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.