John Ignatius Lane

Mayo Clinic - Rochester · Department of Radiology

Objective: To examine patient preference after stapedotomy versus cochlear implantation in a unique case of a patient with symmetrical profound mixed hearing loss and similar postoperative speech perception improvement. Patients: An adult patient with bilateral symmetrical far advanced otosclerosis, with profound mixed hearing loss. Interventio...

Objective: To describe the rare process of osteolytic labyrinthitis, previously referred to as labyrinthine sequestrum, which involves progressive obliteration of the bony and membranous labyrinth with eventual supplantation with soft tissue and, in some cases, bony sequestrum. Patients: Three patients with diverse presentations of osteolytic la...

Noninvasive tumor control of vestibular schwannomas through stereotactic radiosurgery allows high rates of long-term tumor control and has been used primarily for small- and medium-sized vestibular schwannomas. The posttreatment imaging appearance of the tumor, temporal patterns of growth and treatment response, as well as extratumoral complication...

Objectives: A small number of cochlear implant (CI) users experience facial nerve stimulation (FNS), which can manifest as facial twitching. In some patients, this can be resolved by adjusting the electrical stimulation parameters. However, for others, facial stimulation can significantly impair CI outcomes or even prevent its use. The exact mecha...

Background and Purpose The vestibular ganglion, or Scarpa’s ganglion, is a cluster of afferent vestibular neurons within the internal auditory canal (IAC). There is minimal literature describing enhancement of this region on magnetic resonance imaging (MRI) and its correlation to clinical symptoms. Here, we sought to find the prevalence of enhancem...

Background Superior semicircular canal dehiscence (SSCD), an osseous defect overlying the SSC, is associated with a constellation of audiovestibular symptoms. This study sought to compare conventional energy-integrated detector (EID) computed tomography (CT) to photon-counting detector (PCD)-CT in the detection of SSCD. Material and Methods Includ...

BACKGROUND Neurofibromatosis type 2-related schwannomatosis (NF2) is an autosomal dominant tumor-predisposition syndrome characterized by bilateral vestibular schwannomas (VS) as well as other nervous system tumors. Management decisions for NF2-related VS are typically predicated on tumor size, associated symptoms, patient age, and comorbidities. O...

Background and purpose: Anecdotally, postcontrast FLAIR images of vestibular schwannomas can show peritumoral hyperintense signal, hypothesized to represent gadolinium extravasation. This study assessed the incidence of this phenomenon in a cohort of patients with treatment-naïve sporadic vestibular schwannomas. Materials and methods: A retrospe...

Objective: To evaluate the magnetic resonance (MR) image artifact and image distortion associated with the two transcutaneous bone conduction implants currently available in the United States. Study design: Cadaveric study. Methods: Two cadaveric head specimens (1 male, 1 female) were unilaterally implanted according to manufacturer guidelines...

Background: Intra-osseous vessels are normal anatomic structures in the calvarium and skull base. On imaging, these structures-particularly venous lakes-can mimic pathologic abnormalities. This study sought to assess the prevalence of veins and lakes in the skull base on MRI. Materials and methods: A retrospective review was completed of consecu...

Objective: To describe the development, implementation, and validation of a radiology-administered protocol to obtain magnetic resonance imaging (MRI) in patients with cochlear implants and auditory brainstem implants without magnet removal. Study design: Retrospective review and description of novel care pathway. Methods: A radiology-administ...

Objective: To report 20 years of natural history data for a facial paraganglioma and provide a comprehensive review of the existing literature. Patient: 81-year-old female with a remote history of cardiac arrest while under anesthesia who elected to observe her facial paraganglioma for 20 years. Interventions: Observation, clinical documentati...

OBJECTIVE Preoperative differentiation of facial nerve schwannoma (FNS) from vestibular schwannoma (VS) can be challenging, and failure to differentiate between these two pathologies can result in potentially avoidable facial nerve injury. This study presents the combined experience of two high-volume centers in the management of intraoperatively d...

Background and purpose: Artifact from cochlear implant electrodes degrades image resolution on CT. Here, we describe the use of coregistered pre- and postoperative CT images to reduce metallic artifact from the electrodes to assess its position more accurately within the cochlear lumen. Methods: Pre- and postoperative CTs were reviewed after cor...

