Skip to main content

Advertisement

SpringerLink
Log in

Visualisation of passive middle ear implants by cone beam and multi-detector computed tomography: a comparative in vitro study

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Modern passive middle ear titanium prostheses are filigree structures, resulting in poorer depiction on CT compared to prostheses used in the past. We compared the visibility of newer prostheses on cone beam CT (CBCT) to multi-detector CT (MDCT) with standard and lower dose in vitro, and analysed image noise and metal artefacts.

Methods

Six different titanium middle ear prostheses (three partial and one total ossicular replacement prostheses, two stapes prostheses) were implanted twice in formalin-fixed head specimens—first correctly and then with displacement. Imaging was performed using standard CBCT and MDCT as well as MDCT with lower dose (36 single imaging investigations). Images were analysed with knowledge of the used types of middle ear prostheses, but blinded with respect to the positioning in the specific case.

Results

On all images the type of prostheses and their positions could be clearly recognized. Their identifiability including their details was rated as statistically significantly higher for all CBCT investigations than for MDCT. MDCT with lower dose showed the worst results. No statistical differences were found in image noise and metal artefacts.

Conclusions

If available, CBCT should be preferred over MDCT in diagnostic evaluation of passive middle ear prostheses.

Key Points

• Middle ear prostheses became more filigree, leading to poorer visibility on CT.

• High spatial resolution and paraxial reconstructions are necessary requirements for imaging evaluation.

• CBCT and MDCT can identify type and positioning of titanium prostheses.

• Metal artefacts play a minor part in filigree titanium prostheses.

• Regarding visualisation of prostheses details, cone beam CT aids the evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

CBCT:

cone beam CT

MDCT:

multi-detector CT

MIP:

maximum intensity projection

MPR:

multi-planar reconstruction

PORP:

partial ossicular replacement prosthesis

TORP:

total ossicular replacement prosthesis

References

  1. Kösling S, Bootz F (2001) CT and MR imaging after middle ear surgery. Eur J Radiol 40(2):113–118

    Article  PubMed  Google Scholar 

  2. Beutner D, Hüttenbrink KB (2009) Passive and active middle ear implants. Laryngorhinootologie 88(Suppl 1):32–47

    Article  Google Scholar 

  3. Jargalkhuu E, Erdenechuluun B, Mlynski R, Hagen R (2009) Middle ear surgery in Mongolia-first results with middle ear prostheses. Laryngorhinootologie 88(6):387–391

    Article  CAS  PubMed  Google Scholar 

  4. Shah KD, Bradoo RA, Joshi AA, Sapkale DD (2013) The efficiency of titanium middle ear prosthesis in ossicular chain reconstruction: our experience. Indian J Otolaryngol Head Neck Surg 65(4):298–301

    Article  PubMed  Google Scholar 

  5. Quesnel S, Teissier N, Viala P, Couloigner V, Van Den Abbeele T (2010) Long term results of ossiculoplasties with partial and total titanium Vario Kurz prostheses in children. Int J Pedriatr Otorhinolaryngol 74(11):1226–1229

    Article  CAS  Google Scholar 

  6. Hahn Y, Bojrab DI (2013) Outcomes following ossicular chain reconstruction with composite prostheses: hydroxyapatite-polyethylene vs. hydroxyapatite-titanium. Ear Nose Throat J 92(6):250, 252, 254, 256, 258, 260

  7. Mardassi A, Deveze A, Sanjuan M et al (2011) Titanium ossicular chain replacement protheses: prognostic factors and preliminary functional results. Eur Ann Otorhinolaryngol Head Neck Dis 128(2):53–58

    Article  CAS  PubMed  Google Scholar 

  8. Zahnert T (2011) Reconstruction of the middle ear with passive implants. HNO 59:964–973

    Article  CAS  PubMed  Google Scholar 

  9. Offergeld C, Kromeier J, Aschendorff A 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. Offergeld C, Kromeier J, Merchant SN et al (2010) Experimental investigation of rotational tomography in reconstructed middle ears with clinical implications. Hear Res 263(1-2):191–197

    Article  PubMed  Google Scholar 

  11. Bozzato A, Struffert T, Hertel V, Iro H, Hornung J (2010) Analysis of the accuracy of high-resolution computed tomography techniques for the measurement of stapes prostheses. Eur Radiol 20(3):566–571

    Article  PubMed  Google Scholar 

  12. Zaoui K, Kromeier J, Neudert M 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 

  13. De Cock J, Zanca F, Canning J, Pauwels R, Hermans R (2015) A comparative study for image quality and radiation dose of a cone beam computed tomography scanner and a multislice computed tomography scanner for paranasal sinus imaging. Eur Radiol 25(7):1891–1900

    Article  PubMed  Google Scholar 

  14. Hofmann E, Schmidt M, Sedlmair M, Banckwitz R, Hirschfelder U, Lell M (2014) Comparative study of image quality and radiation dose of cone beam and low-dose multislice computed tomography—an in-vitro investigation. Clin Oral Invest 18(1):301–311

