Learning Objectives: In my experience, when you get a group of professionals together and give them the opportunity to determine what they'd like to talk about, you'll end up with enough viable.

Introduction: Various techniques of diffusion-weighted (DW) magnetic resonance imaging (MRI) have shown valuable in diagnosing middle ear (ME) cholesteatoma high accuracy. PROPELLER (periodically rotated overlapping parallel lines) is one of these techniques and the purpose of this study was to investigate its accuracy in detection of primary acquired ME cholesteatomas.

Methods: In a prospective study 37 cases with clinically suspected primary acquired ME cholesteatoma underwent DW PROPELLER MRI scannings prior to surgery. One neuro-radiologist with expertise in Head &Neck Imaging evaluated the images without knowing the surgical findings. The surgical findings were compared with the radiology findings, and outcome measures included sensitivity, specificity, positive and negative predictive values.

Results: Cases with cholesteatoma demonstrated hyperintense foci on PROPELLER DW MRI. In 37 patients, surgery revealed cholesteatoma in 31 cases; 29 of these were MRI positive, whereas two were negative; these cases were between 2–3 mm in diameter. Surgery revealed no cholesteatoma in six cases, and these were all MRI negative. Sensitivity, specificity, and positive and negative predictive values were 94%, 100%, 100%, and 75%, respectively. In the 29 cases with positive radiological findings, the extent and location of the cholesteatoma correlated.well with the surgical findings.

Conclusion: DW PROPELLER MRI imaging is an effective and reliable technique in the diagnosis of cholesteatoma diagnosis with high sensitivity and specificity as well as high correlation between the extension of the disease and surgical findings. Thus, this techniques is a promising radiologic tool, however further studies are warranted with more patients.