Background and purpose: Vestibular schwannomas are benign, generally slow-growing tumors, commonly presenting with hearing loss. Alterations in the labyrinthine signal are seen in patients with vestibular schwannoma; however, the association between imaging abnormalities and hearing function remains poorly defined. The purpose of this study was to...

Background and purpose: There is limited discussion in current literature about the normal imaging appearance of the round window. The purpose of this study was to assess the prevalence and imaging characteristics of gadolinium enhancement in the round window niche on MR imaging to the internal auditory canal. Materials and methods: The presence...

Purpose Congenital absence of the stapedial tendon is a rare entity with characteristic imaging findings, which can go unrecognized due the scarcity of the diagnosis and limited previous description in the imaging literature. We aim to characterize the imaging features of this entity. Methods A series of 9 cases with surgical confirmation of stape...

Objective: Large vestibular aqueduct (LVA) is the most common inner ear dysplasia identified in patients with hearing loss. Our objective was to systematically quantify LVA morphologies and correlate imaging findings with established audiometric outcomes. Study design: Retrospective review. Setting: Tertiary referral center. Patients: Patien...

Objective To characterize normative adult ranges for cochlear promontory thickness relevant to the development of subendosteal and transpromontory electrodes to rehabilitate various neurotologic disorders. Patients Adults (≥18 years). Intervention In vivo radiologic assessment using a 192‐slice CT scanner (Force‐192; Siemens Healthcare) with ultr...

Temporal bone anatomy is highly complex, with a complicated configuration of minute anatomic structures housed in a dense osseous structure. Nevertheless, a robust understanding of this anatomy is essential for clinicians, who must accurately diagnose and describe the various pathologies that exist in this region. In this article, we provide a comp...

Background and purpose: The normal appearance of the vestibular aqueduct on postcontrast MR images has not been adequately described in the literature. This study set out to characterize the expected appearance of the vestibular aqueduct, with particular emphasis on the enhancement of the structure on both 3D FSE T1 and 3D-FLAIR sequences. Materi...

Background and Purpose After cochlear implantation, metallic artifact can obscure nearby structures on CT images, which is problematic in patients with facial nerve stimulation (FNS). This study evaluated the usefulness of co-registered pre- and post-operative examinations to evaluate the cochlear implant and adjacent structures. Materials and Met...

Background and purpose: Photon-counting detector CT is a new technology with a limiting spatial resolution of ≤150 μm. In vivo comparisons between photon-counting detector CT and conventional energy-integrating detector CT are needed to determine the clinical impact of photon counting-detector CT in temporal bone imaging. Materials and methods:...

Standard clinical protocols require hearing protection during magnetic resonance imaging (MRI) for patient safety. This investigation prospectively evaluated the auditory function impact of acoustic noise exposure during a 3.0T MRI in healthy adults. Twenty-nine participants with normal hearing underwent a comprehensive audiologic assessment before...

Objective Describe the presentation and management strategy for patients with symptomatic foramen of Huschke (FH). Patients Adults with persistent FH confirmed on imaging. Interventions Diagnosis and management of symptomatic persistent FH. Main outcome measure Resolution of otologic symptoms. Results A total of four patients with symptomatic,...

Objective The differential of an external auditory canal mass is broad. One rare potential cause is a pneumatocele of the tympanic membrane, which has only been described 1 other time in the literature. This report serves to describe the second case of this pathology, including its unique presentation, and benign clinical course. Methods Case repo...

Objective Report an association between congenital stapes footplate fixation (CSFF) and radiological absence of the pyramidal eminence. Patients Children and adults with intraoperatively confirmed CSFF and an absent stapedial tendon. Interventions Computed tomography (CT); exploratory tympanotomy with stapedotomy. Main outcome measures Absence o...

Since the relatively recent regulatory approval for clinical use in both Europe and North America, 7-Tesla (T) MRI has been adopted for clinical practice at our institution. Based on this experience, this article reviews the unique features of 7-T MRI neuroimaging and addresses the challenges of establishing a 7-T MRI clinical practice. The underly...

