Clinical values and advances in computed tomography evaluation after cochlear implantation / 上海交通大学学报（医学版）

Cochlear implantation has been a standard rehabilitation for children and adult patients with severe to profound sensorineural deafness.The intracochlear localization of the electrode array is one of the key factors related to the postoperative auditory and speech outcomes.Preservation of the residual hearing is related to the trauma to the inner ear structures caused in the insertion process.Optimal insertion depth and positioning of the electrode array is important for frequency discrimination.The post-operative position of the electrode array is evaluated by using plain X ray or computed tomography(CT).Compared to the plain X ray,CT produces three-dimensional(3D)imaging.With the application of post-operative CT evaluation,the integrity of the electrode array can be verified for surgical safety and improving programming accuracy.Different 3D reconstruction techniques and methods based on the post-operative CT imaging have been proposed to facilitate the precise recognition of position of each electrode,thus helpful to evaluate the possible insertion trauma to inner ear structures and the potential effect on auditory and speech outcomes.The post-operative CT evaluation has helped the electrode array design,brought progress to the soft surgery procedure and promoted new technologies such as robotic surgery and navigation.Therefore,it is getting more and more attention.This article reviews the clinical application values and the progress of techniques in post-operative CT evaluation of cochlear implantation.

Clinical value of high-resolution flat detector computed tomography in intracranial covered stent (Willis) implantation / 中华神经医学杂志

Objective:To evaluate the utility of high-resolution flat detector CT (HR-FDCT) in Willis covered stent implantation.Methods:The clinical and imaging data of 23 patients with intracranial aneurysms, intracranial artery dissection or carotid-cavernous fistula treated by Willis covered stents in our hospital from June 2017 to August 2019 were retrospectively analyzed. Images were acquired using conventional FDCT and HR-FDCT; the differences of image quality for stent visualization were compared. Immediately after stent deployment, dual volume 3D fusion images were obtained from 5 s-3D-digital subtraction angiography (DSA) and HR-FDCT, and the stent expansion status was also recorded.Results:A total of 25 Willis covered stents were implanted in 23 patients with a success rate of 100%. As compared with that by FDCT, visualization of fine structures of the stent by HR-FDCT was improved, and the image quality by HR-FDCT was significantly improved as compared with that by FDCT (mean scores: 0.56±0.71 vs. 1.56±0.65, P<0.05). According to the reconstruction of 3D fusion images obtained from 3D-DSA combined with HR-FDCT, one stent was found to have poor apposition (the distal of the stent with kinking) without vascular rupture and internal leakage, and the other 24 stents were found to have good apposition. Conclusions:HR-FDCT could better display Willis covered stent details and afford improved image quality, which instructs surgeons to adopt appropriate treatment strategy. This novel HR-FDCT has great application potential in Willis covered stent implantation.