Volume 101 ·  Issue 47 ·  2021

CT examination of temporal bone is of great value in the diagnosis and treatment of otological diseases, and improvement in spatial resolution is an inevitable demand to enhance diagnostic efficiency. In the past 40 years, the spatial resolution of temporal bone CT has been continuously improved, making great contribution to improving the diagnosis and treatment level of otological diseases. The newly reported 10 μm otology CT device has greatly improved the ability to visualize fine structures and occult lesions of temporal bone key area and effectively reduced radiation dose, therefore it is expected to bring new changes to diagnosis and treatment of otological diseases.

To investigate the changes and clinical significance of coagulation factor activity in tumor patients with abnormal coagulation function.

The clinical data of cancer patients who were hospitalized in Henan Cancer Hospital from January 2020 to June 2021 was collected. Thromboelastography (TEG) was used to monitor the coagulation function of tumor patients. Accordingly, 196 tumor patients with abnormal coagulation function were in the test group, and 36 tumor patients with normal status were in the control group. According to the coagulation index (CI) value of the TEG test results, the test group was divided into two groups: hypercoagulability test group (n=104): CI value>3; hypocoagulation test group (n=92): CI value<-3. Meanwhile, each test group was divided into 3 subgroups according to the R value, K value, α angle and MA value of the TEG results, namely hypercoagulable group one (n=37), hypercoagulable group two (n=34), and hypercoagulable group three (n=33); hypocoagulation group one (n=33), hypocoagulation group two (n=30), and hypocoagulation group three (n=29). The activities of coagulation factors (F) Ⅱ, Ⅴ, Ⅶ, Ⅷ, Ⅸ, Ⅹ, Ⅺ, Ⅻ and von willebrand factor (vWF) were measured and compared for all patients in the test groups and the control group in the same period.

Compared with the normal control group, the hypercoagulable group one showed higher FⅡ, FⅤ, FⅦ, FⅧ, FⅪ and vWF activity, and the values were (1 105±281), (1 352±326), (1 628±397), (1 795±314), (1 389±288) and (1 908±486) U/L, respectively (P<0.01). The hypercoagulable group two showed higher FⅡ, FⅤ, FⅦ, FⅧ FⅩ and vWF activity, and the values were (1 068±189), (1 194±205), (1 529±394), (1 562±241), (1 150±196) and (1 722±415) U/L, respectively (P<0.05). Hypercoagulable group three showed higher FⅦ, FⅩ and vWF activity, and the values were (1 411±196), (1 212±327) and (1 713±457) U/L, respectively (P<0.01). In contrast, the hypocoagulation group one showed lower FⅤ, FⅧ, FⅨ, FⅫ and vWF activity, and the values were (732±96), (695±64), (1 216±191), (832±128) and (1 088±117) U/L, respectively (P<0.05). Hypocoagulation group two showed lower FⅤ, FⅦ, FⅧ and FⅫ activity, and the values were (714±102), (1 125±108), (783±95) and (912±111) U/L, respectively (P<0.01). Hypocoagulation group three had lower FⅪ, FⅫ and vWF activity, and the values were (812±92), (827±179) and (916±76) U/L, respectively (P<0.01).

Only part of the coagulation factor activity changes significantly in the tumor patients with abnormal coagulation function. In tumor patients with hypercoagulable state, the high activity of FⅡ and FⅩ becomes an important factor in anticoagulant therapy, while high FⅤ, FⅧ activity can cause deep vein thrombosis. In the hypocoagulation state, the significant decreases of FⅤ and FⅧ activity often cause bleeding or oozing.

To explore the differences of alignment and operative time between computer assisted surgery (CAS) and personal specific instrumentation (PSI) in total knee arthroplasty (TKA).

Patients with knee osteoarthritis who underwent unilateral primary TKA in Peking University Third Hospital from June 2019 to April 2021 were enrolled in this prospective study and were randomly divided into CAS group and PSI group with random number table. The differences in preoperative general data, operative time, preoperative and postoperative alignment between the two groups were studied.

