Diffusion-weighted MR imaging increases diagnostic accuracy of breast MR imaging for predicting axillary metastases in breast cancer patients.

PURPOSE: To evaluate the incremental value of diffusion-weighted imaging (DWI) to conventional MR imaging (CMRI) to predict ipsilateral metastatic axillary lymphadenopathy in patients with newly diagnosed breast cancer. SUBJECTS AND METHODS: In an IRB approved retrospective single-institution study, newly diagnosed consecutive breast cancer patients with pathological verification of axillary lymph node (LN) status who had undergone breast MR imaging, including DWI as part of their standard MRI between August 1, 2010, and December 31, 2010, were reviewed. Lesion size, tumor grade, and tissue prognostic factors were noted. Ipsilateral axillary LNs were evaluated using morphological criteria on CMRI. Apparent diffusion coefficient (ADC) values of suspicious ipsilateral LNs were obtained and compared with ADC values of contralateral benign axillary LNs. Receiver operating characteristic curves and multivariate logistic regression analyses were used using pathology as the gold standard. RESULTS: Eighty-five eligible patients were identified, with surgical pathology revealing 34 patients (40%) who had malignant and 51 (60%) had benign ipsilateral axillae. The sensitivity of CMRI was 79%, with a specificity of 81%, a positive predictive value (PPV) of 65%, and a negative predictive value (NPV) of 89%. On DWI, the mean ADC value was significantly lower for metastatic LNs (0.89 ± 0.18 × 10-3  mm2 /s) than for benign ipsilateral LNs (1.41 ± 0.21 × 10-3  mm2 /s; P < 0.0001). Using a cutoff ADC value of 0.985 × 10-3  mm2 /s, yielded improved sensitivity, specificity, PPV, and NPV of 83%, 98%, 95%, and 93%, respectively. CONCLUSION: Apparent diffusion coefficient values increase the specificity of CMRI for predicting ipsilateral axillary LN metastases in patients with newly diagnosed breast cancer.

Tomographic evaluation on bone morphology in posterior mandibular region for safe placement of dental implant.

The aim of this study was to examine the morphology of submandibular fossae at edentulous posterior regions of dried mandibles and to determine a safe range for proper lingual angulation during the placement of a dental implant in the posterior mandibular region, with a computerized tomographic scan study. Spiral computed tomographic images of 77 dry adult human mandibles were evaluated to determine the deepest area in the submandibular fossa. Then, the proper lingual angulations for the placement of a dental implant at these regions were measured. Pearson's correlation coefficient was calculated to show the relation between the depths of submandibular fossa and lingual implant angulations. "Paired t test" was used for differences between the lingual implant angulations and the depths of submandibular fossa on each side of the mandibles. Depths of the submandibular fossa and lingual implant angulations were varied between 1.1 and 4.6 mm: 62°-84° on right side of the mandibles, and 1.1-4.5 mm, 65°-83° on left side of the mandibles. There were statistically medium negative correlations between the degree of lingual implant angulations and the depth of submandibular fossa on each side of the mandible (r = -0.44, p < 0.001, and r = -0.38, p = 0.001). There was a statistically significant difference between the right and left sides of the mandibles in terms of the depth of submandibular fossa (p = 0.01). Within the limits of this study, the depth of submandibular fossa was measured as ≥ 2 mm in around 71.5 % of examined regions, and lingual implant angulations were between 62° and 84°. These results may be considered by clinicians who are planning the dental implant placement in posterior mandible to avoid potential risk of lingual cortical plate perforation.

Sonography of fat necrosis of the breast: correlation with mammography and MR imaging.

Fat necrosis (FN) of the breast is a benign nonsuppurative inflammatory process of the adipose tissue. The radiologic appearance ranges from benign to suspicious for malignancy; therefore, it is very important to know the distinguishing radiologic features of FN on different modalities. Mammography is more helpful in identifying FN than ultrasonography in most of the cases, and MRI may also be used to rule out malignancy as an adjunct to mammography and sonography. Even when modern diagnostic modalities are used, biopsy may still be unavoidable for some cases. In conclusion, an accurate history and familiarity with the radiologic findings are crucial to recognizing FN and avoiding unnecessary interventions.

Pararectal mass: an atypical location of splenosis.

