Isolated Congenital Middle Ear Malformations: Comparison of Preoperative 0.1-mm Ultra-High-Resolution CT and...

Area of Science:

• Radiology and Imaging
• Otolaryngology
• Medical Diagnostics

Background:

• Congenital middle ear malformation (CMEM) is a major cause of congenital hearing loss and developmental issues.
• Accurate imaging is crucial for diagnosis and surgical planning of CMEM.

Purpose of the Study:

• To compare the diagnostic performance of 0.1 mm isotropic ultra-high-resolution computed tomography (U-HRCT) against conventional high-resolution computed tomography (HRCT) for isolated CMEM.
• To evaluate the effectiveness of U-HRCT in detecting subtle structural abnormalities and classifying CMEM subtypes using surgical exploration as the gold standard.

Main Methods:

• Retrospective analysis of patients with surgically confirmed isolated CMEM who underwent U-HRCT or HRCT.
• Two blinded neuroradiologists assessed CT images for ten subtle structural abnormalities and CMEM subtypes.
• Comparison of inter-observer and intra-observer agreement, diagnostic sensitivity, and subtype differentiation between U-HRCT and HRCT.

Main Results:

• U-HRCT demonstrated significantly higher inter-observer and intra-observer agreement and concordance with surgical findings compared to HRCT.
• U-HRCT showed superior diagnostic sensitivity for CMEM (100.0% vs. 90.9%) and outperformed HRCT in differentiating subtypes (0.774 vs. 0.352).
• U-HRCT achieved high accuracy (>0.85) in identifying all abnormalities, particularly subtle ones like incus malformations, stapes fixation, and oval window atresia.

Conclusions:

• Isotropic 0.1 mm U-HRCT is clinically superior to conventional HRCT for diagnosing CMEM.
• U-HRCT enhances the detection of subtle abnormalities and improves the classification of CMEM subtypes.
• U-HRCT provides precise preoperative evaluation, leading to better surgical outcomes for patients with CMEM.