Radiological Imaging

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Grade 2 imaging findings in year-old woman in nonacute phase of Meniere disease with high-frequency hearing loss. There is poor visibility of the contents of the vestibular aqueduct in the affected left ear A—D as compared with the unaffected right ear E—H. Arrows show the endolymphatic duct and sac. Note difference in visibility between the affected side and the unaffected side. Grade 3 imaging findings in year-old woman in nonacute phase of Meniere disease. In the affected right ear A—E , the endolymphatic duct and sac are not delineated.

However, the endolymphatic duct and sac arrows can be seen in the unaffected left ear F—J. Grade 3 imaging findings in year-old woman in nonacute phase of Meniere disease with flat hearing impairment. The affected left ear A—D does not show the endolymphatic duct and sac; however, the endolymphatic duct and sac are clearly visible in the unaffected right ear E—H.

Grade 3 imaging findings in a year-old man in the acute phase of Meniere disease. In the affected right ear A—D , the endolymphatic duct and sac are not delineated. However, the endolymphatic duct and sac arrows can be seen in the unaffected left ear F—I. Endolymphatic sac tumour Endolymphatic sac tumours ELST are very rare, locally invasive tumors of endolymphatic sac. Early detection of ELST is very important, because early surgical intervention may prevent further hearing loss. T2: often of heterogenous signal.

Endolymphatic sac tumor. T1-weighted T1W precontrast A and postcontrast B magnetic resonance image MRI show a hyperintense enhancing lesion white arrow, B in the right petrous bone at the expected position of the endolymphatic sac. Computed tomography demonstrates erosion of temporal bone black arrow—C adjacent to the vestibular aqueduct black arrowheads—C , which is characteristic of this tumor.

MRI T1 weighted images of the brain, showing a very large ELST of the left temporal bone, in axial view on the left and coronal view on the right. There has been complete erosion of the petrous temporal bone by the tumor, with significant brainstem and cerebellar compression.

Endolymphatic Sac Tumor Tumour which has relation to the with inner ear. Bilateral acoustic schwannomas are strongly suggestive of neurofibromatosis type 2 NF2. Bilateral vestibular schwannomas are highly suggestive of neurofibromatosis type 2 NF2 , although bilateral tumours are encountered in the familial form of acoustic schwannomas in the absence of other stigmata of NF2. Origin: Most from inferior vestibular nerve, at glial-schwann cell interface.

Clinical presentation. The typical presentation is with sensorineural hearing loss or tinnitus. In some patients this goes unnoticed and presentation is delayed until the lesion is much larger and presents with mass effect. Possibilities include cerebellar and brainstem symptoms e.

Radiographic features: CT May show erosion and widening of the internal acoustic meatus. The density of these tumours on non-contrast imaging is variable, and often they are hard to see, especially on account of beam hardening and streak artefact form the adjacent petrous temporal bone. Contrast enhancement is present, but can be underwhelming, especially in larger lesions with cystic components.

MRI T1 Slightly hypo-intense c.


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Intralabyrinthine schwannoma. T1-weighted postcontrast magnetic resonance image depicts an abnormally enhancing lesion within the left vestibule white arrow. Note that the imaging findings may be indistinguishable from labyrinthitis. Vestibular schwannoma VS. VIII cn schwannoma. Illustration from Diagnostic Imaging, head and neck Harnsberger et al. Signal intensity is low on T1-wi, heterogeneous but predominant high on T2-wi.

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CE is marked and homogenous. Bilateral vestibular schwannomas in a patient with neurofibromatosis 2 NF2. A, B Axial and coronal T1 weighted images with gadolinium enhancement are shown. Note the presence of an associated trigeminal schwannoma arrow. C, D Significant enlargement has occurred over four years, with the left sided vestibular schwannoma causing displacement of the brainstem.

IAC schwannoma and meningioma in patient with NF Meningiomas are a diverse set of tumors arising from the meninges , the membranous layers surrounding the central nervous system. They arise from the arachnoid "cap" cells of the arachnoid villi in the meninges. These tumors are usually benign in nature; however, a small percentage are malignant. Cerebellopontine angle meningioma. T1-weighted postcontrast magnetic resonance image demonstrates a uniformly enhancing mass black arrow in the right cerebellopontine angle. Note the broad-based dural attachment on the petrous bone and small dural tails.

