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Kaufman AC, Fu F, Martinez MC, Fischbein N, Popelka GR, Butts Pauly K, Blevins NH. Use of Ultra-Short Echo Time MRI to Improve Temporal Bone Imaging. Laryngoscope 2024. [PMID: 39166732 DOI: 10.1002/lary.31707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE The short T2 nature of cortical bone causes it to appear similar to air on MR, forcing clinicians to rely on computed tomography imaging, with its attendant ionizing radiation exposure, to define temporal bone structures. Through the use of novel MR sequences with ultra-short echo times (UTE), short T2 structures are now able to be visualized, allowing for improved understanding of anatomical relationships. METHODS Eight patients (50% female) undergoing MR imaging of the skull base for diagnostic purposes (62.5% for vestibular schwannoma surveillance) at a tertiary care center were enrolled to evaluate the safety and efficacy of UTE imaging. CT scans were completed in 37.5% of the patients as part of their workup and used for comparison purposes. The repetition time, short echo time, and long echo time for the UTE sequence were 11, 0.032, and 2.2 msec, respectively. RESULTS The protocol added 6 min to the total scanning time, and all patients tolerated the sequence without issue. The ossicles, mastoid air cells, antrum, and epitympanum were able to be seen and had a high Dice similarity coefficient when compared to CT (>0.5). UTE allowed for clear delineation of all segments of the facial nerve with a signal-to-noise ratio of 35 (although the BRAVO sequences had a superior ratio of 140). Vestibular schwannomas were able to be distinguished from normal brain parenchyma. CONCLUSIONS UTE is safe and effective for visualizing anatomic structures not normally seen on traditional MRI, potentially allowing for improved surgical planning in patients. LEVEL OF EVIDENCE III Laryngoscope, 2024.
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Affiliation(s)
- A C Kaufman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, U.S.A
| | - F Fu
- Department of Otorhinolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - M C Martinez
- School of Medicine, Stanford University, Palo Alto, California, U.S.A
| | - N Fischbein
- Department of Radiology, Stanford University, Palo Alto, California, U.S.A
| | - G R Popelka
- Department of Radiology, Stanford University, Palo Alto, California, U.S.A
| | - K Butts Pauly
- Department of Radiology, Stanford University, Palo Alto, California, U.S.A
| | - N H Blevins
- Department of Otorhinolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
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Moroco AE, Saadi RA, Baker AR, Zhu J, Isildak H. Usage Patterns of CT and MRI in the Evaluation of Otologic Disease. Otol Neurotol 2021; 42:e698-e708. [PMID: 33606467 DOI: 10.1097/mao.0000000000003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the current trends and usage patterns of radiographic imaging for otologic disease by specialty, length of practice, practice setting, geographic region, and pediatric volume. STUDY DESIGN Cross-sectional study. SETTING Survey of physicians. SUBJECTS General Otolaryngologists and Otologists/Neurotologists (O/N) of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS). METHODS AND OUTCOME MEASURES An electronic questionnaire was distributed to AAO-HNS members. Respondents were separated into groups by specialty, length of practice, practice setting, region, and pediatric exposure. Chi-square tests were performed for the determination of significance. RESULTS The survey was sent to 5,168 members of AAO-HNS. The response rate was 10.6% (n = 546) and 18.1% for only O/N (n = 143). Most respondents were generalists (74%), in practice >20 years (51%), with a primarily adult practice (95%). O/N were more often academics (44 versus 17% combined, 40% private; p < 0.001) and saw fewer children (80 fewer than 25%; p < 0.001). Compared with generalists, O/N were more likely to respond with more frequent and earlier magnetic resonance imaging (MRI) utilization in the workup of the majority of otologic diseases. Significant differences in usage patterns for various conditions were demonstrated across all categories, but specialty training was the most common. Generalists (34 versus 12% of O/N; p < 0.001), physicians practicing >20 years (32 versus 18% of < 5 yrs; p = 0.006), and private practice physicians (34 versus 14-20% of others; p < 0.001) relied more heavily on the radiology report to interpret MRI scans. CONCLUSION Subspecialty training seems to be the main variable correlating with significant differences in the use of MRI and computed tomography imaging in patients with otologic disease.
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Affiliation(s)
| | | | - Aaron R Baker
- Department of Otolaryngology - Head and Neck Surgery
| | - Junjia Zhu
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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Abstract
Magnetic resonance (MR) imaging is a crucial tool for evaluation of the skull base, enabling characterization of complex anatomy by utilizing multiple image contrasts. Recent technical MR advances have greatly enhanced radiologists' capability to diagnose skull base pathology and help direct management. In this paper, we will summarize cutting-edge clinical and emerging research MR techniques for the skull base, including high-resolution, phase-contrast, diffusion, perfusion, vascular, zero echo-time, elastography, spectroscopy, chemical exchange saturation transfer, PET/MR, ultra-high-field, and 3D visualization. For each imaging technique, we provide a high-level summary of underlying technical principles accompanied by relevant literature review and clinical imaging examples.
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Affiliation(s)
- Claudia F Kirsch
- Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY
| | - Mai-Lan Ho
- Associate Professor of Radiology, Director of Research, Department of Radiology, Director, Advanced Neuroimaging Core, Chair, Asian Pacific American Network, Secretary, Association for Staff and Faculty Women, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY.
