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Objective:To summarize the clinical and imaging presentations of stapical footplate hernia related to inner ear malformation (SFH-Re-IEM).Methods:The clinical and imaging data of 19 patients (24 ears) with SFH-Re-IEM from Shandong Provincial ENT Hospital between June 2014 to June 2022 were retrospectively analyzed. The clinical presentations and headache and the high resolution CT (HRCT) and MRI findings including associated inner ear malformation (IEM) type, internal auditory canal (IAC) malformation, bony defect of the stapical footplate, the extent, margin, density and signal of the herniation cysts, the density and signal of ipsilateral intratympanic, cochlear osseous labyrinthitis were recorded.Results:Among 19 SFH-Re-IEM patients, including 14 males and 5 females, 3 (1, 12) years old. All of the affected ears presented sensorineural or mixed hearing loss, 1 ear for moderate, 7 ears for severe and 16 ears for extremely severe. Besides this, the vertigo in 1 case, otalgia and ear fullness in 2 cases were found, and the others were detected accidentally. Among 24 ears with SFH-Re-IEM, 9 ears (37.5%) consisting with incomplete partition type Ⅰ, 3 ears (12.5%) with common cavity, 7 ears (29.2%) with cochlear aplasia, 3 ears (12.5%) with cochlear dysplasia type Ⅱ, and 2 ears (8.3%) with Mondini deformity were found respectively. Four ears (16.7%) were associated with IAC enlargement and the bony defect of IAC fundus, 19 ears (79.2%) were accompanied with dysplasia in the IAC fundus. In all the 24 ears with SFH-Re-IEM, the focal bony defect of the affected stapical footplate and the hemispherical soft-tissue-density herniating cysts protruding into the tympanium were presented on HRCT, and the herniating cysts presenting the cerebrospinal fluid-like signal with the well-defined margin and the ipsilateral normal tympanium were shown on the MRI hydrographic sequence. Two ears underwent the perilymphaticum gadolinium based on MRI, which demonstrated the hypersignal gadolinium in the perilymphatic space entered into the herniating cysts. Two ears were accompanied with the cochlear osseous labyrinthitis.Conclusion:The ears with IEM-Re-SFH usually present the serious hearing loss. The ipsilateral severe IEM, focal bony defect of the stapical footplate and perilymph herniating are characteristic imaging appearances.
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Objective: To observe the changes of inner ear in patients with Meniere's disease with 3D-FLAIR MRI after intratympanic (IT) gadolinium injection or intravenous (IV) gadolinium injection. Methods: Totally 36 patients with Meniere's disease were randomly divided into 2 groups. Eighteen of them underwent intravenous injection of GD-BOPTA (IV group), while the rest 18 underwent bilateral IT injection of equivalent dilution of GD-DTPA (IT group). 3D-FLAIR MR examinations were performed after 4 and 24 hours, respectively. ROIs in cochlear perilymph and medulla oblongata were drawn on MRI, and signal-intensity ratio (CM ratio) was subsequently evaluated and compared with paired t test. In addition, the ratio of endolymphatic hydrops (EH) of each group were separately observed and analyzed using chi-squared test. Results: For IT group, comparable CM ratios were found between the affected and unaffected sides of perilymph regions (1.86±0.74 vs 1.68±0.77,n=18,P=0.805). For IV group, significant difference of CM ratios was observed between the affected and unaffected sides of perilymph regions (1.46±0.31 vs 1.26±0.21, n=18, P=0.001). Meanwhile, significantly higher CM ratio was shown in affected sides of perilymph in IT group than that in IV group (1.86±0.74 vs 1.46±0.31,n=18, P=0.044), and significantly higher CM ratio was found in unaffected sides of perilymph in IT group than that in IV group (1.68±0.77 vs 1.26±0.21, n=18, P=0.032). Conclusion: Trans-tympanum administration and intravenous administration inner ear MRI show the same effect, and the former has higher signal intensity, while bilateral inner ear and blood-labyrinth barrier permeability could be observed using the latter with less injury.
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Objective To evaluate the value of spectral CT imaging for the differential diagnosis of squamous cell carcinoma (SQCC) and adenocarcinoma (ADC) of the esophagogastric junction. Methods Forty-five patients with a mass in the esophagogastric junction proved by pathology underwent enhanced scan with spectral CT, including 20 cases of SQCC and 25 cases of ADC. Iodine concentration (IC) , water concentration (WC) , effective atomic number (Eff-Z) and spectral curve slope (λHU) of arterial phase (AP) and venous phase (VP) in the ROI of the mass were measured with gemstone spectral imaging post-processing software. The independent samples t test was used to compare the quantitative parameters above between two groups on the premise of satisfying normal distribution. ROC curves were drawn for the parameters which showed statistical differences and area under the curve (AUC) was used to measure and compare their respective differential diagnostic performance as well as the best threshold value. Results In AP,the average IC, Eff-Z, andλHU of ADC were (1.75±0.40) mg/ml, 8.65±0.22, and 3.33±0.74, respectively. The corresponding parameters of SQCC were (1.40 ± 0.35) mg/ml, 8.50 ± 0.20, and 2.71 ± 0.66, respectively. These parameters of ADC were significantly higher than that of SQCC (t=-2.833,-2.879,-2.678;P<0.05) . In VP, the average IC, Eff-Z, and λHU of ADC were (2.17 ± 0.23) mg/ml, 8.87 ± 0.11, and 4.10 ± 0.44, respectively. The corresponding parameters of SQCC were (1.67 ± 0.20) mg/ml, 8.60 ± 0.11, and 3.19 ± 0.41, respectively. The difference between ADC and SQCC was statistically significant (t=-6.963,-7.218,-6.521;P<0.05). For the average WC, No difference between the two groups in AP and VP was found. ROC curve analysis showed that IC, Eff-Z, andλHU in VP had better differential diagnostic performances than IC, Eff-Z, and λHU in AP, especially Eff-Z in VP. The AUC for it was 0.97. Using 8.72 as a threshold value, the sensitivity and specificity for diagnosis were 88.9% and 94.7% , respectively. Conclusion Multi-parameters quantitative analysis with spectral CT could be useful in the differential diagnosis of SQCC and ADC of the esophagogastric junction.