Objective Spontaneous otogenic pneumatocele is a rare entity resulting from a pressure gradient between a dehiscent temporal bone and the intracranial space. Secondary infection can ensue in patients with concurrent otomastoiditis. The current study discusses the clinical presentation and imaging characteristics of two cases of secondarily infected...

Background and purpose: Although multishot EPI (readout-segmented EPI) has been touted as a robust DWI sequence for cholesteatoma evaluation, its efficacy in disease detection compared with a non-EPI (eg, HASTE) technique is unknown. This study sought to compare the accuracy of readout-segmented EPI with that of HASTE DWI in cholesteatoma detectio...

Postoperative temporal bone imaging after surgical procedures such as ossiculoplasty, tympanomastoidectomy, cochlear implantation, and vestibular schwannoma resection is often encountered in clinical neuroradiology practice. Less common otologic procedures can present diagnostic dilemmas, particularly if access to prior operative reports is not pos...

Persistent stapedial artery is a vascular anomaly with both clinical and surgical implications. Because of its scarcity, however, it remains underrecognized on imaging. Presented here is a series of 10 cases, demonstrating characteristic CT findings associated with this vascular anomaly and its most common pathognomonic imaging signs. The variable...

Background: Fusion of diffusion-weighted imaging (DWI) to computed tomography (CT) has been touted as a possible technique to improve cholesteatomas localization. This study set out to assess the ability of DWI images fused with thin-slice heavily T2-weighted images to similarly localize surgically-confirmed cholesteatomas. Materials and methods:...

Objective: To evaluate adverse events and feasibility of performing 1.5-T MRI in patients with cochlear implants (CI) and auditory brainstem implants (ABI). Setting: Single tertiary academic referral center. Patients: CI and ABI recipients undergoing 1.5-T MRI without internal magnet removal. Intervention(s): MRI after tight headwrap applica...

MRI is firmly established as an essential modality in the imaging of the temporal bone and lateral skull base. It is used to evaluate normal anatomic structures, evaluate for vestibular schwannomas, assess for inflammatory and/or infectious processes, and detect residual and/or recurrent cholesteatoma. It is also extensively used in pre- and postop...

Objectives: To evaluate blood-labyrinth barrier permeability using delayed gadolinium enhanced three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) in patients with untreated sporadic vestibular schwannoma (VS) to interrogate the etiopathogenesis of progressive sensorineural hearing loss. Design: Prospective case series. Setting: S...

Objective Although granulomatosis with polyangiitis (GPA; Wegener’s granulomatosis) is classically characterized by systemic disease involving the kidneys and airway, approximately 10% of patients who have it present with isolated central nervous system disease. When involving the skull base, GPA frequently mimics more common pathology, resulting i...

Objective: The incidence of sporadic vestibular schwannoma (VS) has increased significantly over recent decades. The rising incidence of VS has been largely attributed to the increasing use of magnetic resonance imaging (MRI), especially with regard to incidentally diagnosed tumors. However, no study to date has directly investigated this supposed...

The round window serves to decompress acoustic energy that enters the cochlea via stapes movement against the oval window. Any inward motion of the oval window via stapes vibration leads to outward motion of the round window. Occlusion of the round window is a cause of conductive hearing loss because it increases the resistance to sound energy and...

Temporal bone microanatomy is a common source of consternation for radiologists. Serpentine foramina, branching cranial nerves, and bony canals containing often clinically relevant but often miniscule arterial branches may all cause confusion, even among radiologists familiar with temporal bone imaging. In some cases, the tiniest structures may be...

Objective: IgG4-related disease (IgG4-RD) is a recently recognized disease characterized by fibroinflammatory infiltrates rich in IgG4+ plasma cells that can present as isolated tumor-like lesions of the head and neck. The objective of the current study was to describe the cranial base manifestations of IgG4-RD. Methods: Review of all cases at t...

http://www.ajnr.org/content/com/2019dec AUTO-EVACUATED SECONDARY ACQUIRED CHOLESTEATOMA A 59-year-old man presented for evaluation of right medically refractory otorrhea and right TM perforation at attic. Background: Cholesteatoma (of the middle ear/mastoid): squamous epithelium in the middle ear or mastoid; desquamation results in continued acc...

