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Visualization of anatomy in normal and pathologic middle ears by cone beam CT

  • Otology
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Abstract

Cone beam computed tomography (CBCT, syn. digital volume tomography = DVT) was introduced into ENT imaging more than 10 years ago. The main focus was on imaging of the paranasal sinuses and traumatology of the mid face. In recent years, it has also been used in imaging of chronic ear diseases (especially in visualizing middle and inner ear implants), but an exact description of the advantages and limitations of visualizing precise anatomy in a relevant number of patients is still missing. The data sets of CBCT imaging of the middle and inner ear of 204 patients were analyzed regarding the visualization of 18 different anatomic structures. A three-step scale (excellent visible, partial visible, not visible) was taken. All analyses were performed by two surgeons experienced in otology and imaging. The indications for imaging were chronic middle ear disease or conductive hearing loss. Previously operated patients were excluded to rule out possible confounders. In dependence of a radiological pathology/opacity of the middle ear, two groups (with and without pathology) were built. Regarding the possibility of excellent visualization, significant differences were only found for small bony structures: incu-stapedial joint (25.8 vs. 63.5 %), long process of incus (42.7 vs. 88.8 %), head of stapes (27.0 vs. 62.6 %), anterior crus of stapes (16.9 vs. 40.9 %) and posterior crus of stapes (19.1 vs. 42.6 %). The other structures (semicircular canals, skull base at mastoid and middle ear, jugular bulb, sinus sigmoideus, facial nerve) could be visualized well in both groups with rates around 85–100 %. Even CBCT shows little limitations in visualization of the small structures of the middle and inner ear. Big bony structures can be visualized in normal as well as in pathologic ears. Overall, due to pathology of middle ear, an additional limitation of evaluation of the ossicular chain exists. In future, studies should focus on comparative evaluation of different diseases and different radiological modalities and be performed by radiologists and otologists together to improve the quality of reports and to answer clinical questions more satisfactorily.

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References

  1. German Society of Otorhinolaryngology, H.a.N.S. (2014) Leitlinie—Chronisch mesotympanale Otitis media. AWMF. 017-074

  2. German Society of Otorhinolaryngology, H.a.N.S. (2014) Leitlinie—Cholesteatom. AWMF. 017-006

  3. Stuck BA et al (2011) Leitlinie “Rhinosinusitis”—Langfassung: S2-Leitlinie der Deutschen Gesellschaft fur Hals-Nasen-Ohren-Heilkunde. Kopf- und Hals-Chirurgie. HNO 60(2):141–162

    Article  Google Scholar 

  4. Fokkens WJ et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23:3 (preceding table of contents, 1–298)

    Google Scholar 

  5. Peltonen LI et al (2009) Cone-beam computed tomography: a new method for imaging of the temporal bone. Acta Radiol 50(5):543–548

    Article  CAS  PubMed  Google Scholar 

  6. Peltonen LI et al (2007) Limited cone-beam computed tomography imaging of the middle ear: a comparison with multislice helical computed tomography. Acta Radiol 48(2):207–212

    Article  CAS  PubMed  Google Scholar 

  7. Gupta R et al (2004) Experimental flat-panel high-spatial-resolution volume CT of the temporal bone. AJNR Am J Neuroradiol 25(8):1417–1424

    PubMed  Google Scholar 

  8. Teymoortash A et al (2011) Temporal bone imaging using digital volume tomography and computed tomography: a comparative cadaveric radiological study. Surg Radiol Anat 33(2):123–128

    Article  PubMed  Google Scholar 

  9. Offergeld C et al (2007) Rotational tomography of the normal and reconstructed middle ear in temporal bones: an experimental study. Eur Arch Otorhinolaryngol 264(4):345–351

    Article  PubMed  Google Scholar 

  10. Majdani O et al (2009) Temporal bone imaging: comparison of flat panel volume CT and multisection CT. AJNR Am J Neuroradiol 30(7):1419–1424

    Article  CAS  PubMed  Google Scholar 

  11. Casselman JW, De Foer B, De Bondt BJ (2010) Diffusion-weighted MR imaging of the head and neck. J Radiol 91(3 Pt 2):369–374

    Article  CAS  PubMed  Google Scholar 

  12. De Foer B et al (2008) Detection of postoperative residual cholesteatoma with non-echo-planar diffusion-weighted magnetic resonance imaging. Otol Neurotol 29(4):513–517

    Article  PubMed  Google Scholar 

  13. De Foer B et al (2010) Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging–value in detection. Radiology 255(3):866–872

    Article  PubMed  Google Scholar 

  14. Pein MK et al (2014) Visualization of subtle temporal bone structures. Comparison of cone beam CT and MDCT. Radiologe 54(3):271–278

    Article  CAS  PubMed  Google Scholar 

  15. Prades JM et al (2011) Computed tomography of the normal and pathologic temporal bone. Morphologie 95(311):159–169

    Article  PubMed  Google Scholar 

  16. Struffert T et al (2010) Imaging of cochlear implant electrode array with flat-detector CT and conventional multislice CT: comparison of image quality and radiation dose. Acta Otolaryngol 130(4):443–452

    Article  PubMed  Google Scholar 

  17. Güldner C et al (2012) Potential of dosage reduction in cone-beam-computed tomography (CBCT) for radiological diagnostics of the paranasal sinuses. Eur Arch Otorhinolaryngol 270(4):1307–1315

    Article  PubMed  Google Scholar 

  18. Dalchow C et al (2006) Value of digital volume tomography in patients with conductive hearing loss. Eur Arch Otorhinolaryngol 263(2):92–99

    Article  CAS  PubMed  Google Scholar 

  19. Zaoui K et al (2014) Clinical investigation of flat panel CT following middle ear reconstruction: a study of 107 patients. Eur Radiol 24(3):587–594

    Article  CAS  PubMed  Google Scholar 

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Güldner, C., Diogo, I., Bernd, E. et al. Visualization of anatomy in normal and pathologic middle ears by cone beam CT. Eur Arch Otorhinolaryngol 274, 737–742 (2017). https://doi.org/10.1007/s00405-016-4345-2

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  • DOI: https://doi.org/10.1007/s00405-016-4345-2

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