Introduction Otosclerosis is a primary osteodystrophy of the otic capsule, frequently responsible for acquired hearing loss in adults. Although the diagnostic value of imaging investigations in otosclerosis is debatable, they might still be employed with different goals within the context of the disease. Objectives The present paper aims to review the most recent literature on the use of imaging studies in otosclerosis for the most varied purposes, from routine application and differential diagnosis to prognostic prediction and investigation of surgical failure. Data Synthesis The diagnosis of otosclerosis is usually clinical, but computed tomography (CT) is paramount in particular cases for the differential diagnosis. The routine use, however, is not supported by strong evidence. Even so, there is growing evidence of the role of this method in surgical planning and prediction of postoperative prognosis. In specific scenarios, for example when superior semicircular canal dehiscence (SSCD) syndrome is suspected or in surgical failure, CT is crucial indeed. Magnetic resonance imaging (MRI), however, has limited – although important – indications in the management of individuals with otosclerosis, especially in the evaluation of postoperative complications and in the follow-up of medical treatment in active ostosclerosis. Conclusion Imaging studies have a broad range of well-established indications in otosclerosis. Besides, although the routine use of CT remains controversial, the most recent papers have shed light into new potential benefits of imaging prior to surgery.

The most common HRCT findings in our patient sample were air-space consolidation, small centrilobular nodules and ground-glass opacities, most often in the central and peripheral regions of the middle and lower lung zones.

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ObjectiveThe present study was aimed at evaluating the correlation between diffusion tensor imaging parameters and Loes score as well as whether those parameters could indicate early structural alterations.Materials and MethodsDiffusion tensor imaging measurements were obtained in 30 studies of 14 patients with X-linked adrenoleukodystrophy and were correlated with Loes scores. A control group including 28 male patients was created to establish agematched diffusion tensor imaging measurements. Inter- and intraobserver statistical analyses were undertaken.ResultsDiffusion tensor imaging measurements presented strong Pearson correlation coefficients (r) of –0.86, 0.89, 0.89 and 0.84 for fractional anisotropy and mean, radial and axial diffusivities (p < 0.01). Analysis of changes in diffusion tensor measurements at early stage of the disease indicates that mean and radial diffusivities might be useful to predict the disease progression.ConclusionMeasurements of diffusion tensor parameters can be used as an adjunct to the Loes score, aiding in the monitoring of the disease and alerting for possible Loes score progression in the range of interest for therapeutic decisions.

Introduction  The etiology of Ménière disease (MD), a difficult-to-treat condition with great morbidity, remains controversial in the literature. The possible clinical and diagnostic impact of anatomical variations of the temporal bone among patients with MD has been recently studied. Objective  To identify anatomical variations of the temporal bone associated with the diagnosis of MD. Methods  Thirty-seven patients were included, although each ear was considered separately ( n  = 74). A case group ( n A = 33) was composed of the affected ears of patients with definite MD and a control group ( n B = 41) was used consisting of the ears of individuals who did not meet the criteria for MD and of the contralateral ears from patients with unilateral disease. Tomographic images from the individuals included in the study were submitted to a blinded and systematic evaluation regarding a broad variety of anatomical variations of the temporal bone. Obtained data were compared statistically between the groups and after stratifying the study sample. Significance level was set at 0.05. Results  Among the affected ears, it was observed an increased number of tomographic scans in which the vestibular aqueduct could not be identified ( p  = 0.01, Fisher exact test). No statistically significant differences were observed when comparing the affected and contralateral ears from patients with unilateral MD, between affected ears from patients with unilateral and bilateral disease or between contralateral ears of patients with unilateral affection and patients without the disease. Conclusion  Some anatomical variations might be more frequent in the affected ears of patients with MD, such as the lower rates of individualization of the vestibular aqueduct.

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A 74-year-old man with a history of invasive right parotid gland adenocarcinoma presented with acute onset left hemiparesis. CT angiography showed abnormal cervical and intracranial vascular reflux with enhancement of right middle cerebral artery territory (figure 1). Vascular anomalies were suspected but digital subtraction angiography was normal. There was spontaneous resolution of the symptoms and a follow-up CT showed normalization of the imaging findings (figure 2). Pseudopathological brain parenchymal enhancement has been described rarely, usually as an Figure 1 CT angiography Coronal (A) and axial (B, C) CT angiography done by right side antecubital vein injection reveals jugular and cervical veins reflux (blue arrows) reaching the parotid tumor (orange arrow), with opacification of carotid and vertebral arteries (red arrows) and enhancement of intracranial compartment (yellow arrow). Also note hemithyroid contrast reflux (green arrow).

A 7-month-old with West syndrome was being treated with vigabatrin and a MRI scan was requested to rule out other possible pathologies. The examination revealed typical abnormalities described in the literature with the use of this drug [1][2][3][4] . Vigabatrin was discontinued and follow-up scan showed signal normalization ( Figure). This imaging pattern with the use of vigabatrin is more commonly seen in younger infants (≤12 months), patients with cryptogenic infantile spasms 1 and treatment using relatively high dose of this drug 2,3 . To explain the changes in the diffusion imaging a recent study analyzed the diffusion tensor, but did not reach a definite conclusion if the changes are attributed to myelin abnormalities or to axonal damage 4 . The imaging pattern described here should be promptly recognized by the neuroradiologist in the appropriate context and the treatment using this drug should be discontinued. Figure. Row A shows initial MRI scan with restricted diffusion -high DWI signal (low signal in ADC map not shown) -in the dorsal brain stem, in the globus pallidi and in the thalami. Row B is the corresponding T2 weighted initial scan. Row C shows signal normalization on T2 weighted images three months after discontinuation of vigabatrin (diffusion imaging also normalized, not shown).