Splenosis is the autotransplantation of splenic tissue resulting from the dissemination of cells from the pulp of the spleen after splenic injury or splenectomy. Implants can be found anywhere in the peritoneal cavity, especially on the serosal surfaces of small and large bowel, in the mesentery and diaphragm, implanted in visceral organs, within the thorax and brain, and in surgical scars and may vary in number, shape, and size. We described the sonographic, computed tomography and magnetic resonance imaging findings of pararectal splenosis in a 23-year-old man. The lesions appeared as multiple, well-circumscribed, small, round, homogenously solid masses of different sizes at the retrovesical and pelvic region detected during the imaging workup of Behçet disease.

Glioblastoma Multiforme With CDKN2A, Loss of PTEN and EGFR Amplification, and Diffuse Distant Organ Metastasis Treated With Six Lines of Therapy: A Case Report and Literature Review.

In glioblastoma multiforme (GBM) cases, the tumor usually remains limited to the central nervous system in the expected disease course. Here, we discuss the case of a 41-year-old male patient who presented with extracranial spread, which has been reported in a limited number of cases in the literature. The patient received six lines of treatment including radiotherapy with temozolomide, irinotecan-bevacizumab combination, lomustine, erlotinib, everolimus, and weekly carboplatin-paclitaxel. In addition to systemic treatment, the patient underwent radiotherapy and surgery twice. Despite presenting with features consistent with a poor prognosis and extensive multi-organ metastasis, the patient achieved an overall survival of 25 months. In our view, the clinical course of our case, the follow-up, and the treatment process will add to the literature.

The radiologic roadmap for treatment of an acute appendicitis patient who tested positive for coronavirus disease 19.

Objective: In this study, we aimed to emphasize the role of radiological imaging in determining the treatment of a patient, who tested positive for COVID-19 and diagnosed with acute appendicitis during the pandemic. Methods: A 31-year-old patient presented to the emergency department due to abdominal pain. Ultrasound examination, thoracic and pelvic CT scan were performed. Results: Non-complicated appendicitis can be treated conservatively with antibiotics. Treatment can be maintained by starting with IV antibiotics and bridging therapy with oral antibiotics. Conclusion: This studysummarize how radiological follow-up can be used to decide on the suitability of the patient for appropriate medical treatment as an alternative to surgery in a patient, whose gold standard treatment is emergency surgical intervention, which is frequently encountered in the emergency department during the COVID-19 pandemic. Healthcare workers need to be protected to ensure the continuity of the health system. On the other hand, patients requiring emergency healthcare should also be provided with appropriate treatment. Healthcare professionals should choose the most appropriate treatment method, protecting themselves and their patients as much as possible.

Diffusion-weighted imaging in the characterization of focal liver lesions: efficacy of visual assessment.

OBJECTIVES: The objective of the study was to assess the value of visual assessment of signal intensities on b800 diffusion-weighted images and apparent diffusion coefficient (ADC) maps in differentiation of benign and malignant focal liver lesions (FLLs). METHODS: Approval for this retrospective study was obtained from the institutional review board. One hundred forty-three FLLs in 65 patients (38 women, 27 men; mean age, 50.8 years) underwent magnetic resonance (MR) imaging and diffusion-weighted imaging (DWI) with a respiratory-triggered single-shot echo-planar imaging sequence. Focal liver lesions were evaluated visually according to the signal intensities on b800 and ADC map images, and ADC values were also calculated. The conventional MR imaging, follow-up imaging findings, and histopathologic data were regarded as gold standard. Normal distribution was assessed with Kolmogorov-Smirnov test. The accuracies of visual assessment and ADC values in differentiating benign and malignant FLLs were assessed with the Student t test, and threshold values were determined with receiver operating characteristic curve analysis. RESULTS: By using a cutoff value of 1.21 × 10⁻³ mm²/s, ADC had a sensitivity of 100%, a specificity of 89.3%, and an accuracy of 92.3% in the discrimination of malignant FLLs. With the visual assessment of the DWIs and ADC maps, malignant lesions were differentiated from benign ones, with 100% sensitivity, 92.2% specificity, and 94.4% accuracy. Although some benign lesions were interpreted as malignant, no malignant lesion was determined as benign in visual assessment. CONCLUSIONS: Most FLLs are benign ones such as hemangiomas and cysts, which can be readily and practically characterized only by using visual assessment of DWIs without requiring time-consuming conventional and dynamic contrast-enhanced imaging sequences. Some benign lesions that are falsely interpreted as malignant can be further characterized by using conventional and contrast-enhanced MR studies.

