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Middle and Inner Ear: Improved Depiction with Multiplanar Reconstruction of Volumetric CT Data¹

¹ From the Departments of Radiology (J.I.L., E.P.L., R.J.W., D.R.D.) and Otolaryngology (C.L.W.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55902. Received March 2, 2005; revision requested April 26 and received August 25; accepted August 29. All authors have no financial relationships to disclose.

View larger version (176K): [in a new window]   Figure 1a.  Double-oblique coronal view of the malleus. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the optimal reconstruction plane (white line) for depicting the long axis of the malleus. (c) Reconstructed double-oblique coronal image shows the mallear head (MH), manubrium (MM), and neck (MN) and the tensor tympani (TT) tendon. (d) Reconstructed double-oblique coronal image in another patient shows a pars flaccida cholesteatoma in the superior recess of the tympanic membrane, or the Prussak space (arrow).

 

View larger version (153K): [in a new window]   Figure 1b.  Double-oblique coronal view of the malleus. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the optimal reconstruction plane (white line) for depicting the long axis of the malleus. (c) Reconstructed double-oblique coronal image shows the mallear head (MH), manubrium (MM), and neck (MN) and the tensor tympani (TT) tendon. (d) Reconstructed double-oblique coronal image in another patient shows a pars flaccida cholesteatoma in the superior recess of the tympanic membrane, or the Prussak space (arrow).

 

View larger version (155K): [in a new window]   Figure 1c.  Double-oblique coronal view of the malleus. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the optimal reconstruction plane (white line) for depicting the long axis of the malleus. (c) Reconstructed double-oblique coronal image shows the mallear head (MH), manubrium (MM), and neck (MN) and the tensor tympani (TT) tendon. (d) Reconstructed double-oblique coronal image in another patient shows a pars flaccida cholesteatoma in the superior recess of the tympanic membrane, or the Prussak space (arrow).

 

View larger version (148K): [in a new window]   Figure 1d.  Double-oblique coronal view of the malleus. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the optimal reconstruction plane (white line) for depicting the long axis of the malleus. (c) Reconstructed double-oblique coronal image shows the mallear head (MH), manubrium (MM), and neck (MN) and the tensor tympani (TT) tendon. (d) Reconstructed double-oblique coronal image in another patient shows a pars flaccida cholesteatoma in the superior recess of the tympanic membrane, or the Prussak space (arrow).

 

View larger version (179K): [in a new window]   Figure 2a.  Double-oblique coronal view of the incus and stapes. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the plane of reconstruction (white line). (c) Reconstructed double-oblique coronal image shows normal anatomy of the long axis of the incudal body (IB), including the incudal long process (ILP), incudostapedial joint (ISJ), and stapedial footplate (SFP). (d) Reconstructed long-axis image in another patient shows demineralization (arrow) of the long process in association with cholesteatoma in the oval window, findings confirmed at surgery. (e) Reconstructed long-axis image in a child with CHARGE syndrome shows a stenotic oval window (arrow) with inferior displacement of the facial nerve into the oval window niche and with absence of the semicircular canals. (f) Double-oblique coronal image in another patient provides a long-axis view of a persistent stapedial artery (arrows) in the left ear, that crosses from the carotid canal to the oval window niche and enters the facial nerve canal.

 

View larger version (161K): [in a new window]   Figure 2b.  Double-oblique coronal view of the incus and stapes. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the plane of reconstruction (white line). (c) Reconstructed double-oblique coronal image shows normal anatomy of the long axis of the incudal body (IB), including the incudal long process (ILP), incudostapedial joint (ISJ), and stapedial footplate (SFP). (d) Reconstructed long-axis image in another patient shows demineralization (arrow) of the long process in association with cholesteatoma in the oval window, findings confirmed at surgery. (e) Reconstructed long-axis image in a child with CHARGE syndrome shows a stenotic oval window (arrow) with inferior displacement of the facial nerve into the oval window niche and with absence of the semicircular canals. (f) Double-oblique coronal image in another patient provides a long-axis view of a persistent stapedial artery (arrows) in the left ear, that crosses from the carotid canal to the oval window niche and enters the facial nerve canal.

