Pedro Augusto Gondim Teixeira’s research while affiliated with Diagnosis and International Adaptive Imaging and other places

Background and purpose To evaluate various anatomical parameters and their relationship to chorda tympani nerve (CTN) injury and round window (RW) access during cochlear implantation. Materials and methods Ultra-high-resolution CT images of 66 patients were retrospectively reviewed and compared with operative reports. The facial recess and the round window were analyzed, mainly using the chorda-facial angle (CFA), the width of the facial recess, the CTN-tympanic annulus distance, the RW-mastoid portion of the facial nerve angle, and the type of RW. Results Surgical management of the CTN was uneventful in 59 patients, whereas surgical difficulty occurred in 7, with significant differences only between the CTN-tympanic annulus distance and the RW-mastoid portion of the facial nerve angle (P ≤ 0.04). The optimal cut-off values for predicting surgical difficulty were 0.95 mm and 19°, respectively, with sensitivity, specificity, positive, and negative predictive values of 0.71, 0.67, 0.2 and 0.95 for the distance, and 0.57, 0.95, 0.57 and 0.94 for the angle, respectively. The RW was accessible in 51 patients and cochleostomy was performed in 15 patients, without significant difference between radiological parameters, especially concerning the CFA. Conclusion A CTN-tympanic annulus distance greater than 0.95 mm may help to predict a non-negligible risk of CTN surgical damage, and a RW thinner than 1.85 mm may require exploring the possibility of a cochleostomy approach.

Background We evaluated the accuracy of magnetic resonance imaging (MRI) computed tomography (CT)-like sequences compared to normal-resolution CT (NR-CT) and super-high-resolution CT (SHR-CT) for planning of cochlear implantation. Methods Six cadaveric temporal bone specimens were used. 3-T MRI scans were performed using radial volumetric interpolated breath-hold (STARVIBE), pointwise-encoding time reduction with radial acquisition (PETRA), and ultrashort time of echo (UTE) sequences. CT scans were performed on two scanners for SHR-CT and NR-CT acquisitions. Two radiologists evaluated accuracy based on preimplantation metrics and the ability to identify various anatomical structures, particularly the facial recess and round window. Wilcoxon rank-sum test and intraclass correlation coefficient (ICC) were used. Results The facial nerve was always clearly visible (score ≥ 2) in the MRI, NR-CT, and SHR-CT scans ( p ≥ 0.621). However, the chorda tympani nerve (CTN) was clearly visualized in UTE, STARVIBE, and PETRA sequences in only 33% (2/6 specimens, p = 0.016), 50% (3/6 specimens, p = 0.038), and 83% (5/6 specimens, p = 0.017) of cases, respectively, whereas it was always clearly visualized in SHR and NR-CT ( p = 0.426). The round window (RW) was never visualized in MRI sequences ( p ≤ 0.010), whereas it was identified in all cases in SHR and NR-CT ( p = 1.000). There was a strong correlation between measurements obtained from MRI and CT modalities (ICC ≥ 0.837). Conclusion MRI CT-like sequences assessed the facial nerve in all cases and the CTN in up to 87% of cases. However, the detection of the RW was insufficient for surgical planning. CT and MRI measurements were in agreement. Relevance statement CT-like MRI sequences can image the anatomy of the facial recess and the length of the basal turn of the cochlea with similar accuracy as conventional CT, although they cannot image the round window. Key Points CT-like MRI sequences are not widely used in preoperative cochlear implantation imaging. CT-like sequences can image the facial recess as well as conventional CT. CT-like sequences can image the basal turn length of the cochlea as well as conventional CT. Round window depiction is not possible with CT-like MRI sequences. Graphical Abstract