Risk factors associated with breast arterial calcifications.

BACKGROUND: A number of studies have linked the presence of breast arterial calcifications (BACs) with an increased risk of diabetes, hypertension, coronary artery disease (CAD), and cardiovascular mortality. Because there is a well-established screening system for breast cancer, it has been proposed that the presence of BACs can be used as a warning sign indicating an increased risk of metabolic and vascular diseases. PURPOSE: To determine the relation between BAC and early renal dysfunction. MATERIAL AND METHODS: A retrospective review of 6118 mammograms identified 701 cases with BACs. Women with BACs were compared to a random selection of 362 women without BACs based on available laboratory data. Univariate analysis was conducted according to age groups. RESULTS: The prevalence of BACs was 11.5% in our study. Hyperglycemia increased the odds of BACs by 8.1 (95% CI 3.0-22.1, P < 0.001) in the 50-59-year age group. The presence of an elevated blood urea nitrogen (BUN) and serum creatinine increased the odds of BACs by 2.6 (95% CI 1.2-6.0, P = 0.016) and 2.3 (95% CI 1.0-5.2, P = 0.045) in women ≥70 years of age. Hyperlipidemia was not a significant risk factor for BACs in any age group. CONCLUSION: Our results support the view that the presence of BACs on mammography may be indicative of diabetes in middle-aged women. On the other hand, BACs are not very useful for predicting early renal dysfunction in women <70 years of age.

The Role of Shear Wave Elastography in Differentiating Idiopathic Granulomatous Mastitis From Breast Cancer.

INTRODUCTION: Shear wave elastography (SWE) uses focused radiation forces without manual compression and is intrinsically not operator dependent. Shear waves travel faster in stiffer tissue and slower in softer tissues. PURPOSE: The purpose of this study was to determine the role of SWE, imaging, and point measurements in differentiating idiopathic granulomatous mastitis (IGM) from breast cancer. MATERIAL AND METHODS: Data from 168 patients diagnosed with breast cancer (n= 80) or IGM (n = 88) through image-guided biopsy were included in the study. All patients were evaluated with SWE followed by conventional ultrasonography (US). Shear wave velocity (Vs) and the SWE scoring system (Tsukuba) were used to evaluate lesions, which were classified synchronously according to the Breast Imaging Reporting and Data System (BI-RADS) by using conventional US. Lesion size and BI-RADS scores were recorded, and the scores of the lesions were compared between the two groups. The diagnostic capacity of the Vs value was measured by the area under the receiver operating characteristic curve (AUC, 0.94). RESULTS: The mean age was 37 ± 9 years for patients with IGM and 49 ± 13 years for patients with breast cancer. Both Breast Imaging Report and Data System (BI-RADS) and SWE scores were significantly higher in breast cancer patients than in IGM patients (p < 0.01). However, unlike the Vs values and SWE scores, the BI-RADS scores were not low enough in many IGM cases to avoid biopsy. The mean Vs value of IGM lesions was 2.5 ± 1.17 m/s, which was significantly lower than that of breast cancer (5.2 ± 0.76 m/s, p < 0.01). The cut-off value was 4.1 m/s, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.5%, 93%, 92.6%, 97.6%, and 95.2%, respectively (p < 0.01). CONCLUSION: SWE has high sensitivity and specificity in differentiating IGM from breast cancer with a lower SWE score and Vs value. Implementing this approach in clinical practice could reduce the number of unnecessary biopsies.

Cystic Hygroma with Multiple Benign Bone Lymphangiomas in an Adult Patient: A Rare Entity in the Differential Diagnosis of Multiple Osseous Lesions in Oncology Practice.

Cystic lymphangioma presenting with multiple bone lesions in an adult patient is a rare occurrence, with a limited number of reported cases in the literature. In this case report, we describe a 32-year old female patient with chronic neck and pelvic pain, and multiple lytic bone lesions on radiological imaging, which were eventually discovered to originate from cystic hygroma and widespread bone lymphangiomas that were present for more than 10 years. It should be kept in mind that there may be multiple benign causes of differential diagnosis in patients presenting with findings suggestive of diffuse bone metastasis. Misdiagnosis may cause the patient to receive unnecessary treatments, especially radiotherapy. In this case, we reached the diagnosis of benign disease, diffuse bone lymphangiomatosis. For this purpose, we also examine the long and stable medical history of the patient with the findings of BT, ultrasound, and bone scintigraphy. We think that as long as there are no stable and serious results ofclinical and radiological findings of the patient, the patient should be approached with medical follow-up without treatment.