 

View larger version (157K): [in a new window]   Figure 2c.  Double-oblique coronal view of the incus and stapes. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the plane of reconstruction (white line). (c) Reconstructed double-oblique coronal image shows normal anatomy of the long axis of the incudal body (IB), including the incudal long process (ILP), incudostapedial joint (ISJ), and stapedial footplate (SFP). (d) Reconstructed long-axis image in another patient shows demineralization (arrow) of the long process in association with cholesteatoma in the oval window, findings confirmed at surgery. (e) Reconstructed long-axis image in a child with CHARGE syndrome shows a stenotic oval window (arrow) with inferior displacement of the facial nerve into the oval window niche and with absence of the semicircular canals. (f) Double-oblique coronal image in another patient provides a long-axis view of a persistent stapedial artery (arrows) in the left ear, that crosses from the carotid canal to the oval window niche and enters the facial nerve canal.

 

View larger version (147K): [in a new window]   Figure 2d.  Double-oblique coronal view of the incus and stapes. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the plane of reconstruction (white line). (c) Reconstructed double-oblique coronal image shows normal anatomy of the long axis of the incudal body (IB), including the incudal long process (ILP), incudostapedial joint (ISJ), and stapedial footplate (SFP). (d) Reconstructed long-axis image in another patient shows demineralization (arrow) of the long process in association with cholesteatoma in the oval window, findings confirmed at surgery. (e) Reconstructed long-axis image in a child with CHARGE syndrome shows a stenotic oval window (arrow) with inferior displacement of the facial nerve into the oval window niche and with absence of the semicircular canals. (f) Double-oblique coronal image in another patient provides a long-axis view of a persistent stapedial artery (arrows) in the left ear, that crosses from the carotid canal to the oval window niche and enters the facial nerve canal.

 

View larger version (158K): [in a new window]   Figure 2e.  Double-oblique coronal view of the incus and stapes. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the plane of reconstruction (white line). (c) Reconstructed double-oblique coronal image shows normal anatomy of the long axis of the incudal body (IB), including the incudal long process (ILP), incudostapedial joint (ISJ), and stapedial footplate (SFP). (d) Reconstructed long-axis image in another patient shows demineralization (arrow) of the long process in association with cholesteatoma in the oval window, findings confirmed at surgery. (e) Reconstructed long-axis image in a child with CHARGE syndrome shows a stenotic oval window (arrow) with inferior displacement of the facial nerve into the oval window niche and with absence of the semicircular canals. (f) Double-oblique coronal image in another patient provides a long-axis view of a persistent stapedial artery (arrows) in the left ear, that crosses from the carotid canal to the oval window niche and enters the facial nerve canal.

 

View larger version (164K): [in a new window]   Figure 2f.  Double-oblique coronal view of the incus and stapes. (a, b) Orthogonal axial (a) and sagittal (b) reference images show the plane of reconstruction (white line). (c) Reconstructed double-oblique coronal image shows normal anatomy of the long axis of the incudal body (IB), including the incudal long process (ILP), incudostapedial joint (ISJ), and stapedial footplate (SFP). (d) Reconstructed long-axis image in another patient shows demineralization (arrow) of the long process in association with cholesteatoma in the oval window, findings confirmed at surgery. (e) Reconstructed long-axis image in a child with CHARGE syndrome shows a stenotic oval window (arrow) with inferior displacement of the facial nerve into the oval window niche and with absence of the semicircular canals. (f) Double-oblique coronal image in another patient provides a long-axis view of a persistent stapedial artery (arrows) in the left ear, that crosses from the carotid canal to the oval window niche and enters the facial nerve canal.

 

View larger version (172K): [in a new window]   Figure 3a.  Double-oblique sagittal view of the left malleus and incus. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows the molar tooth–like appearance of the incudal body (IB), incudomallear joint (IMJ), mallear manubrium (MM), and incudal long process (ILP). (d) Double-oblique sagittal image in another patient shows a missing cusp of the molar tooth (arrow), a finding that indicates the complete erosion of the incus by a cholesteatoma, as was proved at surgery.