Objective(s) To determine the accuracy of conventional and diffusion‐weighted (DWI) MRI for the differential diagnosis between mucopyocele and mucocele using surgical diagnosis as a reference. Methods This retrospective study included patients referred to our institution between March 2017 and February 2024 for paranasal sinus MRI to characterize an expansile non‐enhanced sinus filling on CT. The T1 and T2 signal intensities were recorded, as well as the presence of restriction diffusion, of the penumbra sign, the double rim sign, and the presence of parietal micro‐abscesses. Quantitative apparent diffusion coefficient values were also recorded. Results The study included 74 patients aged 18 to 88 years (mean age: 60.4 ± 17.7 years). Of these, 43 had a mucopyocele and 31 had a mucocele. The T1 high signal intensity was different amongst groups as an hypersignal was present in 35.5% of mucoceles and only 4.7% of mucopyoceles ( p = 0.02). The T2 signal did not differ between the two groups ( p = 0.59). The double rim sign and the presence of parietal micro‐abscesses demonstrated 96.8% and 100% specificities, respectively, but were predominantly located in the maxillary sinus. The penumbra sign exhibited a sensitivity of 60.5% and a specificity of 67.7%. All mucopyoceles exhibited a diffusion restriction with an apparent diffusion coefficient of less than 0.78 × 10–3 mm ² /s. Conclusion DWI is the most useful MRI tool for the accurate differential diagnosis between mucopyocele and mucocele in non‐enhanced sinus fillings. Level of Evidence III (case–control study) Laryngoscope , 2024

Objective Our study aims to quantitatively determine the concavity of the glenoid articular surface in patients with hypermobile shoulders compared to those without. Method We examined medical records of shoulder CTs from 2017 to 2022, selecting 50 patients with clinical signs of joint hypermobility for our case group and 54 for our control group. Two blinded readers independently assessed the glenoid morphology, calculating the glenoid concavity angle (GCA) and evaluating the articular surface shape as concave, flat, or convex. They also recorded the presence and severity of glenoid dysplasia. We compared these assessments between groups. Results The mean GCA was significantly lower in the hypermobile group (2.3 ± 3.7° and 2.3 ± 3.8°) versus controls (6.6 ± 3.3° and 5.3 ± 3.8°) (P < 0.05). Interobserver reproducibility was high (ICC=0.76). A stark difference in glenoid morphology was noted between groups (P < 0.001), with a majority of hypermobile patients having a flat or convex glenoid. GCAs decreased with increasing shoulder laxity and dysplasia. GCA showed 77–81 % sensitivity and 55–82 % specificity for detecting shoulder hyperlaxity with a 4° cutoff. Conclusion There is a significant association between GCA and shoulder hyperlaxity, demonstrating diagnostic efficacy and substantial interobserver agreement. Clinical Relevance GCA values lower than 4° warrant further clinical investigation for shoulder hyperlaxity and associated conditions, which is crucial for patient treatment planning.

Purpose To retrospectively identify clinical, pathologic, or imaging factors predictive of local relapse (LR) after preoperative radiotherapy (RT) for soft tissue sarcomas (STS). Methods and Materials This is a retrospective multicenter study of patients who underwent preoperative RT and surgery for limb or trunk wall STS between 2007 and 2018 in French Sarcoma Group centers and were enrolled in the “Conticabase”. Patterns of LR were investigated taking into account the multimodal response after preoperative RT. Diagnostic and surgical samples were compared after systematic review by expert pathologists and patients were stratified by tumor grade. Log-rank tests and Cox models were used to identify prognostic factors for radiation response and LR. Results 257 patients were included; 17 % had low-grade (LG), 72.5 % had high-grade (HG) sarcomas. In HG group, tumors were larger, mostly undifferentiated, and displayed more necrosis and perilesional edema after RT. Median follow-up was 32 months. Five-year cumulative incidence of LR was 20.3 % in the HG group versus 9.7 % in the LG group (p = 0.026). In multivariate analysis, trunk wall location (HR 6.79, p = 0.012) and proportion of viable tumor cellularity ≥ 20 % (HR 3.15, p = 0.018) were associated with LR. After adjusting for tumor location, combination of histotype and cellularity rate significantly correlated with LR. We described three prognostic subgroups for HG sarcomas, listed from the highest to lowest risk: undifferentiated sarcoma (US) with cellularity rates ≥ 20 %; non-US (NUS) with cellularity rates ≥ 20 % or US with cellularity rates < 20 %; and NUS with cellularity rates < 20 %, which shared similar prognostic risks with LG sarcomas. Conclusions HG and LG tumors have different morphological and biological behaviors in response to RT. Combination of cellularity rate with histotype could be a major prognostic for LR. Patients with undifferentiated HG sarcomas with cellularity rates ≥ 20 % after preoperative RT had the highest risk of LR and disease-specific death.

