Types of Temporal Bone Fractures

Dr. Gul Moonis supervises residents and fellows as a radiologist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. There, Gul Moonis, MD, regularly shares her expertise in a wide variety of areas in the field of radiology, including imaging of the temporal bone in cases of severe trauma.

A possible consequence of blunt injury to the head is damage to the temporal bone. When this type of injury occurs, hemorrhage, fracture, and damage to the structures of the inner ear may occur. Therefore, careful evaluation of medical imaging of the area is very important.

When evaluating imaging of the temporal bone in a patient, the doctor will check for fractures. A fracture is typically described in relation to the petrous bone, which forms a long axis. If the fracture is parallel to this axis, it is said to be longitudinal. A transverse fracture is perpendicular to the axis formed by the petrous bone.

Sometimes both longitudinal and transverse fractures present themselves together. These mixed fractures, called oblique fractures, are relatively common. They may result in a variety of issues, such as facial nerve damage and hearing loss. Thorough evaluation by a professional can reveal an accurate picture of these issues and help give patients the best possible prognosis.

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About Adaptive Iterative Reconstruction

As a researcher in the field of head and neck radiology, Dr. Gul Moonis of Harvard Medical School has published in such peer-reviewed periodicals as the American Journal of Neuroradiology and the Journal of Magnetic Resonance Imaging. Gul Moonis, MD, also stands out as a senior author of a 2013 article on the use of adaptive statistical iterative reconstruction (ASIR) to reduce radiation dose in soft tissue neck scans.

Under the basic algorithms of computerized topography (CT) scans, radiologists frequently must choose between high reconstruction speeds and low image noise. In response to this challenge, a technique called statistical iterative reconstruction has arisen that uses multiple reconstruction phases to reduce noise. Because this technique is effective at reducing noise but detrimental to reconstruction time, radiologists have developed a way of beginning this reconstruction after the first round of filtered back projection (FBP) reconstruction.

Known as adaptive statistical iterative reconstruction (ASIR), this technique reduces noise in a way that allows radiologists to increase the operator-selected noise index (mA) during scanning. This in turn supports a lowering of the patient radiology dose without compromising diagnostic accuracy. Clinicians can also adapt the technique to account for differences in patient size and area of the body to be evaluated, as the methodology achieves noise reduction through effective modeling of the scanned tissues.

Gul Moonis, MD: Imaging of Otosclerosis

Otosclerosis is a slowly progressing disorder that affects the inner ear. It’s a leading cause of deafness in adults, usually appearing after the age of 40. It tends to be more common in women, specifically Caucasians. The disease may be hereditary in some individuals.

CT Scans are used in conductive, mixed or sensorineural hearing loss to help pinpoint a cause. In developed cases of hearing loss, imaging of otosclerosis is helpful in assisting professionals like Dr. Gul Moonis determine the type of otosclerosis and exclude contraindications for a cochlear implant.

There are two types of otosclerosis: fenestral and retro-fenestral. Fenestral presents as a lesion anterior to the oval window and can extend to the stapes. Retro-fenestral involves the cochlea. Most doctors prefer to use Multidetector CT imaging of the temporal bone. These scans, in the axial and coronal planes, help detect changes of otosclerosis.

Dr. Gul Moonis Performs Research Comparing Histopathology and Computed Tomography in Otosclerosis

Gul Moonis, MD, serves as a radiologist at Beth Israel Deaconess Medical Center in Boston. She and her colleagues conducted research published in the January 2013 issue of the journal Otology & Neurotology that compared computed tomography (CT) with histopathology in diagnosing otosclerosis. The study consisted of a review of specimen CT scans and a comparison of computed tomography findings with histopathology of the same set of temporal bones.

The research paper, titled “Correlation of computed tomography with histopathology in otosclerosis,” concludes that high-resolution CT is is highly sensitive and specific in diagnosing otosclerosis when compared with histopathology. The researchers also found that the tiny otosclerotic foci witnessed in pathology may be unnoticeable in a CT scan. While CT positively identified cochlear endosteal margin involvement, it had a high false-negative rate.

Dr. Gul Moonis has co-authored a number of papers that have appeared in various publications such as Surgical Neurology; the Ear, Nose, and Throat Journal; and the Journal of Neuroradiology.

Gul Moonis: What is the Difference Between a CT Scan and an MRI?

The “CT” in “CT scan” stands for “computed tomography,” while MRI stands for “magnetic resonance imaging.” These techniques are similar in that they both produce detailed images of internal structures in the body, generally in a series of two-dimensional “slices,” although three-dimensional imaging is becoming a possibility. The CT scan does this by detecting the differences between how different tissues absorb x-ray radiation. Magnetic resonance imaging, by contrast, uses a powerful magnetic field to align free protons in the body, and by detecting their differing amounts in different tissues, creates detailed two-dimensional or three-dimensional images.

Computed tomography scanning uses ionizing radiation and may result in slight increase in cancer risk, especially with repeated use. Magnetic resonance imaging can be more detailed and does not carry the same risks. However, the magnetic resonance imaging machine can be quite claustrophobic and is not suited to those with implanted medical devices such as pacemakers and cochlear implants.

Gul Moonis is a radiologist at the Beth Israel Deaconess Medical Center in Boston and the author of several papers on the subject of radiology.

Gul Moonis: An Overview of Adaptive Statistical Iterative Reconstruction (ASIR)

An accomplished radiologist with many years of experience in the field, Gul Moonis, MD, currently serves as an Attending Staff Radiologist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, and as an Assistant Professor of Radiology at Harvard Medical School. Dr. Gul Moonis possesses a wealth of experience with a variety of CT scanning techniques, including adaptive statistical iterative reconstruction (ASIR).

In general, neck CT scans are used to identify sources of pain and discomfort and diagnose disorders of the neck structures. ASIR refers to an CT scan technique that reduces the total dose of radiation at comparable image quality when compared with more conventional techniques. Although ASIR has not yet become a mainstream practice in most hospitals, initial studies in the head and temporal bone have shown promising results and have prompted researchers to continue studying the technique.

Research on Anosmia Suggests Follow-up Protocol

A research paper co-authored by Dr. Gul Moonis and published in the Annals of Otology, Rhinology, and Laryngology explores the diagnosis of anosmia, the inability to sense smells. The paper explores anosmia through the lens of a specific case involving a 33-year-old patient who complained of an inability to perceive taste and smell following a bicycle accident that caused a blow to her head. Researchers examined evidence from MRI scans performed on this patient shortly after her accident and additional scans performed 18 months later.

The paper documents the progression of her condition as observed in a clinical setting. This progression includes such symptoms as parosmia, the misperception of normal smells as noisome smells, and phantosmia, the hallucination of smells.

In the study, titled Magnetic Resonance Imaging Findings in the Evaluation of Traumatic Anosmia, Gul Moonis and her peers suggest caregivers perform MRI scans in conjunction with formal tests and consultations with ear, nose, and throat specialists to properly manage patients with anosmia resulting from head trauma.