 

View larger version (166K): [in a new window]   Figure 3b.  Double-oblique sagittal view of the left malleus and incus. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows the molar tooth–like appearance of the incudal body (IB), incudomallear joint (IMJ), mallear manubrium (MM), and incudal long process (ILP). (d) Double-oblique sagittal image in another patient shows a missing cusp of the molar tooth (arrow), a finding that indicates the complete erosion of the incus by a cholesteatoma, as was proved at surgery.

 

View larger version (175K): [in a new window]   Figure 3c.  Double-oblique sagittal view of the left malleus and incus. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows the molar tooth–like appearance of the incudal body (IB), incudomallear joint (IMJ), mallear manubrium (MM), and incudal long process (ILP). (d) Double-oblique sagittal image in another patient shows a missing cusp of the molar tooth (arrow), a finding that indicates the complete erosion of the incus by a cholesteatoma, as was proved at surgery.

 

View larger version (157K): [in a new window]   Figure 3d.  Double-oblique sagittal view of the left malleus and incus. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows the molar tooth–like appearance of the incudal body (IB), incudomallear joint (IMJ), mallear manubrium (MM), and incudal long process (ILP). (d) Double-oblique sagittal image in another patient shows a missing cusp of the molar tooth (arrow), a finding that indicates the complete erosion of the incus by a cholesteatoma, as was proved at surgery.

 

View larger version (164K): [in a new window]   Figure 4a.  Double-oblique axial view of the stapes at the oval window. (a, b) Orthogonal coronal (a) and sagittal (b) reference images show the plane of reconstruction (white line). Obliquity in two planes was required to optimally profile both the stapes and oval window. (c) Double-oblique axial view shows a normal stapes, including the stapedial anterior crus (SAC), posterior crus (SPC), and footplate (SFP), at the level of the oval window. (d) Double-oblique axial image in a child with CHARGE syndrome shows a unipolar left stapes (arrow). (e) Double-oblique axial view in another patient shows a remote temporal bone fracture with foreshortening of the posterior crus (arrow), subluxation of the footplate (white arrowhead), and posttraumatic ossification of the vestibule (black arrowhead).

 

View larger version (156K): [in a new window]   Figure 4b.  Double-oblique axial view of the stapes at the oval window. (a, b) Orthogonal coronal (a) and sagittal (b) reference images show the plane of reconstruction (white line). Obliquity in two planes was required to optimally profile both the stapes and oval window. (c) Double-oblique axial view shows a normal stapes, including the stapedial anterior crus (SAC), posterior crus (SPC), and footplate (SFP), at the level of the oval window. (d) Double-oblique axial image in a child with CHARGE syndrome shows a unipolar left stapes (arrow). (e) Double-oblique axial view in another patient shows a remote temporal bone fracture with foreshortening of the posterior crus (arrow), subluxation of the footplate (white arrowhead), and posttraumatic ossification of the vestibule (black arrowhead).

 

View larger version (173K): [in a new window]   Figure 4c.  Double-oblique axial view of the stapes at the oval window. (a, b) Orthogonal coronal (a) and sagittal (b) reference images show the plane of reconstruction (white line). Obliquity in two planes was required to optimally profile both the stapes and oval window. (c) Double-oblique axial view shows a normal stapes, including the stapedial anterior crus (SAC), posterior crus (SPC), and footplate (SFP), at the level of the oval window. (d) Double-oblique axial image in a child with CHARGE syndrome shows a unipolar left stapes (arrow). (e) Double-oblique axial view in another patient shows a remote temporal bone fracture with foreshortening of the posterior crus (arrow), subluxation of the footplate (white arrowhead), and posttraumatic ossification of the vestibule (black arrowhead).