A total of 80 patients were enrolled in this study, including 40 patients in the CAS group with an average age of (68±6) years (male/female, 6/34 cases) and 40 patients in the PSI group with an average age of (69±6) years (male/female, 5/35 cases). There was no significant differences in gender, age, height, weight, body mass index, surgical side, preoperative hip-knee-ankle (HKA) angle, and preoperative HKA angle deviation between the two groups (all P>0.05). The accuracy of sagittal femoral component angle (sFCA) (1.7°±1.2° vs 2.5°±1.4°,P<0.05) and sagittal tibial component angle (sTCA) (1.2°±0.9° vs 2.3°±1.8°,P<0.01) of the CAS group were both smaller than those in the PSI group, but there was no significant difference in the accuracy of postoperative HKA angle, mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibia angle (mMPTA) between the two groups (allP>0.05). The precision of postoperative HKA angle and sTCA of the CAS group were both smaller than those in the PSI group (2.0°±1.0° vs 2.6°±1.7°, 1.2°±0.9° vs 2.3°±1.8°, bothP<0.01), but there was no significant differences in the precision of mLDFA, mMPTA and sFCA between the two groups (allP>0.05). The rate of outliers of postoperative HKA angle (10.0% vs 27.5%,P<0.05), sFCA(5.0% vs 20.0%,P<0.05) and sTCA (2.5% vs 22.5%,P<0.01) of the CAS group were all smaller than those in the PSI group, but there was no significant difference in the rate of outliers of mLDFA and mMPTA between the two groups (bothP>0.05). CAS group had significantly longer surgical time than the PSI group ((81±12) min vs (52±8) min,P<0.01).

CAS is better than PSI in overall coronal alignment and sagittal position of the prosthesis after TKA. However, CAS requires a longer operation time.

To assess whether myocardial fibrosis affects the protective efficiency of ischemic preconditioning (IPC) against myocardial ischemia/reperfusion injury (MIRI) in type 2 diabetic rats.

Type 2 diabetic rat model was established. Fifty-four normal and 54 diabetic spragus-dawley (SD) rats were equally divided into 6 groups (n=18) using the random number table method: (1) Control group (C group); (2) Ischemia reperfusion injury (IRI) control group (IRI group); (3) IPC group; (4) Diabetic control group (DC group); (5) Diabetic IRI group (DIRI group); (6) Diabetic IPC group (DIPC group). After the reperfusion, blood samples were obtained for measuring serum concentrations of creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) using enzyme-linked immunosorbent assay (ELISA). The myocardial infarction size (IS) was assessed by double staining method with Evan′s blue and Triphenyl tetrazolium chloride (TTC), and the myocardial collagen volume fraction (CVF) and perivascular collagen area (PVCA) were assessed by Masson staining.

A stable and effective rat model with long-term diabetes was established in the current study. Compared with the normal rat groups, the CVF and PVCA significantly increased (all P<0.05) in the diabetic rat groups. The levels of CK-MB, cTnI and IS in the IPC group were (6.6±0.8) ng/ml, (0.5±0.1) ng/ml and (25.1±4.7) %, which showed significant decrease compared with (12.3±1.1) ng/ml, (1.2±0.3) ng/ml and (52.3±8.1) % in IRI group (allP<0.05). Among the diabetic rat groups, the CK-MB and cTnI levels in DIPC group were (11.5±0.9) and (1.1±0.1) ng/ml, apparently lower than the levels of (16.6±2.2) and (1.4±0.3) ng/ml in the DIRI group (bothP<0.05). Compared with the IPC group, the IS, CK-MB and cTnI levels significantly increased in the DIPC group (allP<0.05).

Myocardial fibrosis exists in rats with long-term type 2 diabetes, which weakens the protective effect of IPC on diabetes MIRI.

To analysis the anatomical features of normal vestibular nerve canal based on 10 μm otology CT.

Sixty-seven patients (103 ears) underwent 10 μm otology CT examinations in Department of Radiology, Beijing Friendship Hospital, Capital Medical University from September 2020 to March 2021 were retrospectively recruited. There were 24 males and 43 females, aged from 18 to 70 (40±17) years. According to the morphology of the inferior vestibular nerve canal, it can be divided into four types as follows: uniform straight type, curved type, ampullary type and direct connection. The anatomical variables of the superior vestibular nerve canal (external orifice, isthmus and internal orifice widths, canal length, angle with labyrinthine segment of the facial nerve) and inferior vestibular nerve canal (widths of the externaland internal orifice, canal length, angles with long axis of the vestibule and the modiolus) between the different sides, genders and canal morphologies were analyzed and compared, respectively.

