Quick case: Recurrent Cholesteatoma

Non-echoplanar DWI has revolutionized the care of patients after cholesteatoma surgery. Does this patient have a recurrence?

[@caiyu538]

Great.

[@nathanielyangmd528]

Does the addition of a hi-res T2-weighted sequence like the CISS or FIESTA, and a hi-res contrast T1 series, provide useful information that, when combined with the DWI sequence, allow for a more accurate assessment of temporal bone pathology ? I would think that these other sequences would have been helpful in diagnosing a mastoid abscess, with or without a cholesteatoma present.

[@ENT_Imaging]

We do include those sequences in our cholesteatoma protocol. In addition to assessing for alternative pathology, it is useful for anatomic localization. It is sometimes difficult to determine exactly where the restricted diffusion is located within a sea of inflammatory debris. Correlating with the SSFP sequences allows you to be specific about the location of the cholesteatoma.

[@immane75]

Excellent as usual . I do work on a 3T Siemens Lumina and unfortunately I can’t do Frontal Diffusion HASTE ! Do you have any idea on how I can do ? TIA

[@ENT_Imaging]

All my clinical scanners are GE, so I'm probably not the right person to ask, but we do have some Siemens scanners in our research lab. We use RESOLVE when we scan for cholesteatoma on the Siemens scanners. I understand that TGSE BLADE is also good, but I have no personal experience with it.

[@immane75]

@@ENT_Imaging THanks a lot ,we do use resolve for prostate , I will phone the siemens ingeneer and ask him to set it up . Thanks a lot.

[@caiyu538]

Based on my previous research experiences with Siemens, you can check if your institute are qualified to update the MRI pulse sequence with Siemens, or buy the MRI pulse sequence from them, or signed a research contract with Siemens and they may provide the sequence for free use for several years.

[@immane75]

@@caiyu538 Thanks , I will ask.