 

View larger version (155K): [in a new window]   Figure 4d.  Double-oblique axial view of the stapes at the oval window. (a, b) Orthogonal coronal (a) and sagittal (b) reference images show the plane of reconstruction (white line). Obliquity in two planes was required to optimally profile both the stapes and oval window. (c) Double-oblique axial view shows a normal stapes, including the stapedial anterior crus (SAC), posterior crus (SPC), and footplate (SFP), at the level of the oval window. (d) Double-oblique axial image in a child with CHARGE syndrome shows a unipolar left stapes (arrow). (e) Double-oblique axial view in another patient shows a remote temporal bone fracture with foreshortening of the posterior crus (arrow), subluxation of the footplate (white arrowhead), and posttraumatic ossification of the vestibule (black arrowhead).

 

View larger version (177K): [in a new window]   Figure 4e.  Double-oblique axial view of the stapes at the oval window. (a, b) Orthogonal coronal (a) and sagittal (b) reference images show the plane of reconstruction (white line). Obliquity in two planes was required to optimally profile both the stapes and oval window. (c) Double-oblique axial view shows a normal stapes, including the stapedial anterior crus (SAC), posterior crus (SPC), and footplate (SFP), at the level of the oval window. (d) Double-oblique axial image in a child with CHARGE syndrome shows a unipolar left stapes (arrow). (e) Double-oblique axial view in another patient shows a remote temporal bone fracture with foreshortening of the posterior crus (arrow), subluxation of the footplate (white arrowhead), and posttraumatic ossification of the vestibule (black arrowhead).

 

View larger version (176K): [in a new window]   Figure 5a.  Oblique sagittal view of the stapes immediately lateral to the oval window. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows normal anatomy of the stapedial posterior crus (SPC), stapedial anterior crus (SAC), and cochlear promontory (CP). (d) Double-oblique sagittal image in a patient with congenital conductive hearing loss depicts congenital fixation of the stapedial posterior crus to the cochlear promontory (arrow). The synostosis was lysed at surgery, and stapedial ossiculoplasty was performed, with resultant restoration of normal conductive hearing.

 

View larger version (168K): [in a new window]   Figure 5b.  Oblique sagittal view of the stapes immediately lateral to the oval window. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows normal anatomy of the stapedial posterior crus (SPC), stapedial anterior crus (SAC), and cochlear promontory (CP). (d) Double-oblique sagittal image in a patient with congenital conductive hearing loss depicts congenital fixation of the stapedial posterior crus to the cochlear promontory (arrow). The synostosis was lysed at surgery, and stapedial ossiculoplasty was performed, with resultant restoration of normal conductive hearing.

 

View larger version (179K): [in a new window]   Figure 5c.  Oblique sagittal view of the stapes immediately lateral to the oval window. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows normal anatomy of the stapedial posterior crus (SPC), stapedial anterior crus (SAC), and cochlear promontory (CP). (d) Double-oblique sagittal image in a patient with congenital conductive hearing loss depicts congenital fixation of the stapedial posterior crus to the cochlear promontory (arrow). The synostosis was lysed at surgery, and stapedial ossiculoplasty was performed, with resultant restoration of normal conductive hearing.

 

View larger version (158K): [in a new window]   Figure 5d.  Oblique sagittal view of the stapes immediately lateral to the oval window. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows normal anatomy of the stapedial posterior crus (SPC), stapedial anterior crus (SAC), and cochlear promontory (CP). (d) Double-oblique sagittal image in a patient with congenital conductive hearing loss depicts congenital fixation of the stapedial posterior crus to the cochlear promontory (arrow). The synostosis was lysed at surgery, and stapedial ossiculoplasty was performed, with resultant restoration of normal conductive hearing.

 

View larger version (182K): [in a new window]   Figure 6a.  Single-oblique sagittal view of the round window. (a) Orthogonal axial reference image shows the plane of reconstruction (white line) through the round window. (b) Single-oblique sagittal image provides a profile of the normal round window (RW) within the round window niche and shows its location in relation to the carotid canal (CC), labyrinthine segment of the facial nerve canal (FN), sinus tympani (ST), and superior vestibular nerve canal (SVN). (c) Single oblique sagittal reconstruction in a patient with fenestral and retrofenestral otospongiosis shows a lucent halo (arrow) that surrounds the bony labyrinth and similarly lucent otospongiotic plaques (arrowheads) in the round window niche.