100% superior vestibular nerve canals and 75.7% (78/103) inferior vestibular nerve canals are clearly depicted by otology CT. The left-side ear presented with larger internal orifice diameter of the superior vestibular neve canal [(1.46±0.47) mm vs (1.31±0.41) mm], and a smaller angle between the inferior vestibular neve canal and the modiolus [(41.6±16.9)° vs (51.6±21.0)°] than the right-side ear (allP<0.05, respectively), respectively. Compared to females, males demonstrated larger internal orifice of the superior vestibular nerve canal [(1.55±0.37) mm vs (1.28±0.36) mm,P<0.05]. The uniform straight type of the inferior vestibular nerve canal was the most common type (62.1%, 64/103), followed by the direct connection (19.4%, 20/103), and the ampullary type was the least common type (4.9%, 5/103). There were significant differences in external diameter and angles with the long axis of the vestibule and the modiolus between the four morphologies of the superior vestibular nerve canal (allP<0.05, respectively).

Ten μm otology CT is capable of depicting normal vestibular nerve canal clearly. Quantitative measurement of the normal vestibular nerve canal can provide references for the imaging diagnosis and preoperative evaluation of lesions in this area.

To assess the changes of the spatial location of the malleus in patients with chronic otitis media (COM) using 10 μm otology CT.

Forty-five patients with COM (COM group, 45 ears) and 55 patients without external and middle ear disease (control group, 89 ears), who underwent 10 μm otology CT examination in Department of Radiology, Beijing Friendship Hospital, Capital Medical University from October 2020 to March 2021, were retrospectively collected during the same period. In the COM group, there are 20 males and 25 females, aged from 20 to 78 (40±14) years. In the control group, 29 were males and 26 were females, with age of 19 to 57 (32±11) years. The shortest distance between the malleus head and the upper wall, the distance between the outer edge of the malleus neck and the scutum, the distance between the outer edge of the malleus neck and the pars flaccida of the tympanic membrane, the shortest distance between the malleus head and the anterior wall, the shortest distance between the anterior process and the anterolateral wall, the shortest distance between the tip of the malleus handle and the promontory, and the shortest distance between the malleus head and the tympanic segment of the facial nerve were measured and compared between the two groups.

Compared with the control group, the head-upper wall distance (M (Q₁, Q₃)) (0.81 (0.48, 1.21) mm vs 0.57 (0.33, 0.90) mm) and the neck-scutum distance (1.79 (1.54, 2.13) mm vs 1.65 (1.48, 1.83) mm) were larger in the COM group (all P<0.05), and the neck-tympanic membrane distance (1.32 (1.15, 1.49) mm vs 1.45 (1.31, 1.59) mm) and the handle-promontory distance (1.56 (1.33, 2.09) mm vs 2.10 (1.74, 2.43) mm) were reduced in the COM group (allP<0.05, respectively). The neck-tympanic membrane distance on the left was larger than those on the right in the COM group (1.39 (1.19, 1.51) mm vs 1.21 (0.87, 1.31) mm,P<0.05).

There are changes in the relative position of the malleus in patients with COM, which are helpful for further understanding the imaging manifestations in patients with COM.

To evaluate the application of 10 μm otology CT on evaluation of isolated malleus fixation (IMF) in patients with conductive hearing loss.

A total of 19 patients (25 sides) with idiopathic hearing loss, including 8 males and 11 females, aged between 4 to 50 years, who underwent 10 μm otology CT examination in Department of Radiology, Beijing Friendship Hospital, Capital Medical University from October 2020 to July 2021, were retrospectively collected. For those patients with idiopathic hearing loss, there were 5 cases (6 sides), including 2 males and 3 females, with an average age of 18-70 [65(20,68)] years, with bony connection between malleus and tympanum wall. Eighteen sex-and age-matched cases with normal hearing group, including 6 males and 12 females, with an average age of 20-68 (39±14) years, as the ratio of 1∶3, were included as the controls. The distances of the tegmen tympani between malleus head and horizontal semicircular canal, as well the distances between malleus head and horizontal semicircular canal were retrospectively measured and further compared between the two groups.

The incidence of IMF in patients with idiopathic conductive hearing loss without other etiologies was 24.0% (6/25). The specificity of 10 μm otology CT in diagnosing IMF was 100%. The distances of tegmen tympani between horizontal semicircular canal and malleus head in IMF patients were significantly smaller compared with the controls [-0.65(-1.21, -0.35) mm vs 1.34(0.04, 1.68) mm;0.92(0.51, 1.49) mm vs 2.82(1.76, 3.53) mm](both P<0.05, respectively). There was no significant difference in distances between malleus head and horizontal semicircular canal [-1.30 (-1.90, -0.46)mm vs -0.42 (-1.15, 0.05),P=0.057].