Magnetic resonance image shows enlargement of the left cerebellopontine angle CPA white arrows , with mass effect on the brainstem. Hyperintensity on diffusion-weighted imaging C and hypointensity on fast imaging employing steady- state acquisition FIESTA D differentiates the epidermoid from an arachnoid cyst.

Internal auditory canal IAC lipoma.


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A hyperintense lesion black arrow— A in the anterior aspect of the right IAC is seen on noncontrast T1- weighted magnetic resonance image. FLAIR with fat saturation completely suppresses signal from the lesion, confirming lipoma white arrow—B. A glomus jugulare tumour is a paraganglioma of the head and neck that is confined to the jugular fossa. While it is a rare tumour, it is the most common of the jugular fossa tumours. The lesion is arising from the 9th and 10th nerves and most common of middle ear. The unique names is according to the location: Jugular bulb- Glomus jugulare.

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Middle ear- Glomus tympanicum. Carotid body- Carotid body tumour. Vagus nerve- Glomus vagale. Clinical presentation: Pulsating tinnitus with conductive hearing loss,, Invasion of the cochlea, lead to sensorineural hearing loss. Otoscopy shows blue tympanic membrane. Radiographic features CT: CT is most useful at assessing the bony margins of the tumour, which are typically irregularly eroded with a moth-eaten pattern. Eventually as the tumour enlarges the jugular spine is eroded and the mass extends into the middle ear, as well as inferiorly into the infratemporal fossa.

CT is excellent at assessing the integrity of the ossicles and bony labyrinth. DSA - angiography Angiography demonstrates an intense tumour blush, with the most common feeding vessel being the ascending pharyngeal. Early draining veins are also noted due to intra-tumoural shunting. Nuclear medicine Indium labelled octreotide accumulates in these tumours due to the presence of receptors for somatostatin, best visualized with SPECT, but requires the tumour to be greater than 1.

Glomus tympanicum Glomus jugulare. A mass is present in the jugular foramen black asterisks. Note the anterior displacement of the carotid flow void white arrows and a large flow void posteriorly black arrows within the tumor.

Axial computed tomography D shows irregular bony erosion extending into the petrous portion of carotid artery canal white arrowhead. Note the vertical segment of the facial nerve just lateral to the tumor black arrowhead. Glomus jugulare Bony tumour related to the inner ear Fibrous dysplasia of bone is a fibro-osseous tissue disease which has unknown etiology and characterized by replacement of normal bone by a variable amount of fibrous tissue and woven bone. The disease may be unifocal, multifocal or as seen in McCune Albright Syndrome.

Fibrous dysplasia rarely involves temporal bone and diagnosis is made with the displacement of neighboring structures. The aim of treatment is cosmetic and functional. Osteochondroma: An abnormal, solitary, benign growth of bone and cartilage, typically at the end of a long bone. Osteochondromas are usually discovered in persons 15 to 25 years of age and are the most common benign bone tumor.

An osteochondroma is rarely occur at the ear. Polyostotic fibrous dysplasia. Fibrous dysplasia affecting the ossicles and facial nerve canal. Aneurysmal bone cyst of the temporal bone Osteochondroma Metastasis of the inner ear. Metastasis of the inner ear is usually hematogenous dissemination from mammary carcinoma, renal cell carcinoma and bronchogenic carcinoma as being three most common tumours this embolic type of metastasis. The second is direct invasion by nearby tumour such as those of the epipharynx and the parotid gland via perineural spread.

Tumour cells occupy the internal auditory canal invading the V11th and V nerve trunks. Features of perineural spread: 1- Enlargement and enhancement of the involved nerve. A year- old man presented with 1 month of decreased vision, left facial numbness, and swelling. Physical examination demonstrated left- sided exophthalmos and blindness.

He was also unable to smell. Contrast-enhanced T1-weighted MRI demonstrated a large lesion that originated in the paranasal sinuses and extended through the cribriform plate into the anterior cranial fossa. Perineural spread: facial nerve acinic cell carcinoma of left parotid gland. B Postoperative MRI — skull base resection open arrow , postoperative changes closed arrow. Jump to navigation. For more than 32 years, Diagnostic Radiological Imaging has proudly served the patients and referring physicians of Sacramento County.

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