Diagnostic Value of HRCT and Non-EPI DWI-MRI in Middle Ear Cholesteatoma: Accuracy and Preoperative Impact.
OBJECTIVE To compare the diagnostic performance of high-resolution computed tomography (HRCT) and non-echo-planar diffusion-weighted magnetic resonance imaging (non-EPI DWI-MRI) for middle ear cholesteatoma and to assess the added value of their combined use in preoperative evaluation. METHODS Imaging data sets from 85 subjects (65 with surgically or histopathologically confirmed cholesteatoma, 20 controls) were retrospectively analyzed. HRCT, non-EPI DWI-MRI, and combined HRCT+DWI-MRI interpretations were compared against reference standards. Diagnostic metrics included sensitivity, specificity, accuracy, localization error, and interobserver agreement (κ). RESULTS HRCT demonstrated high sensitivity (95.4%) for detecting bony erosions and ossicular abnormalities, whereas non-EPI DWI-MRI showed greater specificity (85.0%) in distinguishing cholesteatoma from other soft tissues. The combined approach yielded optimal diagnostic performance (sensitivity 93.8%, specificity 92.0%, accuracy 93.2%) and the lowest localization error (mean 1.8 mm). Interobserver agreement was excellent (κ=0.88). CONCLUSION High-resolution computed tomography and non-echo-planar diffusion-weighted MRI provide complementary diagnostic information in the evaluation of middle ear cholesteatoma. Their combined interpretation may improve diagnostic confidence and radiologic assessment of lesion extent; however, the direct impact on surgical outcomes requires further prospective validation.