IMF is not uncommon in conductive hearing loss without other causes, which can be clearly shown by 10 μm otology CT. Its occurrence is related to the local downward shift of tegmen tympani above the malleus, without upwards displacement of the malleus.

To evaluate the morphology of isthmus of the vestibular aqueduct (VA) and its relationship with the occurrence, course of Meniere′s disease (MD) and the degree of hearing loss based on 10 μm otology CT.

A total of 13 patients with MD in Beijing Friendship Hospital, Capital Medical University from October 2020 to July 2021, including 4 males and 9 females, age from 16 to 77 (56±16) years, were prospectively enrolled. All patients underwent 10 μm otology CT examination. The included lesion side was the MD affected group (14 sides), and the non-lesion side was the MD healthy group (12 sides). According to the 1∶2 side, 16 sex-and side matched cases (28 sides) without external and middle ear disease were included in the control group, including 4 males and 12 females, age from 16 to 77 (56±14) years. The horizontal semicircular canal showed on the largest plane was considered as the standard cross-section, and continuous observation was made on this image. According to the display type of isthmus of the VA, it was divided into Ⅰ to Ⅳ grades. Kruskal Wallis test was used to compare the morphological differences of VA isthmus among the affected group, the healthy group and the control group. The degree of hearing impairment was assessed by pure tone audiometry (PTA) results, which were divided into normal/mild/moderate/moderately severe/severe/extremely severe hearing impairment. Spearman correlation analysis was used to compare the correlation between the morphological rating of VA isthmus on the affected side and age, course of disease and the results of pure tone audiometry (PTA).

The proportions of VA isthmic morphology GRADE Ⅰ,Ⅱ,Ⅲ,Ⅳ in the MD affected group were 28.6% (4/14), 42.9% (6/14), 21.4% (3/14), 7.1% (1/14), those in the MD healthy group were 0 (0/12), 33.3% (4/12), 33.3% (4/12), 33.3% (4/12), and those in the control group were 0 (0/28), 7.1% (2/28), 64.2% (18/28), 28.6% (8/28). The VA isthmus scores [M (Q1, Q3)] of MD affected group was lower than that of MD healthy group [2 (1, 3) vs 3 (2, 4)] and control group [2 (1, 3) vs 3 (3, 4)] (allP<0.05, respectively). The morphology of the VA isthmus on the affected side of MD was negatively correlated with age (r=-0.81, P=0.002), and there was no correlation with the course of disease and degree of hearing impairment (r=-0.40, r=-0.26; all P>0.05, respectively).

The stenosis of the VA isthmus in MD was a possible anatomical factor for the occurrence of MD.

To evaluate the imaging features of otosclerosis based on10 μm otology CT.

Data of 27 patients with otosclerosis (51 sides) in Beijing Friendship Hospital, Capital Medical University from October 2020 to July 2021 were retrospectively collected, including 9 males and 18 females age ffrom 22 to 70 (42±12) years. All patients underwent 10 μm otology CT examination and surgical treatment. The types, amounts and involved sites of otosclerosis were analyzed and the sensitivity of 10 μm otology CT in diagnosing otosclerosis were evaluated.

Fenestral type accounted for 49.0% (25/51 sides), and diffuse type accounted for 51.0% (26/51 sides),and he retrofenestral type without fenestral lesion was not seen. Single lesions accounted for 45.1% (23/51 sides) and multiple lesions accounted for 54.9% (28/51 sides). The incidence of involvement of the fissula ante fenestram and annular ligaments were both 100%. The incidence of involvement of stapes footplate, vestibule, cochlea, round window, inner auditory canal wall, facial nerve canal, stapes muscle and semicircular canal was 60.8% (31 sides), 33.3% (17/51 sides), 21.6% (11/51 sides), 17.6% (9/51 sides), 13.7% (7/51 sides), 9.8% (5/51 sides), 7.8% (4/51 sides) and 5.9% (3/51 sides), respectively. The sensitivity of 10 μm otology CT in diagnosis of otosclerosis was 100%.

10 μm otology CT can fully display the imaging features of otosclerosis, and has the potential to be an effective routine method for otosclerosis.

To evaluate different protocol optimization strategies for temporal bone between10 μm otology CT and multi-slice CT (MSCT).

