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Background: In cases of suspected mastoiditis, imaging is used to evaluate the extent of mastoid destruction and possible complications. The role of magnetic resonance imaging (MRI) in mastoiditis has not been systematically evaluated. Purpose: To assess the diagnostic performance of MRI in patients with suspected acute mastoiditis. Material and Methods: Twenty-three patients with suspected acute mastoiditis were included in this retrospective study (15 boys, 8 girls; mean age, 2 years 11 months). All patients were examined on a 1.5 T MRI system. The MRI examination included both enhanced and non-enhanced turbo spin echo (TSE), diffusion-weighted images, and venous time-of-flight magnetic resonance angiography (TOF MRA) for the evaluation of the venous sinuses. Surgical findings, as well as clinical and imaging follow-up were used as the standard of reference. The sensitivity and accuracy of MRI for mastoiditis and subperiosteal abscesses was calculated. Results: Twenty (87%) of 23 patients had mastoiditis, and 12 (52%) of 23 patients had a subperiosteal abscess in addition to mastoiditis. Mastoiditis and subperiosteal abscesses were identified by MRI in all cases. Sensitivity for mastoiditis was 100%, specificity was 66%, and accuracy was 86%. Sensitivity for subperiosteal abscesses was 100% and accuracy was 100%. Conclusion: Multiparametric MRI has high accuracy for mastoiditis and subperiosteal abscesses. [ABSTRACT FROM AUTHOR]