Imaging Studies of the Temporal Bone(I)精选.pptVIP

Imaging Studies of the Temporal Bone (I) Introduction CT is best suited for conductive hearing loss MRI is best for the evaluation of retrochochlear sensorineural hearing loss CT is the choice of bone destruction from inflamation or metastasis MRI is the choice of perineural invasion or intracranial extension of disease CT Measured in Hounsfield Units (HU) -1000 HU, air 0 HU, water 10~100 HU, soft tissue +1000, cortical bone CT Orbitomeatal line, extending from inferior orbital rim to the external auditory canal, used as a horinontal reference Axial section is 30 degree above this line Coronal section is 120 degree above this line MRI Signal emitted by the protons of fat and water Signal is influenced by local environment, which determines the spin-lattice (T1) and spin-spin (T2) relaxation times. Adjusting the parameter of MRI pulse sequences allows a dominant effect, resulting in T1-or T2 weighted. MRI T2W = Fat and Water are bright or hyperintense T1W = Fat is bright, tissue are intermediate, Water is dark (hypointense) Inner ear and internal auditory canal (IAC) are fluid-filled, T2W has advantage. Gadolinium-based Constrast Gd shorten T1 relaxation time that increases in signal on T1W Nasal mucosa on T1W +C MRI contraindication Any metal has the potential to produce physically heat up, or abruptly displace. Cochlear implants have been considered absolute contraindications. Newer devices without adverse effect, Med-El Combi 40+ External Auditory Canal (EAC) Tympanic bone forming the Anterior Inferior Part of posterior wall Squamous temporal bone forming the roof Thickening in EAC lining on CT usually is cerumen Congential Anomalies of the EAC Failure of 1st and 2nd branchial arches usually involve malformations of both auricle and canal EAC atresia or stensosis: Failure of epithelial cells of the 1st branchial groove to canalize 1st pharyngeal pouch develops at the same time: middle ear and mastoid CT studies for Surgical Repairs CT is deferred until 5y/o to a