that mimics tumour. FDG-PET has no established role here.
Reference: Scott-Brown Otorhinolaryngology Head and Neck Surgery, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.