Right lower quadrant pain: not always appendicitis but epiploic appendagitis of appendix.

Epiploic appendagitis is a condition that mimics acute abdomen, causing inflammation of epiploic appendages. This paper aimed to present a case of "epiploic appendagitis of the appendix", which is a rare cause of right lower quadrant pain. A 45-year-old male patient with abdominal pain was referred to the radiology clinic for abdominal CT. The pain localized to the right lower quadrant and no signs of peritoneal irritation were present on physical examination. On images of abdominal CT the diameter of the appendix measured as 7 mm. The wall thickness was within normal limits and no mucosal enhancement noted. Appendiceal air was present in the lumen. An oval lesion of fat density with a hyperdense rim was seen adjacent to the anterior part of the appendix. It was causing striations and heterogeneous appearance in the surrounding mesenteric fat tissue with central areas of high attenuation. The findings noted down as "hyper-attenuating ring sign" and "central dot sign". These pathognomonic CT findings were consistent with epiploic appendagitis and the case reported as epiploic appendagitis of the appendix. After conservative non-surgical medical treatment symptoms of patient revealed. To prevent unnecessary surgery, it is important to exclude conditions requiring emergency surgical intervention with imaging. The most effective technique recommended for imaging is CT with IV opaque. Increasing awareness and knowledge of radiologists regarding epiploic appendagitis of the appendix will rule out the possibility of potential misdiagnosis in imaging and will avoid the resultant unnecessary surgery.

Sesamoid bones of the hand: A multicenter study.

OBJECTIVES: This study aims to document a detailed investigation on the sesamoid bones (SBs) of Turkish subjects from different parts of Turkey in a multi-center study, in both hands, according to gender, frequency and divisions of the bones' coexistence and bilaterality by radiography. PATIENTS AND METHODS: This retrospective and three-centered study was performed between June 2010 and April 2012. Sesamoid bones were examined by anteroposterior and oblique X-rays of 1,444 hands of 772 subjects (367 males, 405 females; mean age 42.7 years; range, 18 to 87 years). All X-rays were evaluated by at least two independent observers. In controversial circumstances, at least three observers together gave the final decision by consensus. RESULTS: Metacarpophalengeal (MCP) joint of the thumb (MCP 1) had sesamoid in all subjects (100%) and it was seen bilaterally. The prevalence of the SB was 42.8% in the second MCP joint (MCP 2) in 772 subjects and 36.6% in 1,444 hands, 1.6% in the third MCP joint (MCP 3) for the subjects and 1.1% for the hands, 0.1% in the fourth MCP joint (MCP 4) for the subjects and 0.1% for the hands, and 72.5% in the fifth MCP joint (MCP 5) for the subjects and 62.5% for the hands. The prevalence of SB in the first interphalangeal joint (IP 1) was 21.8% and SB was detected in 18.6% of the hands. Sesamoid bones of the MCP 2, MCP 5, and IP 1 was recorded more frequently in females. Sesamoid bone of the same joints (MCP 2, MCP 5 and IP 1) was detected more frequently bilaterally than unilateral right side and more frequently unilaterally on right side than unilateral left side. CONCLUSION: The distribution of SBs varies according to hand regions, gender, and side. Having knowledge of the locations and the rate of bilaterality of SBs may assist clinicians in both clinical and radiological diagnoses.

Comparing the Performances of Magnetic Resonance Imaging Size vs Pharmacokinetic Parameters to Predict Response to Neoadjuvant Chemotherapy and Survival in Patients With Breast Cancer.