Ten adult skull specimens (20-sides temporal bones) were prospectively enrolled. From October to November 2020, the temporal bones were scanned under four different imaging conditions using 10 μm otology CT (90 kV, 120 mAs; 90 kV, 140 mAs; 100 kV, 120 mAs; 100 kV, 140 mAs) and MSCT (120 kV, 220 mAs; 120 kV, 310 mAs; 140 kV, 160 mAs; 140 kV, 220 mAs), respectively. The image quality was subjectively scored using 5-grade scores, and the contrast noise ratio (CNR) of the image was measured. The absorbed dose of tissues and organs under different imaging conditions was measured by thermoluminescence dosimeter, and the effective dose was calculated. The figure of merit (FOM) is defined as the ratio of the square of the mean CNR to the effective dose. χ² test was used to compare the difference of subjective scores of different scanning parameter groups, and paired t test was used to analyze and compare the difference of image CNR of different scanning parameter groups. The image quality, radiation dose and FOM of the combination of recommended parameters of the two devices were analyzed and compared.

For 10 μm otology CT, under 100 kV condition, the CNR of 140 mAs group was better than that of 120 mAs group (11.27±1.85 vs 10.26±1.38, P<0.001). There was no significant difference in subjective scores between the two groups [5.00 (4.00, 5.00) vs 5.00 (4.25, 5.00),P=0.264]. For MSCT, under 120 kV condition, the subjective scores and CNR of 310 mAs group were better than those of 220 mAs at 120 kV [4.00(3.00, 4.00) vs 3.00(3.00, 3.00),P=0.002;5.24±0.62 vs 4.60±0.62,P<0.001]. According to the principle of image quality-radiation dose optimization, the combination of 100 kV with 120 mAs and 120 kV with 310 mAs are recommended for 10 μm otology CT and MSCT, respectively. The subjective scores and CNR of 10 μm otology CT images were better than those of MSCT (5.00 (4.25, 5.00) vs 4.00 (3.00, 4.00), 10.26±1.38 vs 5.48±0.22,P<0.001). The effective dose was 1/3 of that of MSCT (82.99 μSv vs 252.56 μSv), and the FOM was 11.16 times of that of MSCT (1 268.44 mSv^-1 vs 113.71 mSv^-1).

The temporal bone image quality of newly developed 10 μm otology CT is significantly better than that of MSCT, and its effective dose is lower than that of MSCT, which has more accurate and safer application potential.

To explore the performance of a deep learning algorithm that combined multi-view fusion with active contour constrained for ossicles segmentation on the 10 μm otology CT images.

The 10 μm otology CT image data from 79 cases (56 cases were from volunteers and 23 cases were from specimens) were retrospectively collected in the Radiology Department of Beijing Friendship Hospital from October 2019 to December 2020. An annotation of malleus, incus, and stapes were conducted. Then the datasets were established and were divided into training set (n=55), validation set (n=8), and test set (n=16). Using the rapid localization of the region of interest combined with the precise segmentation algorithm, the malleus, incus and stapes were segmented and fused from three perspectives of coronal, sagittal and cross-sectional views. Besides, an active contour loss was designed simultaneously for the segmentation of stapes. Dice similarity coefficient (DSC) was used as the objective evaluation metric for the evaluation of the segmentation results. The inter group DSC of the proposed method was compared with that of the basic method and other methods.

The average DSC values of the multi-view fusion segmentation algorithm for malleus, incus and stapes reached up to 94.2%±2.7%, 94.6%±2.6% and 76.0%±5.5%, respectively. After adopting the constraint of active contour loss method, the average DSC of stapes was improved (76.4%±5.4% vs 76.0%±5.5%). The visualization results also demonstrated that the segmentation results of the stapes were more complete.

Multi-view fusion algorithm based on 10 μm otology CT images can realize accurate segmentation of malleus and incus. Combined with the constraint of active contour loss method, the segmentation accuracy of stapes can be further improved.

A young male patient with a disease course of 11 years was reported. The main manifestations were recurrent fever, abdominal pain and large red maculopapular rash on the face, neck, chest and back. Multiple superficial ulcers of small intestine and colon and mesenteric lymph node enlargement were found by multiple examinations. After whole exome gene detection and comprehensive analysis, it was confirmed that the patient had heterozygous variation of NOD2 gene c.1540T>C (p.Y514H), and finally was diagnosed as YAO syndrome. This disease is a rare clinical disease, which is difficult to diagnose and often has a long diagnosis cycle. Timely updating the understanding of rare emerging diseases, overviewing the clinical characteristics of patients and combining new technologies will help to make the diagnosis clear as soon as possible.