 

View larger version (175K): [in a new window]   Figure 6b.  Single-oblique sagittal view of the round window. (a) Orthogonal axial reference image shows the plane of reconstruction (white line) through the round window. (b) Single-oblique sagittal image provides a profile of the normal round window (RW) within the round window niche and shows its location in relation to the carotid canal (CC), labyrinthine segment of the facial nerve canal (FN), sinus tympani (ST), and superior vestibular nerve canal (SVN). (c) Single oblique sagittal reconstruction in a patient with fenestral and retrofenestral otospongiosis shows a lucent halo (arrow) that surrounds the bony labyrinth and similarly lucent otospongiotic plaques (arrowheads) in the round window niche.

 

View larger version (174K): [in a new window]   Figure 6c.  Single-oblique sagittal view of the round window. (a) Orthogonal axial reference image shows the plane of reconstruction (white line) through the round window. (b) Single-oblique sagittal image provides a profile of the normal round window (RW) within the round window niche and shows its location in relation to the carotid canal (CC), labyrinthine segment of the facial nerve canal (FN), sinus tympani (ST), and superior vestibular nerve canal (SVN). (c) Single oblique sagittal reconstruction in a patient with fenestral and retrofenestral otospongiosis shows a lucent halo (arrow) that surrounds the bony labyrinth and similarly lucent otospongiotic plaques (arrowheads) in the round window niche.

 

View larger version (176K): [in a new window]   Figure 7a.  Double-oblique coronal short-axis view of the cochlea. (a, b) Orthogonal axial (a) and sagittal (b) reference images show parallel planes of reconstruction (white lines) along the short axis of the cochlea. Note the inferior tilt of the cochlea on b. (c–e) Consecutive double-oblique coronal images provide en face views of normal anatomy of the apical turn (AT) (c), middle turn (MT) (d), and basal turn (BT) (e) of the cochlea (Mo = modiolus). (f) Double-oblique coronal image in another patient shows posttraumatic ossification of the basal turn of the right cochlea (arrow), a sequela of remote trauma, with persistent lucency of the fracture lines (arrowheads) through the superior and lateral walls of the labyrinth.

 

View larger version (152K): [in a new window]   Figure 7b.  Double-oblique coronal short-axis view of the cochlea. (a, b) Orthogonal axial (a) and sagittal (b) reference images show parallel planes of reconstruction (white lines) along the short axis of the cochlea. Note the inferior tilt of the cochlea on b. (c–e) Consecutive double-oblique coronal images provide en face views of normal anatomy of the apical turn (AT) (c), middle turn (MT) (d), and basal turn (BT) (e) of the cochlea (Mo = modiolus). (f) Double-oblique coronal image in another patient shows posttraumatic ossification of the basal turn of the right cochlea (arrow), a sequela of remote trauma, with persistent lucency of the fracture lines (arrowheads) through the superior and lateral walls of the labyrinth.

 

View larger version (170K): [in a new window]   Figure 7c.  Double-oblique coronal short-axis view of the cochlea. (a, b) Orthogonal axial (a) and sagittal (b) reference images show parallel planes of reconstruction (white lines) along the short axis of the cochlea. Note the inferior tilt of the cochlea on b. (c–e) Consecutive double-oblique coronal images provide en face views of normal anatomy of the apical turn (AT) (c), middle turn (MT) (d), and basal turn (BT) (e) of the cochlea (Mo = modiolus). (f) Double-oblique coronal image in another patient shows posttraumatic ossification of the basal turn of the right cochlea (arrow), a sequela of remote trauma, with persistent lucency of the fracture lines (arrowheads) through the superior and lateral walls of the labyrinth.