PURPOSE: To compare the value of dynamic contrast-enhanced magnetic resonance imaging-pharmacokinetic (PK) parameters vs tumor volume in predicting breast cancer neoadjuvant chemotherapy response (NACR) and patient survival. SUBJECTS AND METHODS: Sixty-six patients with locally advanced breast cancer who underwent breast MRI monitoring of NACR were retrospectively analyzed. We compared baseline transfer constant (Ktrans), reflux rate contrast (kep), and extracellular extravascular volume fraction (ve) with the same parameters obtained at early postchemotherapy MRI, and examined model-independent changes in time-intensity curves (maximum slope, contrast enhancement ratio, and IAUC90). Tumor size changes (tumor volume, single dimension, and Response Evaluation Criteria in Solid Tumors [RECIST]) were also analyzed. The Spearman correlation test was used to assess the association between size and PK parameters, and regression analysis to assess the association with 5-year disease-free survival. RESULTS: Higher ve values at baseline were associated with greater decreases in tumor size (P = 0.008). Changes in Ktrans and IAUC90 were the strongest predictors of NACR. Changes in IAUC90 (P = 0.04) and RECIST (P = 0.003) were independently associated with pathologic response. The only parameter significantly associated with 5-year survival was change in RECIST (P = 0.001). However, there was a trend toward statistical significance for changes in ve and Ktrans, with greater changes associated with longer survival. CONCLUSION: Changes in PK and dynamic contrast-enhanced magnetic resonance imaging kinetic parameters may have a role in predicting NACR in breast tumors. Although changes in Ktrans and IAUC90 are helpful in predicting NACR, they do not show significant association with survival. Early RECIST size change measured by MRI remains the strongest predictor of overall patient survival.

Sciatic nerve compression due to femoral neck osteochondroma: MDCT and MR findings.

A 34-year-old man presented with a 15-month history of pain along the left sciatic nerve. Radiographs and computed tomography (CT) revealed an exostosis on the postero-inferior aspect of the left femoral neck. Ultrasonographic examination of left upper thigh and a pelvic magnetic resonance (MR) imaging showed an enlarged sciatic nerve adjacent to the exostosis. Although peroneal and ulnar neuropathies due to the compression by exostosis are reported frequently, imaging findings of sciatic nerve involvement were not well documented in the literature. Multidetector CT and MR findings of a sciatic nerve compression caused by a femoral neck exostosis were presented.

Neuralgic amyotrophy, diagnosed with magnetic resonance neurography in acute stage: a case report and review of the literature.

OBJECTIVE: We present a case of neuralgic amyotrophy (NA) diagnosed with magnetic resonance neurography (MRN) in the acute stage. METHODS: NA is an uncommon neurologic syndrome that affects mainly the brachial plexus. MRN is considered to be more sensitive than magnetic resonance imaging (MRI) for peripheral nervous system disorders. A case of acute NA with the sudden onset of shoulder pain and weakness in the shoulder girdle is presented. RESULTS: Electrodiagnostic testing revealed an upper trunk lesion. Plexitis that could not be demonstrated with conventional MRI was revealed with MRN. The left brachial plexus was thickened and hyperintense with MRN, consistent with plexitis. CONCLUSIONS: MRN should be the preferred imaging modality for the diagnosis of acute NA. This might not only help early diagnosis and guide treatment but also prevent unnecessary testing.

Imaging features of benign adrenal cysts.

Benign adrenal gland cysts (BACs) are rare lesions with a variable histological spectrum and may mimic not only each other but also malignant ones. We aimed to review imaging features of BACs which can be helpful in distinguishing each entity and determining the subsequent appropriate management.

Apparent diffusion coefficient value in invasive ductal carcinoma at 3.0 Tesla: is it correlated with prognostic factors?

OBJECTIVE: To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic factors in patients with invasive ductal carcinoma (IDC). METHODS: 48 lesions belonging to 47 patients with histopathologically proven IDC were examined using conventional MR and diffusion-weighted imaging at a 3.0-T system. All of the patients had modified radical mastectomies or breast-sparing surgery plus axillary lymph node dissection. The ADC values acquired from the ADC maps consisted of six different b-values (0, 50, 100, 500, 1000 and 1500 s mm(-2)) and were compared with the patients' ages, tumour size, histological grade of the lesions, tumour localization, lesions' distance to skin surface and nipples, the existence of axillary lymph node involvement, the number of involved axillary lymph nodes, oestrogen/progesterone receptor status, peritumoral lymphovascular invasion status and the existence of human epidermal growth factor 2 (c-erbB-2) overexpression. RESULTS: A statistically significant relationship was found regarding axillary lymph node involvement (p = 0.027), and oestrogen/progesterone receptor status (p = 0.013). No significant relationship was detected regarding other prognostic factors (p > 0.05). CONCLUSION: Among various prognostic factors, ADC values were significantly correlated with only axillary lymph node positivity and oestrogen/progesterone receptor status. ADVANCES IN KNOWLEDGE: In the present study, the relationship between ADC values of IDC lesions that are acquired at a high magnetic field (3.0 T) system by using multiple b-values and some specific prognostic factors that were not evaluated before in the medical literature was investigated.