Background and purpose: Temporal lobe encephaloceles are increasingly identified and treated as epileptogenic foci. However, there is relatively scant research on the prevalence of asymptomatic encephaloceles. This study set out to describe the frequency of incidental temporal lobe encephaloceles and middle cranial fossa pits. Materials and metho...

Objective: The aim of this study was to quantitatively demonstrate radiation dose reduction for sinus and temporal bone examinations using high-resolution photon-counting detector (PCD) computed tomography (CT) with an additional tin (Sn) filter. Materials and methods: A multienergy CT phantom, an anthropomorphic head phantom, and a cadaver head...

Forced exhalation against a closed glottis, known as the Valsalva maneuver, is an important clinical diagnostic and therapeutic tool due to its physiologic effects. Several unique conditions and anatomic changes can occur with repetitive or acute changes in pressure from the Valsalva maneuver. We will discuss and review various pertinent head and n...

Importance Preoperative assessment of nasal soft-tissue envelope (STE) thickness is an important component of rhinoplasty that presently lacks validated tools. Objective To measure and assess the distribution of nasal STE thickness in a large patient population and to determine if facial plastic surgery clinicians can predict nasal STE thickness b...

Objective: The etiology of sensorineural hearing loss (SNHL) in patients with jugular paraganglioma (JP) whose tumors lack inner ear fistulae or vestibulocochlear nerve involvement is unknown. Recent literature has proposed that occlusion of the inferior cochlear vein may be causative. Herein, we assess the association between radiologic involveme...

Background and purpose: The prevalence of patent facial nerve canals and meningoceles along the facial nerve course is unknown. This study aimed to assess the frequency of such findings in asymptomatic patients. Materials and methods: A retrospective review was completed of patients with high-resolution MR imaging of the temporal bone whose clin...

Objective The purpose of this article was to provide a combined pathologic and radiologic review of previous pathologically diagnosed facial nerve “hemangiomas” to confirm that these lesions are most characteristic of venous malformations rather than neoplasms. Study Design Retrospective radiologic, clinical, and histopathologic review of all pati...

Objectives To present a rare case of traumatic facial neuroma involving the geniculate ganglion and review relevant literature. Patient Thirty-year-old man. Intervention Microsurgical resection via combined mastoid-middle fossa approach with great auricular nerve interpositional graft. Main Outcome Measures Patient demographics and pre- and postope...

Objectives/Hypothesis To investigate the prevalence and course of cochlear obliteration according to microsurgical approach to inform clinical decision making regarding optimal timing of cochlear implantation. Study Design Retrospective radiologic review and chart review. Methods Patients who underwent microsurgical resection of vestibular schwan...

Background: Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis. Up to 50% of patients develop central nervous system involvement, and a subset of these patients can present with isolated tumor-like masses. Objective: To describe the skull base manifestations of ECD with an emphasis on aspects most pertinent to surgeons wh...

Purpose: To examine the etiology, clinical course, and management of recurrent peripheral facial nerve paralysis. Methods: Retrospective review at a single tertiary academic center and systematic review of the literature. Clinical presentation, laboratory and imaging findings, treatment and outcome for all cases of recurrent ipsilateral, recurre...

Objective/background: We have anecdotally observed patients with high-flow ventral cerebrospinal fluid (CSF) leaks resulting from penetrating osseous spicules or calcified discs to be relatively thin. The purpose of this study was to explore the validity of this observation and determine if a potential association exists between low body mass inde...

Background and purpose: Bony internal auditory canal diverticula are relatively common, occurring in approximately 5% of temporal bone CTs. Internal auditory canal diverticula have historically been considered incidental; however, a recent publication reported that internal auditory canal diverticula are associated with sensorineural hearing loss....

Objectives: To highlight superior semicircular canal dehiscence (SSCD) involving the superior petrosal sinus (SPS), and to propose a novel classification system for SPS associated SSCD with potential surgical implications. Study design: Multicenter retrospective review. Setting: Three tertiary referral centers. Patients: All patients diagnos...

