Non-Echoplanar Diffusion Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma

Cholesteatomas are lesions that develop in pneumatized areas of the temporal bone, such as the middle ear and mastoid, or both, and are extremely rarely detected in the external auditory canal. Because it has benefits over CT, diffusion weighted imaging MRI (DWI-MRI) can be a useful technique in the identification of cholesteatoma. Image distortion and artefacts are less visible with non-echo planar imaging DWI techniques than with other DWI techniques. Aims and Objectives: 1) To assess the usefulness of HRCT scan in Chronic suppurative otitis media (CSOM) with cholesteatoma in depicting the status of the middle ear structures. 2) To correlate HRCT findings of temporal bone with surgical findings in Chronic suppurative otitis media (CSOM) with cholesteatoma with respect to the following parameters: Presence or absence of cholesteatoma, Extent of cholesteatoma, Status of ossicular chain, Integrity of the facial canal, Detection of erosions or dehisence in the bony labyrinth, and Detection of erosions or dehisence in the dural or sinus plates. 3) Comparison with Non Echo planar imaging diffusion weighted for presence or absence of cholesteatoma. 4) 3D FIESTA Magnetic resonance imaging with 3D reconstruction of membranous vestibule and cochlea for better delineating associated complications. Materials and Methods: Total 40 patients of clinically suspected CSOM with cholestaetoma were enrolled for this study. All patients were scanned using a non-contrast High-resolution computed tomography technique and MRI. HRCT findings were noted according to the proforma. MRI DWI was recorded as either positive or negative for cholesteatoma & directly correlated with post-surgical presence or absence of cholesteatoma.3D FIESTA for detection of membranous labyrinthine erosion/defect was correlated with surgical findings of bony labyrinthine erosions. Results: Cholesteatoma was shown to be common in the third decade of life in our study. The most often implicated middle ear structures in our investigation were the epitympanum, aditus, and antrum. The most often eroded ossicle is the stapes, followed by the incus. The tympanic section of the facial canal is the most often affected segment, while the posterior semicircular canal is the most commonly degraded of the bony labyrinth structures. Conclusion: HRCT temporal bone, in combination with non-echoplanar DWI MRI and 3D Fiesta, can help with accurate diagnosis and pre-operative assessment of cholesteatoma.