CT VIRTUAL ENDOSCOPY IN ASSESSING OSSICULAR CHAIN DISRUPTION CSUSED BY TEMPORAL BONE FRACTURE AND EAR TRAUMA

Objective To explore the value of computed tomography virtual endoscopy(VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral computerized tomography(CT) was completed in 35 cases of temporal bone fracture and 5 cases of tympanum trauma, all with intact or healed tympanum. Three-dimensional reconstruction was completed using a virtual endoscopy software. Audiological tests were conducted in all patients and evaluation of facial nerve injury in patients with facial paralysis. Patients with mild conductive deafness, ossicular chain subluxation on VE, and no facial paralysis were treated conservatively for 4-12 weeks with repeated hearing evaluation; those with facial paralysis underwent surgery if no recovery after 4- 8 weeks of conservative treatment. Patients with moderate to severe conductive hearing loss or mixed hearing loss, incus long process fracture or dislocation on VE and facial paralysis, underwent ossicular chain reconstruction and facial nerve decompression after conservative treatment for 4-8 weeks, or exploratory tympanotomy only if no facial paralysis. VE, audiological tests and facial nerve function tests were repeated in 3-6 months after surgery. Results Of the 6 cases with mild conductive hearing loss, ossicular chain subluxation and no facial paralysis, 3recovered to normal hearing spontaneously and 3 showed no significant improvement, after 4-12 weeks of conservative treatment. After conservative treatment for 4-8 weeks, 3 of the 12 cases with mild conductive deafness, ossicular chain dislocation on VE and facial paralysis recovered to normal hearing and HouseBrackmann(HB) grade I facial function from HB grade II,4 showed facial function recovery to HB grade I(n=2) or II(n=2) from HB grade III but no hearing recovery, and 5 gained no recovery and went on to receive exploratory tympanotomy and facial nerve decompression. The 11 cases with moderate to severe conductive deafness, incus long process fracture or dislocation on VE and facial paralysis all received ossicular chain reconstruction and facial nerve decompression after 4-8 weeks of conservative treatment. The 7 cases with moderate to severe conductive deafness, dislocated or fallen incus on VE but no facial paralysis received ossicular chain reconstruction after conservative treatment. The 4 cases with mixed hearing loss, dislocated or fallen incus on VE and no facial paralysis received ossicular chain repair via the intact canal wall epitympanum approach after conservative treatment. Pharmacological therapies continued postoperatively in these patients to treat sensorineural deafness. Although temporal bone CT scans displayed the fracture line and malleus/incus abnormalities, VE provided additional detailed information on dislocation of incudomalleal and incudostapedial joints, incus dislocation or fracture, separation between crus longum incudis and stapes, and incus shifting. These were all confirmed during surgery. VE results and surgery findings were 100% consistent in patients with ossicular chain disruption. Conclusion VE can provide reliable visual evidence for accurate assessment of traumatic ossicular chain disruption, timing of surgery and individualizing surgical strategies and postoperative follow-up.

Comparison of CT virtual endoscopy with electronic colonoscopy in 30 colonic carcinoma patients

Abstract:Objective To evaluate the clinical application of CT virtual endoscopy (CTVE) in the diagnosis and treatment of colonic carcinoma. Methods We collected 30 patients pathologically proven to have colonic carcinomas as examined by CTVE and electronic colonoscopy (EC), correlating the CTVE and EC images respectively with surgical pathology in three aspects: tumor morphological features, degree of circumferential bowel wall involvement and longitudinal extent of tumor. Results CTVE imaging of colonic carcinomas showed morphological features: polypoid pattern (11 patients), ulcerative pattern (11), and infiltrative pattern (8); degree of circumferential bowel wall involvement: less than 1/2 (4 patients), from 1/2 to 3/4 (6), and more than 3/4 (20); and their longitudinal extent: 1.0-3.0?cm (7 patients), 31-5.0?cm (10), and 5.1-11.0?cm (13). Correlation of CTVE and EC with surgical pathology was found. Comparison of CTVE with surgical pathology showed tumor morphological features: concordant (26 patients), and disconcordant (4); degree of circumferential bowel wall involvement: concordant (25), disconcordant (5); and longitudinal extent of the tumor: concordant (23), disconcordant (7). Comparison of EC with surgical pathology showed tumor morphological features: concordant (22 patients), disconcordant (8); degree of circumferential bowel wall involvement: concordant (28), disconcordant (2); and longitudinal extent of the tumor: concordant (14), disconcordant (3), and undefined by EC (13). Conclusions The images obtained by CTVE in colonic carcinoma are similar to those obtained by EC. CTVE is an excellent alternative to EC for patients who cannot tolerate EC and for cases with incomplete EC.

CT virtual endoscopy of the auditory ossicular chain: clinical applications

Objective To evaluate the clinical applications and limitations of CT virtual endoscopy (CTVE) in theauditory ossicular chain.Methods CTVE of the auditory ossicular chain was performed with 1.0 mm collimation at pitch 1.0, bone algorithm, 9.6 cm field of view, and 0.1 - 0.2 mm reconstruction interval in 40 patients with middle ear diseases. 30 cases were confirmed by surgery. Results were compared with the findings of axial high resolution CT (HRCT) and multiplanar reformation (MPR) images and surgery.Results The accuracy of CTVE images in detecting ossicular destruction was 92.6%, significantly higher than that of axial HRCT (83.9%) and multiplanar reformation (76.5%) images. CTVE could also clearty reveal the postoperative condition and congenital dysplasia of the auditory ossicular chain.Conclusions CTVE can clearly demonstrate a three-dimensional image of the auditory ossicular chain and is useful in evaluating diseases of the ear, especially the auditory ossicles. CTVE could not clearly demonstrate abnormal soft tissue within the tympanic cavity, abnormal changes of the tympanic membrane and tympanic walls, and could be easily influenced by artificial factors.