Objective To present a case of spontaneous cerebrospinal fluid (CSF) otorrhea from a fallopian canal meningocele involving the geniculate fossa and review all cases of fallopian canal CSF leak reported in the literature with discussion of management and outcomes. Methods A 53-year-old woman with history of morbid obesity and hypertension presented...

Background and purpose: Evaluating abnormalities of the temporal bone requires high-spatial-resolution CT imaging. Our aim was to assess the performance of photon-counting-detector ultra-high-resolution acquisitions for temporal bone imaging and compare the results with those of energy-integrating-detector ultra-high-resolution acquisitions. Mate...

Objective: Evaluate prevalence and pattern of occipital pneumatization (OP). Patients: Individuals with imaging evidence of OP on computed tomography (CT). Intervention(s): High resolution CT scans of the temporal bone. Main outcome measure: The prevalence and pattern of OP on 1000 CT scans performed at a large academic healthcare system. R...

Objective: To date, less than 150 cases of middle ear adenomatous neuroendocrine tumors (MEANTs) have been reported in the English literature. The objective of this study was to provide a contemporary analysis of these rare lesions and develop a consensus-driven staging system. Study design: Multi-institutional retrospective histopathologic, rad...

Objectives Primary skull base lymphoma (PSBL) represents a rare manifestation of extranodal lymphoma. Presenting with nonspecific symptomatology and imaging findings, PSBL often masquerades as more common cranial base pathology and thus can present a diagnostic challenge. The objectives of this study were to characterize the manifestations and clin...

Objective (1) Assess 3-dimensional volumetric growth of untreated sporadic vestibular schwannomas (VSs) in a large cohort of patients treated with conservative observation. (2) Compare volumetric and conventional linear diameter measurements for detecting tumor growth. Study Design Case series with chart review. Setting Tertiary skull base referr...

Objective: Non-contrast MRI of the internal auditory canal (IAC) using high-resolution T2WI has been proposed as the primary screening study in patients with sudden or asymmetric sensorineural hearing loss (ASNHL). However, there are concerns that non-contrast MRI may not detect labyrinthine pathology, specifically intralabyrinthine schwannomas (IL...

Background: Gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) (T1WI) is the conventional imaging technique of choice to detect vestibular schwannoma (VS) recurrence or regrowth, despite suboptimal specificity secondary to enhancing postoperative changes. Furthermore, recent concerns regarding the accumulation of gadolinium in body t...

Objective: To report the presentation, diagnosis, management, and convalescence of labyrinthine sequestrum (LS) and summarize all previously published cases. Patient(s): Eleven-year-old female with LS. Intervention(s): Multidisciplinary diagnostic evaluation and treatment. Main outcome measures: Imaging and laboratory findings, medical and s...

Objective: Non-contrast MRI of the internal auditory canal (IAC) using high-resolution T2WI (T2 weighted image) has been proposed as the primary screening study in patients with sudden or asymmetric sensorineural hearing loss (ASNHL). However, there are concerns that non-contrast MRI may not detect labyrinthine pathology, specifically intralabyrin...

Objectives: To compare the diagnostic yield of high-resolution volumetric T2-weighted MRI (HRT2-MRI) with high-resolution computed tomography (HRCT) for diagnosis of large vestibular aqueduct (LVA). Study design: Three board-certified neuroradiologists performed an independent, blinded radiological review for diagnosing LVA with 2:1 age-matched...

Hypothesis: A new generation 192-slice multi-detector computed tomography (MDCT) clinical scanner provides enhanced image quality and superior electrode localization over conventional MDCT. Background: Currently, accurate and reliable cochlear implant electrode localization using conventional MDCT scanners remains elusive. Methods: Eight fresh...

Objectives: To report a contemporary review from a single-institution series on Paget's disease of the temporal bone (PDTB). Study design: Retrospective chart review of patients evaluated from 1998 to 2016. Setting: Quaternary referral center. Patients: Patients with radiographically confirmed PDTB. Main outcome measures: Clinical, audiolo...