 

View larger version (170K): [in a new window]   Figure 7d.  Double-oblique coronal short-axis view of the cochlea. (a, b) Orthogonal axial (a) and sagittal (b) reference images show parallel planes of reconstruction (white lines) along the short axis of the cochlea. Note the inferior tilt of the cochlea on b. (c–e) Consecutive double-oblique coronal images provide en face views of normal anatomy of the apical turn (AT) (c), middle turn (MT) (d), and basal turn (BT) (e) of the cochlea (Mo = modiolus). (f) Double-oblique coronal image in another patient shows posttraumatic ossification of the basal turn of the right cochlea (arrow), a sequela of remote trauma, with persistent lucency of the fracture lines (arrowheads) through the superior and lateral walls of the labyrinth.

 

View larger version (175K): [in a new window]   Figure 7e.  Double-oblique coronal short-axis view of the cochlea. (a, b) Orthogonal axial (a) and sagittal (b) reference images show parallel planes of reconstruction (white lines) along the short axis of the cochlea. Note the inferior tilt of the cochlea on b. (c–e) Consecutive double-oblique coronal images provide en face views of normal anatomy of the apical turn (AT) (c), middle turn (MT) (d), and basal turn (BT) (e) of the cochlea (Mo = modiolus). (f) Double-oblique coronal image in another patient shows posttraumatic ossification of the basal turn of the right cochlea (arrow), a sequela of remote trauma, with persistent lucency of the fracture lines (arrowheads) through the superior and lateral walls of the labyrinth.

 

View larger version (163K): [in a new window]   Figure 7f.  Double-oblique coronal short-axis view of the cochlea. (a, b) Orthogonal axial (a) and sagittal (b) reference images show parallel planes of reconstruction (white lines) along the short axis of the cochlea. Note the inferior tilt of the cochlea on b. (c–e) Consecutive double-oblique coronal images provide en face views of normal anatomy of the apical turn (AT) (c), middle turn (MT) (d), and basal turn (BT) (e) of the cochlea (Mo = modiolus). (f) Double-oblique coronal image in another patient shows posttraumatic ossification of the basal turn of the right cochlea (arrow), a sequela of remote trauma, with persistent lucency of the fracture lines (arrowheads) through the superior and lateral walls of the labyrinth.

 

View larger version (176K): [in a new window]   Figure 8a.  Single-oblique sagittal long-axis view of the cochlea. (a) Orthogonal axial reference image shows the plane of reconstruction (white line). (b) Oblique sagittal image depicts normal anatomy of the apical (AT), basal (BT), and middle (MT) turns of the cochlea. (c) A slightly more medial view of the normal cochlea shows the aperture of the cochlear nerve (CA) and the central conical bony pillar of the cochlea, the modiolus (Mo). (d) Single-oblique sagittal reconstruction gives a long-axis view of the right cochlea in a patient with a stenotic internal auditory canal and absence of the cochlear nerve at high-resolution MR imaging. Note the small apical internal auditory canal (arrow), the absence of the cochlear nerve aperture, and the small hyperattenuating modiolus (arrowhead).

 

View larger version (142K): [in a new window]   Figure 8b.  Single-oblique sagittal long-axis view of the cochlea. (a) Orthogonal axial reference image shows the plane of reconstruction (white line). (b) Oblique sagittal image depicts normal anatomy of the apical (AT), basal (BT), and middle (MT) turns of the cochlea. (c) A slightly more medial view of the normal cochlea shows the aperture of the cochlear nerve (CA) and the central conical bony pillar of the cochlea, the modiolus (Mo). (d) Single-oblique sagittal reconstruction gives a long-axis view of the right cochlea in a patient with a stenotic internal auditory canal and absence of the cochlear nerve at high-resolution MR imaging. Note the small apical internal auditory canal (arrow), the absence of the cochlear nerve aperture, and the small hyperattenuating modiolus (arrowhead).

 

View larger version (151K): [in a new window]   Figure 8c.  Single-oblique sagittal long-axis view of the cochlea. (a) Orthogonal axial reference image shows the plane of reconstruction (white line). (b) Oblique sagittal image depicts normal anatomy of the apical (AT), basal (BT), and middle (MT) turns of the cochlea. (c) A slightly more medial view of the normal cochlea shows the aperture of the cochlear nerve (CA) and the central conical bony pillar of the cochlea, the modiolus (Mo). (d) Single-oblique sagittal reconstruction gives a long-axis view of the right cochlea in a patient with a stenotic internal auditory canal and absence of the cochlear nerve at high-resolution MR imaging. Note the small apical internal auditory canal (arrow), the absence of the cochlear nerve aperture, and the small hyperattenuating modiolus (arrowhead).

