Non-EPI DWI sequence MRI artifacts in passive prostheses/titanium meshes and their impact on cholesteatoma assessability

Introduction Surgical removal is the treatment of choice for a cholesteatoma. Depending on the size, the operation involves partial resection of the ossicular chain and, if necessary, the bony skull base. Titanium foreign materials (prostheses, meshes) can be used to restore sound transmission and to cover larger defects of the skull base. After the operation, recurrence and residual control are necessary. This can be done by means of second-look surgery or an MRI examination with a non-EPI DWI sequence. Similar to other metal implants, artifacts may occur in the image due to the titanium used. The assessment of the limitation of cholesteatoma detection by means of non-EPI DWI sequence-generated MRI artifacts due to the titanium foreign material (prosthesis, mesh) is of central importance, which has been neglected so far.