Imagerie Haute Résolution en pathologie de l’oreille et de la base du crâne

Abstract : Since the beginning of the 1990s, the imaging of the ear and skull base has grown considerably. Recently, poorly known pathologies have been investigated by imaging, in particular with MRI. The objective of my research works was to develop high resolution (HR) sequences dedicated to the ear and the skull base, allowing a fine semiological analysis and a characterization of these various pathologies. The purpose is to contribute to a more appropriate medical management. The beginning of my work was directed towards the internal auditory canal. My initial purpose was to determine and develop a three-dimensional HR T2 sequence for the inner ear and the internal auditory canal as well as a spin echo T1 HR with thin slices. These sequences allowed the precise analysis of the extension of vestibular schwannomas in the fundus of the internal auditory canal. This study has indentified a relevant criteria for the therapeutic choice (surgery versus radiosurgery) and for the choice of the surgical approach. My work has also aimed to the development of diffusion sequences dedicated to the skull base. The purpose was to develop a HR diffusion sequences in the follow-up of operated cholesteatoma of the middle ear. Recurrence of cholesteatoma is frequent and the operated ears are sometimes difficult to analyze on CT, particularly when the postoperative cavity is completely filled. Specific MRI sequences are then necessary to differentiate a recurrent cholesteatoma from fibro-inflammatory tissue. The fact that the diffusion coefficient between fibro-inflammatory tissue and cholesteatoma is different has been shown by several authors. However these early sequences of echoplanar imaging (EPI) diffusion with low resolution were poorly suited to the temporal bone and the skull base. Our work was to finalize and develop a sequence of turbo spin echo HR diffusion, adapted to the ear and skull base for the screening of recurrent cholesteatoma and validate this sequence by comparison with delayed post gadolinium spin echo T1 sequence and surgery. My work on the HR imaging of the skull base also enabled me to develop some other sequences: spin echo T1 and 3D HR gradient echo T1 with fat saturation allowing for the detailed analysis of perineural spread to the skull base, mainly in nasopharyngeal cancers. This work helped to define the precise pathways of extension of these tumours in order not to underestimate the initial stage of these tumours in the TNM UICC classification. This work together with those of other researchers allowed the recent update of the UICC classification in nasopharyngeal tumours. One of my main research topics has been the screening, analysis and description of the pathologies of the inner ear. A longitudinal study from 1998 to 2008, including all the intralabyrinthine pathologies discovered to the University Center of Lille, allowed to define and characterize three major different pathologies: intralabyrinthine schwannoma, labyrinthitis and intralabyrinthine hemorrhage. These pathologies require different treatments. We were also able to define prognostic criteria in particular criteria of severity requiring a rapid and adapted medical management. Within the framework of my research on the pathologies of the inner ear, we were also interested in the syndrome of dehiscence of the superior semicircular canal. This clinical syndrome was recently described by Minor in 1998. A retrospective study of the cases discovered between 2007 and 2009, included a HR TDM of the temporal bone and a HR MRI (in particular imaging fusion between the 3D HR time-of-flight (TOF) and the 3D HR T2 sequences), enabled to identify a variant of the classic form of dehiscence. [...]
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Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2010. Français. 〈NNT : 2010LIL2S035〉
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Frédérique Dubrulle. Imagerie Haute Résolution en pathologie de l’oreille et de la base du crâne. Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2010. Français. 〈NNT : 2010LIL2S035〉. 〈tel-00586076〉



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