To evaluate the prevalence of shoulder adhesive capsulitis (AC) signs on MR studies of patients with various common shoulder conditions. MR images of 316 patients were retrospectively evaluated. Patients were divided into three groups: controls (66 patients), clinical AC (63 patients), and study group (187 patients). The final diagnosis of AC was reached clinically. The study group was composed of patients with focal and massive rotator cuff tears, active hydroxyapatite deposition disease, fractures around the shoulder, and post-surgery. The following AC signs were evaluated: inferior glenohumeral ligament (IGHL) thickening; coracohumeral ligament (CHL) thickening; and hyperintensity of the inferior glenohumeral ligament, which was graded in four classes. The IGHL signal intensity was statistically higher in patients with fractures than in controls (P = 0.008). There was no statistically significant difference in IGHL signal between the AC group and patients with massive rotator cuff tears and active hydroxyapatite deposition disease (P > 0.1). IGHL thickness in patients with fractures, massive rotator ruptures, and active hydroxyapatite deposition disease was significantly higher compared to controls (P < 0.02) and significantly lower compared to the AC group (P < 0.0001). Based on these findings, a grading system for fibro-inflammatory capsular changes is proposed. MR AC signs are frequent in patients with shoulder conditions other than AC; however, in these patients, capsular changes are less prominent than in patients with clinical AC.

Background, aims: Stapes footplate thickness measurement using ultra-high-resolution CT has been described only in the lateral semicircular canal plane. The purpose of this study was to compare stapes footplate thickness between the lateral semicircular canal and stapes axial planes in patients with otosclerosis compared to controls. Material and methods: We performed a retrospective single-center study of patients undergoing high-resolution temporal bone CT. Two radiologists measured stapes footplate thickness in both the lateral semicircular canal and stapes axial planes. Results: Between February 2020 and October 2022, we collected 81 ears from 49 patients (75% of women; mean age 51.22 ± 16.6 years, 17 otosclerosis, and 64 controls). In the stapes axial plane, there was a significant anterior thickening in otosclerosis patients (Reader 1: 0.52 ± 0.12 [0.3-0.7] vs. 0.41 ± 0.08 [0.3-0.6], p = 0.001; Reader 2: 0.54 ± 0.06 [0.5-0.7] vs. 0.39 ± 0.08 [0.2-0.6], P < 0.001) compared to controls. These differences were not significant using the lateral semicircular canal plane. Conclusion: The stapes footplate was thickened at its AC in otosclerosis patients using only the stapes axial plane. Significance: We propose to use the stapes axial plane instead of the lateral semicircular canal plane when analyzing the stapes.

Purpose: To compare image quality and radiation exposure between super- and ultra-high-resolution helical and super-high-resolution volumetric CT of the temporal bone. Methods: Six cadaveric temporal bone specimens were used to evaluate key temporal bone structures using the following CT reconstruction and acquisition modes: helical and single-volume acquisition modes in super-high resolution (0.25-mm slice thickness, 1024 ² matrix), and helical mode in ultra-high resolution (0.25-mm slice thickness, 2048 ² matrix). Two observers performed 5 previously described preoperative measurements, measured noise and signal-to-noise ratios for air, and noise for bone, and rated the visualization of 5 anatomical structures on a 4-point scale, for each reconstruction mode. Radiation dose exposure was recorded for each examination. Results: There was no significant difference between any of the quantitative or qualitative measurements in any of the reconstruction and acquisition modes. There was a slight increase in noise and a decrease in signal-to-noise ratio in the air using the single-volume mode (115 ± 13.1 HU and 8.37 ± 0.91, respectively) compared to the helicoidal super-high-resolution (92.4 ± 11.8 HU and 10.8 ± 1.26, respectively) and helicoidal ultra-high-resolution (91.1 ± 10.7 HU and 10.9 ± 1.39, respectively) modes ( P < .002). The volumic CT dose index was 50.9 mGy with helical acquisition and 29.8 mGy with single-volume acquisition mode ( P < .0001). Conclusion: The single-volume super-high-resolution acquisition mode allows a reduction in radiation dose exposure without compromising image quality compared to helical scanning, but with a slightly lower signal-to-noise ratio in air with the single-volume mode, while there was no difference in image quality between the helical super- and ultra-high-resolution modes.