The key structure of the ear is fine and tiny, buried deep in the bone. High-resolution CT of temporal bone plays a key role in the cognition of key structures, etiology diagnosis and treatment follow-up; Imaging devices include multi-slice spiral CT, cone beam CT, and Micro CT. Multi-slice spiral CT is the most commonly used imaging examination method in otology clinic. Cone beam CT and Micro CT have higher spatial resolution, lower radiation dose, and unique advantages in displaying microstructure. They have also been deeply studied in temporal bone. This article reviews the equipment characteristics of spiral CT, cone beam CT and Micro CT in recent three years at home and abroad, and the application research progress in finding the normal structure of temporal bone and diagnosing and treating common diseases.

Since 1990s, minimally invasive surgical techniques have been gradually applied to the treatment of hallux valgus. Up to now, three generations of minimally invasive techniques have been gradually developed, including the first generation of Reverdin-Isham technique without internal fixation, the second generation of Bösch technique mainly relying on temporary internal fixation of Kirschner wire, the third generation of minimally invasive techniques represented by minimally invasive descending distal metatarsal Chevron osteotomy combined with Akin osteotomy (MICA) and other improved techniques. Each minimally invasive technique has its own significant curative effect, but compared with open surgery and different minimally invasive surgery, the difference in clinical effect is not obvious, and doctors need to make individual selection of surgical procedures for different patients with hallux valgus. At present, there is no clear evidence in follow-up studies that minimally invasive techniques have significant advantages over open techniques, and large samples and long-term randomized controlled studies are still needed to confirm it.

Otosclerosis is one of the causes of progressive hearing loss in people aged 20 to 50 years. High-resolution CT (HRCT) is the first imaging method of choice for preoperative diagnosis of otosclerosis. In order to improve the detection rate of otosclerosis, this study proposed a systematic flow chart based on HRCT: whether there is a density reduction area in the anterior vestibular window area (0~3 points, where 0 points are no density reduction areas and 3 points are significant density reduction areas); Whether there is new bone formation in the vestibular window and the round window, which is manifested as bone thickening, stenosis or obstruction of both windows; Whether there are areas of reduced density in bone around cochlea, semicircular canal and internal auditory canal; Superior semicircular canal fracture, ossicular chain deformity, volute widening or hammer head fixation were excluded. To verify the diagnostic efficacy of this flow chart, the study retrospectively included 17 laterals with otosclerosis confirmed by middle ear surgery from 2010 to 2016 as the test group, and 21 laterals with cochlear implant and no otosclerosis confirmed as the control group. Systematic evaluation of preoperative HRCT images of both groups by a radiologist using a blinded method accurately diagnosed otosclerosis in all 17-side test groups and excluded otosclerosis in 21-side control groups. In the test group, the density reduction was observed in the anterior area of the vestibular window on 17 sides, of which 9 sides (53.0%) had new bone formation, and 8 sides (47.1%) showed the density reduction around the cochlea. When bone density is reduced in the anterior vestibular window area, physicians have increased confidence in diagnosing the reduced density area around the cochlea. HRCT images evaluated by a systematic flow chart are a tool for highly accurate assessment of otosclerosis and improve the diagnosis rate of otosclerosis by physicians.

The key structures of temporal bone are mostly hidden in bone, so CT is the first imaging tool for diagnosing temporal bone lesions. With the development of imaging technology, CT with higher spatial resolution (ultra-high resolution CT) has been used in clinical practice. The study was based on a 128-slice spiral CT instrument with Z-axis resolution scale of 0.25 mm and X-axis resolution scale of 0.125 mm and Y-axis resolution scale of 0.125 mm. The visibility of 27 tiny structures in 18 normal temporal bones was evaluated by an otologist and a radiologist, respectively, into clear display, display and non-display, and the evaluation results were compared transversely with previous studies. The results showed an inter-observer assessment agreement of 89% for ultra-high resolution CT of the temporal bone. The CT can clearly show the protrusion of the malleus, the lenticular process of the incus, the anterior and posterior arch of the stapes, the floor plate of the stapes, the volute axis, the vestibular aqueduct, the superficial petrous nerve and the anterior malleus ligament, etc., and can partially show the stapes tendon, the cord tympanic nerve, the cochlear bone spiral plate, etc. Compared with previous studies, the overall display ability of this CT on the microstructure of temporal bone is similar to that of cone beam CT, and is higher than that of previous spiral CT. Ultra-high resolution CT provides good visualization of the microstructures of the temporal bone in normal subjects.