Cochlear Aqueduct Morphology in Superior Canal Dehiscence Syndrome

The cochlear aqueduct (CA) connects the scala tympani to the subarachnoid space and is thought to assist in pressure regulation of perilymph in normal ears, however, its role and variation in inner ear pathology, such as in superior canal dehiscence syndrome (SCDS), is unknown. This retrospective radiographic investigation compared CA measurements and classification, as measured on flat-panel computerized tomography, among three groups of ears: controls, n = 64; anatomic superior canal dehiscence without symptoms (SCD), n = 28; and SCDS, n = 64. We found that in a multinomial logistic regression adjusted for age, sex, and BMI, an increase in CA length by 1 mm was associated with a lower odds for being in the SCDS group vs. control (Odds ratio 0.760 p = 0.005). Hierarchical clustering of continuous CA measures revealed a cluster with small CAs and a cluster with large CAs. Another multinomial logistic regression adjusted for the aforementioned clinical covariates showed an odds ratio of 2.97 for SCDS in the small CA cluster as compared to the large (p = 0.004). Further, no significant association was observed between SCDS symptomatology-vestibular and/or auditory symptoms-and CA structure in SCDS ears. The findings of this study lend support to the hypothesis that SCDS has a congenital etiology.

Flat-panel conebeam CT in the clinic: history and current state

Research into conebeam CT concepts began as soon as the first clinical single-slice CT scanner was conceived. Early implementations of conebeam CT in the 1980s focused on high-contrast applications where concurrent high resolution ( < 200    μ m ), for visualization of small contrast-filled vessels, bones, or teeth, was an imaging requirement that could not be met by the contemporaneous CT scanners. However, the use of nonlinear imagers, e.g., x-ray image intensifiers, limited the clinical utility of the earliest diagnostic conebeam CT systems. The development of consumer-electronics large-area displays provided a technical foundation that was leveraged in the 1990s to first produce large-area digital x-ray detectors for use in radiography and then compact flat panels suitable for high-resolution and high-frame-rate conebeam CT. In this review, we show the concurrent evolution of digital flat panel (DFP) technology and clinical conebeam CT. We give a brief summary of conebeam CT reconstruction, followed by a brief review of the correction approaches for DFP-specific artifacts. The historical development and current status of flat-panel conebeam CT in four clinical areas-breast, fixed C-arm, image-guided radiation therapy, and extremity/head-is presented. Advances in DFP technology over the past two decades have led to improved visualization of high-contrast, high-resolution clinical tasks, and image quality now approaches the soft-tissue contrast resolution that is the standard in clinical CT. Future technical developments in DFPs will enable an even broader range of clinical applications; research in the arena of flat-panel CT shows no signs of slowing down.

[The role of cone-beam CT during transarterial chemoembolization for liver cancer]

PURPOSE

The role of interventional radiology in the treatment of hepatic malignancies is steeply raising. Our purpose is to present the importance of cone-beam CT (CBCT) during TACE (transarterial chemoembolization) procedures for liver tumours.

PATIENTS AND METHODS

Between 1st of June 2013 and 31st of July 2016, we performed 130 TACE procedures in 64 patients in the Borsod University Teaching Hospital at Miskolc. During some of the treatments of 44 patients CBCT was also performed.

RESULTS

All procedures were successful and carried out safely. CBCT gave new information in 22,7%, that influenced further treatment. It helped to precisely localize tumours, corrected the number or the size of hepatic malignancies. With CBCT it was easier to identify the feeding arteries of the tumour, plan the actual treatment and also to assess the efficacy of the previous treatment.

DISCUSSION

The gold standard therapy of intermediate-stage HCC (according to Barcelona's criteria) is TACE. Beside, it can be safely and efficiently performed also in early stage or advanced stage in cases of contraindications for alternative therapies. Cone-beam CT is a dynamic examination which gives you an intraoperative, 3D CT-like imaging in the angio suit, without moving the table or the catheterised patient. Literature has already cited preliminary datas about prolonged survival for those patients treated with the help of CBCT intraoperatively.

CONCLUSION

Intraoperative CBCT in patients with TACE treatment for hepatic malignancies can provide information that can improve the therapeutic results. Therefore we suggest the routine use of this imaging option during all TACE procedures if patients are eligible.