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Wolber P, Shabli S, Anagiotos A, Moellenhoff K, Schwarz D, Lang-Roth R. The diagnostic value of computed tomography in delayed complications after cochlear implantation. Acta Otolaryngol 2021; 141:111-116. [PMID: 33045882 DOI: 10.1080/00016489.2020.1829702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Delayed complications after cochlear implant (CI) surgery can result in the need for revision surgery. Temporal bone computed tomography (tCT) is frequently used in the diagnostic work-up for these patients. AIMS/OBJECTIVES We aimed to test for the value of tCT in delayed complications after CI surgery. MATERIAL AND METHODS Retrospective chart review including all patients with CI who were consecutively enrolled in our academic tertiary care centre and received a tCT due to delayed complications between January 2008 and December 2017. RESULTS A total of 85 patients with a mean age of 28 years at CI surgery were identified. Mean time between CI and tCT was 4.3 years. Reasons for performance of tCT were device malfunction (20%), cephalgia (20%), scalp hematoma/seroma (15.3%), device failure (11.8%), vertigo (10.6%), local infection (7.1%), trauma (5.9%), meningism (3.5%), tinnitus (3.5%) and facial palsy (2.4%). No abnormalities in tCT were detected in 82.4%. However, an abnormal tCT was a predictor for surgical therapy (p < .001). CONCLUSIONS AND SIGNIFICANCE We recommend the performance of tCT in CI patients with delayed complications to identify or rule out pathology in order to choose the most ideal and relevant individual treatment.
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Affiliation(s)
- Philipp Wolber
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Sami Shabli
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Andreas Anagiotos
- Department of Otolaryngology, Nicosia General Hospital, Nicosia, Cyprus
| | - Kathrin Moellenhoff
- Medical Faculty, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - David Schwarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
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Smith JD, Harvey RN, Darr OA, Prince ME, Bradford CR, Wolf GT, Else T, Basura GJ. Head and neck paragangliomas: A two-decade institutional experience and algorithm for management. Laryngoscope Investig Otolaryngol 2017; 2:380-389. [PMID: 29299512 PMCID: PMC5743157 DOI: 10.1002/lio2.122] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/07/2017] [Indexed: 01/02/2023] Open
Abstract
Objectives Paragangliomas of the head and neck and cranial base are typically benign, slow‐growing tumors arising within the jugular foramen, middle ear, carotid bifurcation, or vagus nerve proper. The objective of this study was to provide a comprehensive characterization of our institutional experience with clinical management of these tumors and posit an algorithm for diagnostic evaluation and treatment. Methods This was a retrospective cohort study of patients undergoing treatment for paragangliomas of the head and neck and cranial base at our institution from 2000–2017. Data on tumor location, catecholamine levels, and specific imaging modalities employed in diagnostic work‐up, pre‐treatment cranial nerve palsy, treatment modality, utilization of preoperative angiographic embolization, complications of treatment, tumor control and recurrence, and hereditary status (ie, succinate dehydrogenase mutations) were collected and summarized. Results The mean (SD) age of our cohort was 51.8 (±16.1) years with 123 (63.4%) female patients and 71 (36.6%) male patients. Catecholamine‐secreting lesions were found in nine (4.6%) patients. Fifty‐one patients underwent genetic testing, with mutations identified in 43 (20 SDHD, 13 SDHB, 7 SDHD, 1 SDHA, SDHAF2, and NF1). Observation with serial imaging, surgical extirpation, radiation, and stereotactic radiosurgery were variably employed as treatment approaches across anatomic subsites. Conclusion An algorithmic approach to clinical management of these tumors, derived from our longitudinal institutional experience and current empiric evidence, may assist otolaryngologists, radiation oncologists, and geneticists in the care of these complex neoplasms. Level of Evidence 4
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Affiliation(s)
- Joshua D Smith
- University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Rachel N Harvey
- University of Michigan College of Literature Sciences, and the Arts Ann Arbor Michigan U.S.A
| | - Owen A Darr
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Mark E Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Tobias Else
- Division of Metabolism Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Gregory J Basura
- Department of Otolaryngology-Head and Neck Surgery Kresge Hearing Research Institute Ann Arbor Michigan U.S.A
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Geerts B, Leclercq D, Tezenas du Montcel S, Law-ye B, Gerber S, Bernardeschi D, Galanaud D, Dormont D, Pyatigorskaya N. Characterization of Skull Base Lesions Using Pseudo-Continuous Arterial Spin Labeling. Clin Neuroradiol 2017; 29:75-86. [DOI: 10.1007/s00062-017-0623-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
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Abstract
Paragangliomas of the head and neck are rare vascular skull-base tumors derived from the paraganglionic system with an estimated incidence of 1:30,000 accounting for 3% of all paragangliomas. The most common paraganglioma locations of the head and neck in descending order are the carotid body, jugular, tympanic, and vagal paragangliomas. This article discusses the clinical characterics, normal anatamy, imaging findings and protocols, pathology, staging, and differential diagnosis for paragangliomas of the head and neck.
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