The anatomy of the temporal bone is complex, and diagnosis of middle ear disease can be challenging when based on CT or MR imaging. The radiologic differential diagnosis can be enhanced by knowing the clinical and otoscopic examination results, but, often, this information is not readily available to the radiologist. Otoscopic imaging provides info...

Objectives: To describe the clinical presentation, radiological features, and outcome of patients with plasmacytoma of the temporal bone. Methods: Multicenter retrospective case series of all patients diagnosed with plasmacytoma of the temporal bone between 1990 and 2015. Comprehensive literature review of all previously published cases. Result...

Objective: To describe a unique case of an asymptomatic arteriovenous lesion of the internal auditory canal (IAC) and present the associated imaging findings. Methods: Retrospective case report and review of the literature. Results: A 55-year-old man presented for further evaluation of a left-sided sudden sensorineural hearing loss that occurr...

An ultrahigh-resolution (UHR) data collection mode was enabled on a whole-body, research photon counting detector (PCD) computed tomography system. In this mode, 64 rows of [Formula: see text] detector pixels were used, which corresponded to a pixel size of [Formula: see text] at the isocenter. Spatial resolution and image noise were quantitatively...

Objective: Demonstrate the association of radiographic dural enhancement with increased tumor adherence at the porus acusticus, which may influence completeness of resection and facial nerve outcome. Study design: Case series with chart review. Setting: Academic referral center. Subjects and methods: A total of 205 consecutive patients with...

Objectives: To elucidate the clinical behavior, treatment, and outcomes of tenosynovial giant cell tumors (TGCT) involving the temporomandibular joint (TMJ) and adjacent temporal bone. Study design: Retrospective case series with histopathologic review. Methods: A retrospective chart review was performed identifying and collecting data from al...

The globe and ocular adnexa are complex structures that require a multimodality approach for optimal evaluation. High-resolution imaging with MR imaging can offer key information regarding extrascleral disease, perineural tumor spread, and intracranial involvement beyond the scope of other imaging modalities. We incorporated volumetric imaging into...

Objectives: The frequency of intratumoral hemorrhage (ITH) in vestibular schwannoma (VS) remains undefined. Methods: Retrospective case series of all patients diagnosed with hemorrhagic VS between 2003 and 2015 at a single tertiary academic skull base center. Results: Five patients with ITH were evaluated, representing 0.4% of all newly diagno...

Background/purpose: Brain herniation into presumed arachnoid granulations (BHAG) is an increasingly recognized entity. Though it has previously been described as isointense to brain matter on magnetic resonance imaging (MRI), we have encountered 21 cases in our clinical practice, many of which have signal abnormality in the herniated or adjacent p...

Objective: Estimate the prevalence of craniocervical pneumatization (CCP) and describe successful treatment of this condition with clinical and radiologic correlation. Patients: Individuals with documented CCP on computed tomography (CT). Intervention(s): CT scans of the head, temporal bone, face, neck, and cervical spine. Cessation of habitua...

A high-resolution (HR) data collection mode has been introduced to the whole-body, research photon-counting-detector CT system installed in our laboratory. In this mode, 64 rows of 0.45 mm × 0.45 mm detectors pixels were used, which corresponded to a pixel size of 0.225 mm × 0.225 mm at the iso-center. Spatial resolution of this HR mode was quantif...

Background and purpose: We adopted an imaging algorithm in 2011 in which extradural fluid on spinal MR imaging directs dynamic CT myelography. We assessed algorithm compliance and its effectiveness in reducing repeat or unnecessary dynamic CT myelograms. Materials and methods: CT myelograms for CSF leaks from January 2011 to September 2014 were...

Object: In the evaluation of spondylodiscitis, a number of factors are thought to contribute to the positive-predictive-value of spine biopsy including biopsy technique and equipment, number of sample obtained, timing of antibiotics, imaging findings and lab values. The purpose of this study was to examine which technical, MR imaging, laboratory a...

The computed tomography (CT) and MRI findings of infantile tumoral calcinosis and the utility of image-guided biopsy are demonstrated. A 5-month old presented with torticollis and a calcified cervical spinal mass. The radiologic appearance suggested a malignant neoplasm, prompting CT-guided biopsy, which diagnosed tumoral calcinosis. We hope to inc...