Russo C, Elefante A, Cavaliere M, et al. - This study sought to examine the role of apparent diffusion coefficient (ADC) in determining the risk of recurrence for primary middle ear cholesteatoma, proposing stratification based on the pre-operative mean ADC (mADC) and normalized (nADC) ADC values. Researchers performed a prospective study recruiting a total of 60 individuals with primary unilateral middle ear cholesteatoma who underwent a three-years-long follow-up to evaluate the presence of recurrent disease after macroscopically complete excisional surgery. This study compared baseline MRI examination mADC and nADC values in the group with early evidence of recurrent cholesteatoma and the group with no evidence of recurrence by using T statistics. The evidence showed that ADC values appeared discriminating in distinguishing cholesteatomas with a higher risk of early recurrence, both for mean and normalized ADC, with optimized tissue characterization and outcome prediction.