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Localized Pericochlear Hypoattenuating Foci at Temporal-Bone Thin-Section CT in Pediatric Patients: Nonpathologic Differential Diagnostic Entity?¹

¹ From the Departments of Radiology (J.P., S.R.) and Oto-Rhino-Laryngology (A.P.), Helsinki University Hospital, Haartmaninkatu 4, POB 340, FIN-00029 HUS, Finland; Departments of Oto-Rhino-Laryngology (A.J., W.D.B.) and Radiology (C.C., S.R.), Vienna University Hospital, Vienna, Austria; and Department of Health and Disability, National Public Health Institute of Finland, Helsinki (M.H.). Received September 1, 2002; revision requested November 9; final revision received May 23, 2003; accepted June 9. Address correspondence to J.P. (e-mail: johanna.pekkola@hus.fi).

View larger version (159K): [in a new window]   Figure 1a. Images obtained as part of the preoperative work-up for cochlear implantation in a girl aged 2 years 2 months with Jervell and Lange-Nielsen syndrome. (a) Transverse thin-section CT image at the level of the right oval window. Localized hypoattenuating area (arrow in a and c) that resembles the lesions of otosclerosis is anterior to the oval window. There is no expansion or encroachment of the oval window margin. (b) Coronal reconstruction image in the plane of the right oval window (arrow). Oval window area is intact. (c) Coronal reconstruction image in a plane anterior to the right oval window. The hypoattenuating focus is anterior to the oval window and curves slightly, which corresponds to the form of the cochlea.

View larger version (158K): [in a new window]   Figure 1b. Images obtained as part of the preoperative work-up for cochlear implantation in a girl aged 2 years 2 months with Jervell and Lange-Nielsen syndrome. (a) Transverse thin-section CT image at the level of the right oval window. Localized hypoattenuating area (arrow in a and c) that resembles the lesions of otosclerosis is anterior to the oval window. There is no expansion or encroachment of the oval window margin. (b) Coronal reconstruction image in the plane of the right oval window (arrow). Oval window area is intact. (c) Coronal reconstruction image in a plane anterior to the right oval window. The hypoattenuating focus is anterior to the oval window and curves slightly, which corresponds to the form of the cochlea.

View larger version (113K): [in a new window]   Figure 1c. Images obtained as part of the preoperative work-up for cochlear implantation in a girl aged 2 years 2 months with Jervell and Lange-Nielsen syndrome. (a) Transverse thin-section CT image at the level of the right oval window. Localized hypoattenuating area (arrow in a and c) that resembles the lesions of otosclerosis is anterior to the oval window. There is no expansion or encroachment of the oval window margin. (b) Coronal reconstruction image in the plane of the right oval window (arrow). Oval window area is intact. (c) Coronal reconstruction image in a plane anterior to the right oval window. The hypoattenuating focus is anterior to the oval window and curves slightly, which corresponds to the form of the cochlea.

View larger version (180K): [in a new window]   Figure 2a. Transverse thin-section CT images obtained in a boy aged 6 years 1 month with auricular and external canal malformations. The ossicles are deformed and located abnormally, and the floor of the middle cranial fossa is flattened. (a) Image at the level of the left round window. Area of the fissula ante fenestram shows a hypoattenuating focus (arrow in a and c) that is slightly triangular. (b) Image at the level of the left oval window. Hypoattenuating focus does not extend up to the level of the oval window. (c) Coronal reconstruction image anterior to the left oval window. Hypoattenuating area is longitudinal and below the oval window.

View larger version (177K): [in a new window]   Figure 2b. Transverse thin-section CT images obtained in a boy aged 6 years 1 month with auricular and external canal malformations. The ossicles are deformed and located abnormally, and the floor of the middle cranial fossa is flattened. (a) Image at the level of the left round window. Area of the fissula ante fenestram shows a hypoattenuating focus (arrow in a and c) that is slightly triangular. (b) Image at the level of the left oval window. Hypoattenuating focus does not extend up to the level of the oval window. (c) Coronal reconstruction image anterior to the left oval window. Hypoattenuating area is longitudinal and below the oval window.

View larger version (127K): [in a new window]   Figure 2c. Transverse thin-section CT images obtained in a boy aged 6 years 1 month with auricular and external canal malformations. The ossicles are deformed and located abnormally, and the floor of the middle cranial fossa is flattened. (a) Image at the level of the left round window. Area of the fissula ante fenestram shows a hypoattenuating focus (arrow in a and c) that is slightly triangular. (b) Image at the level of the left oval window. Hypoattenuating focus does not extend up to the level of the oval window. (c) Coronal reconstruction image anterior to the left oval window. Hypoattenuating area is longitudinal and below the oval window.