Effects of magnetic field strength and b value on the sensitivity and specificity of quantitative breast diffusion-weighted MRI.

BACKGROUND: To evaluate the effect of b value or the magnetic field strength (B0) on the sensitivity and specificity of quantitative breast diffusion-weighted imaging (DWI). METHODS: A total of 126 patients underwent clinical breast MRI that included pre-contrast DWI imaging using b values of both 1,000 and 1,500 s/mm2 at either 1.5 T (n=86) or 3.0 T (n=40). Quantitative apparent diffusion coefficients (ADC) were measured and compared for 18 benign, 33 malignant lesions, and 126 normal breast tissues. Optimal ADCmean threshold for differentiating benign and malignant lesions was estimated and the effect of b values and B0 were examined using a generalized estimating equations (GEE) model. RESULTS: The optimal ADCmean threshold was 1.235×10-3 mm2/s for b value of 1,000 and 0.934×10-3 mm2/s for b value of 1,500. Using these thresholds, the sensitivities and specificities were 96% and 89% (b value =1,000, B0 =1.5 T), 89% and 98% (b value =1,000, B0 =3.0 T), 88% and 96% (b value =1,500, B0 =1.5 T), and 67% and 100% (b value =1,500, B0 =3.0 T). No significant difference was found between different B0 (P=0.26) or b values (P=0.28). CONCLUSIONS: Better sensitivity is achieved with DWI of b value =1,000 than with b value =1,500. However, b value and B0 do not significantly impact diagnostic performance of DWI when using appropriate thresholds.

Identifying women's knowledge about risk factors of breast cancer and reasons for having mammography.

The aim of this study was to identify breast cancer risk factors and reasons for having mammography of the women who applied for mammography, as well as to determine their level of knowledge about risk factors and level of risk perception, and anxiety concerning breast cancer. This cross-sectional descriptive study was conducted from June 15, 2010 through September 10, 2010, in a university hospital in Ankara, Turkey. A questionnaire prepared by the researchers was used to collect the data. The mean age of the women was 52.1 ± 9.98 years. Sixteen percent of the women had a family history of breast cancer. The majority of participants had mammograms (75.8%) before and had gained knowledge about breast cancer and its screening (73.7%). The leading source of information about breast cancer was physicians (46.2%). Physician recommendations, having breast-related complaints, and family history of breast cancer were important reasons to obtain mammography. The mean knowledge score about risk factors of breast cancer was 4.15 ± 2.73 and the mean anxiety score was 1.65 ± 1.61. It was found that some socio-demographic and obstetrical characteristics of women, their family history, and risk perceptions about breast cancer affect their knowledge and anxiety scores about breast cancer. In conclusion, the present study identified a number of factors affecting mammography participation for women. The results of this study can be helpful in promoting screening for breast cancer.

HASTE diffusion-weighted MRI for the reliable detection of cholesteatoma.

PURPOSE: To assess the detection efficiency of Half-Fourier acquisition single-shot turbo spin-echo (HASTE) diffusion-weighted magnetic resonance imaging (MRI) for cholesteatoma. MATERIALS AND METHODS: A total of 21 patients with suspected primary (n=16) or recurrent cholesteatoma (n=5) underwent MRI in a 1.5 Tesla scanner using an adapted protocol for cholesteatoma detection that included a coronal HASTE diffusion-weighted MRI sequence. The cholesteatoma diagnosis was based on evidence of a hyperintense lesion at b-1000 on diffusion-weighted images. The imaging findings were correlated with findings from surgery or clinical evaluations in all patients. RESULTS: HASTE diffusion-weighted MRI successfully detected 11 primary and 5 recurrent lesions out of 17 cholesteatomas (sensitivity, 94.1%). One primary cholesteatoma with a diameter of 4-5 mm was missed. MRI of patients without cholesteatoma were correctly interpreted as negative for cholesteatoma (specificity, 100%). The positive and negative predictive values for the HASTE diffusion-weighted MRI in detecting cholesteatoma were 100% and 80%, respectively. CONCLUSION: HASTE diffusion-weighted MRI offers great promise for cholesteatoma screening. The addition of this sequence to the posterior fossa MRI protocol may preclude unnecessary cholesteatoma surgery.