 

View larger version (127K): [in a new window]   Figure 8d.  Single-oblique sagittal long-axis view of the cochlea. (a) Orthogonal axial reference image shows the plane of reconstruction (white line). (b) Oblique sagittal image depicts normal anatomy of the apical (AT), basal (BT), and middle (MT) turns of the cochlea. (c) A slightly more medial view of the normal cochlea shows the aperture of the cochlear nerve (CA) and the central conical bony pillar of the cochlea, the modiolus (Mo). (d) Single-oblique sagittal reconstruction gives a long-axis view of the right cochlea in a patient with a stenotic internal auditory canal and absence of the cochlear nerve at high-resolution MR imaging. Note the small apical internal auditory canal (arrow), the absence of the cochlear nerve aperture, and the small hyperattenuating modiolus (arrowhead).

 

View larger version (154K): [in a new window]   Figure 9a.  Single-oblique sagittal view of the superior semicircular canal. (a) Orthogonal axial reference image shows the plane of reconstruction (white line) through the roof of the superior semicircular canal. (b) Oblique sagittal image shows integrity of the bone in the roof of the superior semicircular canal (SSC), as well as a normal appearance of the facial nerve (FN) and the lateral semicircular canal (LSC). (c) Single-oblique sagittal image in a patient with Tullio syndrome shows dehiscence of the superior semicircular canal (arrow).

 

View larger version (153K): [in a new window]   Figure 9b.  Single-oblique sagittal view of the superior semicircular canal. (a) Orthogonal axial reference image shows the plane of reconstruction (white line) through the roof of the superior semicircular canal. (b) Oblique sagittal image shows integrity of the bone in the roof of the superior semicircular canal (SSC), as well as a normal appearance of the facial nerve (FN) and the lateral semicircular canal (LSC). (c) Single-oblique sagittal image in a patient with Tullio syndrome shows dehiscence of the superior semicircular canal (arrow).

 

View larger version (172K): [in a new window]   Figure 9c.  Single-oblique sagittal view of the superior semicircular canal. (a) Orthogonal axial reference image shows the plane of reconstruction (white line) through the roof of the superior semicircular canal. (b) Oblique sagittal image shows integrity of the bone in the roof of the superior semicircular canal (SSC), as well as a normal appearance of the facial nerve (FN) and the lateral semicircular canal (LSC). (c) Single-oblique sagittal image in a patient with Tullio syndrome shows dehiscence of the superior semicircular canal (arrow).

 

View larger version (175K): [in a new window]   Figure 10a.  Single-oblique sagittal view through the vestibular aqueduct. (a) Orthogonal axial reference image shows the plane of reconstruction (white line), which includes the medial wall of the vestibule and the vestibular aqueduct. (b) Single-oblique sagittal image shows the spatial orientation of the normal vestibular aqueduct (VA), which enters the vestibule just anterior and medial to the opening of the common crus (CC). (c) Single-oblique sagittal image in a patient with profound sensorineural hearing loss shows a dilated vestibular aqueduct (arrow).

 

View larger version (155K): [in a new window]   Figure 10b.  Single-oblique sagittal view through the vestibular aqueduct. (a) Orthogonal axial reference image shows the plane of reconstruction (white line), which includes the medial wall of the vestibule and the vestibular aqueduct. (b) Single-oblique sagittal image shows the spatial orientation of the normal vestibular aqueduct (VA), which enters the vestibule just anterior and medial to the opening of the common crus (CC). (c) Single-oblique sagittal image in a patient with profound sensorineural hearing loss shows a dilated vestibular aqueduct (arrow).

