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Objective To predict skull base osteomyelitis in patients with necrotising otitis externa using diffusion-weighted imaging. Methods A retrospective analysis was conducted of 25 necrotising otitis externa patients with skull base osteomyelitis (n = 1 or without skull base involvement (n = 14) who underwent a single-shot diffusion-weighted imaging of the skull base. Results The respective mean apparent diffusion coefficient values of the skull base, as determined by two reviewers, were 0.851 ± 0.15 and 0.841 ± 0.14 ×10-3mm2/s for the sku