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Objectives   Magnetic resonance imaging (MRI) and in particular diffusion-weighted imaging (DWI) have been broadly proven to be the reference imaging method to discriminate between cholesteatoma and noncholesteatomatous middle ear lesions, especially when high tissue specificity is required. The aim of this study is to define a range of apparent diffusion coefficient (ADC) values within which the diagnosis of cholesteatoma is almost certain.Methods   The study was retrospectively conducted on a cohort of 124 patients. All patients underwent first- or second-look surgery because primary or secondary acquired cholesteatoma was clinically suspected; they all had preoperative MRI examination 15 days before surgery, including DWI from which the ADC maps were calculated.Results   Average ADC value for cholesteatomas was 859,4 × 10 −6  mm 2 /s (range 1545 × 10 −6  mm 2 /s; IQR = 362 × 10 −6  mm 2 /s;  σ  = 276,3 × 10 −6  mm 2 /s), while for noncholesteatomatous inflammatory lesions, it was 2216,3 × 10 −6  mm 2 /s (range 1015 × 10 −6  mm 2 /s; IQR = 372,75 × 10 −6  mm 2 /s;  σ  = 225,6 × 10 −6  mm 2 /s). Interobserver agreement with Fleiss' Kappa statistics was 0,96. No overlap between two groups' range of values was found and the difference was statistically significant for  p  < 0.0001.Conclusions   We propose an interval of ADC values that should represent an appropriate benchmark range for a correct differentiation between cholesteatoma and granulation tissue or fibrosis of noncholesteatomatous inflammatory lesions.

ADC Benchmark Range for Correct Diagnosis of Primary and Recurrent Middle Ear Cholesteatoma