 

View larger version (165K): [in a new window]   Figure 10c.  Single-oblique sagittal view through the vestibular aqueduct. (a) Orthogonal axial reference image shows the plane of reconstruction (white line), which includes the medial wall of the vestibule and the vestibular aqueduct. (b) Single-oblique sagittal image shows the spatial orientation of the normal vestibular aqueduct (VA), which enters the vestibule just anterior and medial to the opening of the common crus (CC). (c) Single-oblique sagittal image in a patient with profound sensorineural hearing loss shows a dilated vestibular aqueduct (arrow).

 

View larger version (173K): [in a new window]   Figure 11a.  Double-oblique sagittal view of the facial nerve canal. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows normal anatomy of the tympanic (FNt) and mastoid (FNm) segments of the facial nerve canal, the lateral semicircular canal (LSC), and the tensor tympani (TT) muscle. (d) Double-oblique sagittal image in a child with CHARGE syndrome shows the inferior location of an aberrant tympanic segment of the facial nerve canal (arrow) and the absence of the lateral semicircular canal, which should appear immediately superior to the facial nerve canal. (e) Double-oblique sagittal image in another patient shows a remote complex temporal bone fracture (arrow) that transects the tympanic facial nerve canal (arrowhead).

 

View larger version (174K): [in a new window]   Figure 11b.  Double-oblique sagittal view of the facial nerve canal. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows normal anatomy of the tympanic (FNt) and mastoid (FNm) segments of the facial nerve canal, the lateral semicircular canal (LSC), and the tensor tympani (TT) muscle. (d) Double-oblique sagittal image in a child with CHARGE syndrome shows the inferior location of an aberrant tympanic segment of the facial nerve canal (arrow) and the absence of the lateral semicircular canal, which should appear immediately superior to the facial nerve canal. (e) Double-oblique sagittal image in another patient shows a remote complex temporal bone fracture (arrow) that transects the tympanic facial nerve canal (arrowhead).

 

View larger version (177K): [in a new window]   Figure 11c.  Double-oblique sagittal view of the facial nerve canal. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows normal anatomy of the tympanic (FNt) and mastoid (FNm) segments of the facial nerve canal, the lateral semicircular canal (LSC), and the tensor tympani (TT) muscle. (d) Double-oblique sagittal image in a child with CHARGE syndrome shows the inferior location of an aberrant tympanic segment of the facial nerve canal (arrow) and the absence of the lateral semicircular canal, which should appear immediately superior to the facial nerve canal. (e) Double-oblique sagittal image in another patient shows a remote complex temporal bone fracture (arrow) that transects the tympanic facial nerve canal (arrowhead).

 

View larger version (154K): [in a new window]   Figure 11d.  Double-oblique sagittal view of the facial nerve canal. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows normal anatomy of the tympanic (FNt) and mastoid (FNm) segments of the facial nerve canal, the lateral semicircular canal (LSC), and the tensor tympani (TT) muscle. (d) Double-oblique sagittal image in a child with CHARGE syndrome shows the inferior location of an aberrant tympanic segment of the facial nerve canal (arrow) and the absence of the lateral semicircular canal, which should appear immediately superior to the facial nerve canal. (e) Double-oblique sagittal image in another patient shows a remote complex temporal bone fracture (arrow) that transects the tympanic facial nerve canal (arrowhead).

 

View larger version (183K): [in a new window]   Figure 11e.  Double-oblique sagittal view of the facial nerve canal. (a, b) Orthogonal axial (a) and coronal (b) reference images show the plane of reconstruction (white line). (c) Double-oblique sagittal image shows normal anatomy of the tympanic (FNt) and mastoid (FNm) segments of the facial nerve canal, the lateral semicircular canal (LSC), and the tensor tympani (TT) muscle. (d) Double-oblique sagittal image in a child with CHARGE syndrome shows the inferior location of an aberrant tympanic segment of the facial nerve canal (arrow) and the absence of the lateral semicircular canal, which should appear immediately superior to the facial nerve canal. (e) Double-oblique sagittal image in another patient shows a remote complex temporal bone fracture (arrow) that transects the tympanic facial nerve canal (arrowhead).

 

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