Fusion of middle ear optical coherence tomography and computed tomography in three ears

ImportanceMiddle ear OCT imaging in patients has not previously been directly compared to a standard of care clinical 3D imaging technology such as CT. This represents the first such comparison and provides new insight into OCTs capabilities, strengths and limitations. ObjectiveTo qualitatively compare the capabilities of middle ear OCT to CT in normal and pathological ears on representative slices in co-registered OCT and CT datasets. Design, Setting, and ParticipantsOne normal middle ear, one ear affected by traumatic injury and one ear with cholesteatoma were imaged with both OCT and high-resolution clinical temporal bone CT. Participants were drawn from the patient population of a tertiary otology clinic. CT and OCT images were aligned using rigid co-registration with manual landmark selection. Main Outcomes and MeasuresImages were analyzed qualitatively for field of view, resolution, shadowing, artefacts, soft tissue and bony tissue contrast and presentation of diagnostically important features. ResultsIn the three imaged ears, OCT was capable of visualizing many of the important features indicative of middle ear pathology. When compared to CT, OCT was found to exhibit a limited field of view (FOV) largely confined to the mesotympanum and subject to shadowing from bony structures. However, OCT could resolve soft tissue features that were not readily apparent in the CT images, to have a higher resolution than CT and to provide excellent anatomical fidelity with CT which allowed OCT images to be accurately co-registered with CT images. Conclusions and RelevanceThe results support a role for middle ear OCT in otological diagnostics. While OCT is not capable of replacing CT due to its limited FOV and inability to image through thick bony tissues, it can visualize many signs of pathology including some soft tissue features that are difficult to visualize with CT. Given OCTs ability to image in real-time, its compatibility with in-office imaging and its lack of ionizing radiation, it may, despite its limitations compared to CT, be an appealing imaging modality for many applications in middle ear diagnostics. Key PointsO_ST_ABSQuestion (1 sentence)C_ST_ABSWhat are the strengths and limitations of middle ear optical coherence tomography (OCT) imaging compared to computed tomography (CT) in real-world clinical imaging scenarios? Finding (1-2 sentence)OCT and CT imaging produce complementary diagnostic information with CT offering unobstructed images of bony anatomy and OCT providing the ability to visualize soft tissue. Meaning (1 sentence)OCT, CT and fused OCT/CT imaging can each provide useful, complementary diagnostic information in clinical otology.