The Indispensable Role of High-Resolution Computed Tomography in the Evaluation of Temporal Bone Pathologies: A Comprehensive Review

Abstract

High-Resolution Computed Tomography (HRCT) has fundamentally transformed the diagnostic approach to pathologies affecting the temporal bone. This complex anatomical region, housing the delicate structures of the auditory and vestibular systems, necessitates imaging with high spatial resolution for accurate assessment. This review provides a comprehensive analysis of the current and evolving role of HRCT in the evaluation of a wide spectrum of temporal bone diseases. It details HRCT techniques and protocols, normal radiological anatomy, and its application in diagnosing congenital anomalies, inflammatory and infectious conditions such as otitis media, cholesteatoma, and mastoiditis, traumatic injuries including fractures and ossicular dislocations, neoplastic conditions (benign and malignant), and otosclerosis. The diagnostic utility of HRCT is compared with other imaging modalities, notably Magnetic Resonance Imaging (MRI) and Cone-Beam Computed Tomography (CBCT), highlighting their respective strengths, limitations, and complementary roles. Furthermore, the critical contribution of HRCT to pre-operative planning for various otologic surgeries, including cochlear implantation and mastoidectomy, is extensively discussed. While acknowledging the limitations of HRCT, such as poor soft tissue differentiation and ionizing radiation exposure, this review also explores future directions, including the burgeoning field of artificial intelligence (AI) and its potential to enhance image interpretation and diagnostic efficiency. HRCT remains a cornerstone in temporal bone imaging, primarily due to its unparalleled ability to delineate minute osseous anatomy, directly impacting clinical decision-making and patient management.