Fig. 11.

Indeterminate appearance of residual cholesteatoma: Value of ADC. The coronal a T2 weighted and b b0 DWI images show a small focus of high signal soft tissue at the left hypotympanum, which returns just mildly high signal relative to brain tissue on c the b1000 DWI image, raising the possibility of a residual pearl (similar to Fig. 9a). d The ADC map demonstrates low signal and value compatible with cholesteatoma, thereby increasing observer confidence. e This was later confirmed as a 3–4 mm cholesteatoma at the left hypotympanum on second-look surgery