    Article  Google Scholar 

  15. Carrafiello G, Dizonno M, Colli V et al (2010) Comparative study of jaws with multislice computed tomography and cone-beam computed tomography. Radiol Med 115(4):600–611

    Article  CAS  PubMed  Google Scholar 

  16. Bremke M, Lüers JC, Stenner M et al (2013) Radiologic examinations in human temporal bone specimens using digital volume tomography and high-resolution computed tomography after implantation of middle ear prosthesis and cochlear implant electrode array. Otol Neurotol 34(7):1321–1328

    Article  PubMed  Google Scholar 

  17. Teymoortash A, Hamzei S, Murthum T, Eivazi B, Kureck I, Werner JA (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 

  18. Williams MT, Ayache D (2004) Imaging of the postoperative middle ear. Eur Radiol 14(3):482–495

    Article  PubMed  Google Scholar 

  19. Pein MK, Brandt S, Plontke SK, Kösling S (2014) Visualisation of subtle temporal bone structures. Comparison of cone beam CT and MDCT. Radiologe 54(3):271–278

    Article  CAS  PubMed  Google Scholar 

  20. Lane JI, Lindell EP, Witte RJ, DeLone DR, Driscoll CL (2006) Middle ear and inner ear: improved depiction with multiplanar reconstruction of volumetric CT data. Radiographics 26(1):115–124

    Article  PubMed  Google Scholar 

  21. Dastidar P, Pertti R, Karhuketo T (1997) Axial HRCT, two-dimensional and maximum intensity projection reconstructions in temporal bone lesions. Acta Otolaryngol Suppl 529:43–46

    Article  CAS  PubMed  Google Scholar 

  22. Mehanna AM, Baki FA, Eid M, Negm M (2014) Comparison of different computed tomography post-processing modalities in assessment of various middle ear disorders. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-014-2920-y

    PubMed  Google Scholar 

  23. Knörgen M, Brandt S, Kösling S (2012) Comparison of quality on digital X-ray devices with 3D-capacity for ENT-clinical objectives in imaging of temporal bone and paranasal sinuses. Röfo 184(12):1153–1160

    PubMed  Google Scholar 

  24. Peltonen LI, Aarnisalo AA, Kortesniemi MK, Suomalainen A, Jero J, Robinson S (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 

  25. Kyriakou Y, Kolditz D, Langner O, Krause J, Kalender W (2011) Digital volume tomography (DVT) and multislice spiral CT (MSCT): an objective examination of dose and image quality. Röfo 183(2):144–153

    CAS  PubMed  Google Scholar 

  26. Mlynski R, Nguyen TD, Plontke SK, Kösling S (2014) Presentation of floating mass transducer and vibroplasty couplers on CT and cone beam CT. Eur Arch Otorhinolaryngol 271(4):665–672

    Article  PubMed  Google Scholar 

  27. Granström G, Gröndahl HG (2011) Imaging of osseointegrated implants in the temporal bone by Accuitomo 3-dimensional cone beam computed tomography. Otol Neurotol 32(2):199–203

    Article  PubMed  Google Scholar 

  28. Liang X, Jacobs R, Hassam B et al (2010) A comparative evaluation of cone beam computed tomography (CBCT) and multi-slice CT (MSCT). Part I. On subjective image quality. Eur J Radiol 75(2):265–269

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was partially supported by Heinz Kurz GmbH Medizintechnik (Dusslingen, Germany) which provided the passive titanium middle ear prostheses and by Vibrant MedEl (Innsbruck, Austria) which supported the transport of the specimens between the Department of Anatomy and the imaging department. The authors themselves did not receive any financial support.

We thank the Department of Anatomy of the Martin-Luther-University Halle-Wittenberg (Director: Prof. Dr. med. Dr. agr. Bernd Fischer) for providing the specimens, Mrs. Jana Gräfenhain and Mr. Hans-Joachim Heine for their assistance in the Anatomy Laboratory and radiographers Mrs. A. Winkler and Mrs. M Beer for their technical support with the radiological imaging.

The scientific guarantor of this publication is Thi Dao Nguyen. 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. No complex statistical methods were necessary for this paper. Additional institutional review board approval was not required because the investigations were made on human heads from human donors to the University Institute of Anatomy for academic use. Written informed consent was not required for this study because the investigations were made on human heads from human donors to the University Institute of Anatomy for academic use. Methodology: prospective, diagnostic study/experimental, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle Saale, Germany

    T. D. Nguyen & S. Kösling

  2. Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Doberaner Straße 137-139, 18057, Rostock, Germany

    R. Mlynski

  3. Department of Otorhinolaryngology, Head and Neck Surgery,, University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle Saale, Germany

    S. K. Plontke

Authors
  1. T. D. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Kösling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Mlynski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. K. Plontke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. D. Nguyen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nguyen, T.D., Kösling, S., Mlynski, R. et al. Visualisation of passive middle ear implants by cone beam and multi-detector computed tomography: a comparative in vitro study. Eur Radiol 26, 4538–4544 (2016). https://doi.org/10.1007/s00330-016-4312-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4312-8

Keywords

Search

Navigation