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Bioactive glass granules for mastoid and epitympanic surgical obliteration: CT and MRI appearance

European Radiology volume 29, pages 5617–5626 (2019)Cite this article

Abstract

Purpose

To evaluate the appearance of mastoid and epitympanic obliteration using S53P4 bioactive glass (BG) granules in high-resolution computed tomography (HRCT) and MRI.

Materials and methods

Patients undergoing mastoid and epitympanic obliteration between May 2013 and December 2015 were prospectively included in an uncontrolled clinical study. All patients underwent a temporal HRCT scan 1 year after surgery, aimed at evaluating the attenuation, homogeneity, and osseointegration of the BG granules, as well as the ventilation of the middle ear and the volume of the obliterated paratympanic spaces. If a cholesteatoma was found during surgery, additional MRI, including at least pre- and post-contrast T1-weighted, T2-weighted, and axial non-echo-planar diffusion-weighted (DW) sequences, was performed 1 year after surgery, to study the normal signal of the BG granules and the presence of residual cholesteatoma and/or other temporal bone pathologies.

Results

Seventy cases were included. On 1-year HRCT, the mean attenuation of the BG granules was 888.34 ± 166.10 HU. The obliteration was found to be mostly homogeneous with partial osseointegration. The appearance of the BG granules having a low-intensity signal in T2-weighted imaging and DW MRI was always different from the appearance of cholesteatoma. A longer follow-up has shown no attenuation or signal modification of the BG granules compared with the 1-year imaging.

Conclusion

Radiological follow-up of patients operated on with mastoid and epitympanic obliteration using BG granules is effective using both HRCT and MRI. A cholesteatoma and/or other potential complications could easily be detected due to the specific radiological appearance of the BG granules.

Key Points

• The appearance of mastoid and epitympanic obliteration by S53P4 bioactive glass (BG) granules on high-resolution computed tomography (HRCT) scans was homogeneous with an attenuation significantly higher than the attenuation of cholesteatoma and lower than mastoid bone attenuation.

• The granules have a low-intensity signal on non-echo-planar diffusion-weighted sequences and on T2-weighted images and present contrast enhancement allowing the differential diagnosis with cholesteatoma and effective for the detection of other underlying temporal bone pathologies.

• The volume and radiological appearance of the obliteration appear to be stable with time.

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Abbreviations

BG:

Bioactive glass

CWD:

Canal-wall-down

CWU:

Canal-wall-up

HRCT:

High-resolution computed tomography

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. AP-HP, Otology, Auditory Implants and Skull Base Surgery Department, Hôpitaux Universitaires Pitié Salpêtrière – Charles Foix, 75013, Paris, France

    Daniele Bernardeschi, Baptiste Hochet & Olivier Sterkers

  2. Inserm UMR_S 1159, “Réhabilitation chirurgicale mini-invasive et robotisée de l’audition”, F-75018, Paris, France

    Daniele Bernardeschi, Baptiste Hochet & Olivier Sterkers

  3. AP-HP, Neuroradiology department, Hôpitaux Universitaires Pitié Salpêtrière – Charles Foix, 75013, Paris, France

    Bruno Law-ye, Didier Dormont & Nadya Pyatigorskaya

  4. AP-HP, Neuropathology Department, Hôpitaux Universitaires Pitié Salpêtrière – Charles Foix, 75013, Paris, France

    Franck Bielle

  5. UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Sorbonne Universités, F-75013, Paris, France

    Nadya Pyatigorskaya

  6. Neuroradiology Department, Pitié-Salpetriere Hospital, 75013, Paris, France

    Nadya Pyatigorskaya

Authors
  1. Daniele Bernardeschi
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  2. Bruno Law-ye
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  3. Franck Bielle
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  4. Baptiste Hochet
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  5. Olivier Sterkers
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  6. Didier Dormont
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  7. Nadya Pyatigorskaya
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Corresponding author

Correspondence to Nadya Pyatigorskaya.

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The scientific guarantor of this publication is Daniele Bernardeschi.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• prospective

• cross-sectional study

• performed at one institution

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Bernardeschi, D., Law-ye, B., Bielle, F. et al. Bioactive glass granules for mastoid and epitympanic surgical obliteration: CT and MRI appearance. Eur Radiol 29, 5617–5626 (2019). https://doi.org/10.1007/s00330-019-06120-z

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  • DOI: https://doi.org/10.1007/s00330-019-06120-z

Keywords

  • Cholesteatoma
  • Middle ear
  • Mastoidectomy
  • Osseointegration