OBJECTIVES: Cochlear implantation is an increasingly used technique for auditory rehabilitation of pediatric and adult population. Safe implantation is achieved in most cases; however, intraoperative complications and misplacement of the electrode are observed in some. The aim of this presentation was to review the characteristics of patients with extra-cochlear electrode insertion, postoperative diagnostic methods, and considerations in revision surgery. MATERIALS and METHODS: In total, 423 cases of cochlear implantation performed in our clinic between 2012 and 2018 were retrospectively analyzed and those of extra-cochlear implantation were evaluated. RESULTS: Extra-cochlear insertion was found in 3 patients. The electrode was placed into the internal acoustic canal in the first case, superior semicircular canal in the second case, and internal carotid artery canal in the third case. Cochlear insertion was achieved in all cases with re-implantation, and no complication was observed. CONCLUSION: This case series highlights that rare, but potentially serious, consequences of misplacement of the electrode in cochlear implantation can be successfully avoided and treated via a multidisciplinary approach. Cite this article as: Gözen ED, Tevetoğlu F, Yener HM, Kara E, Ataş A, Şirolu S, et al. Extra-Cochlear Insertion in Cochlear Implantation: A Potentially Disastrous Condition. J Int Adv Otol 2019; 15(3): 358-63.

The Prostate Imaging Quality (PI-QUAL) V2 is a simplified update of PI-QUAL V1 for assessing image quality in multiparametric prostate MRI (mpMRI), aimed at improving clinical use and reproducibility. This study evaluated inter-reader agreement of PI-QUAL V2 among basic prostate readers using multicenter mpMRI data and compared it to PI-QUAL V1. Five readers assessed T2-weighted, DWI (including ADC maps), and DCE images from 274 men (median age: 71 years, IQR: 60–78) across five centers. Inter-reader agreement was measured using weighted Gwet’s AC1 coefficients and compared using bootstrapped confidence intervals. For PI-QUAL V1, coefficients ranged from 0.659 to 0.855, indicating substantial-to-almost perfect agreement. For PI-QUAL V2, coefficients ranged from 0.821 to 0.897, showing almost perfect agreement. All 10 pairwise comparisons achieved almost perfect agreement for PI-QUAL V2, compared to only 3 of 10 for V1. Additionally, three comparisons showed non-overlapping confidence intervals, indicating statistically significant improvements with V2. PI-QUAL V2 demonstrated consistently higher inter-reader agreement than V1, with basic prostate readers achieving almost perfect agreement across multicenter mpMRI data. These findings highlight the improved reliability and clinical applicability of PI-QUAL V2.

Background: Emerging evidence suggests multiparametric prostate MRI's role in evaluating prostate cancer (PCa) aggressiveness. Purpose: To evaluate the utility of quantitative sequences in prostate MRI for assessing peripheral zone PCa aggressiveness, focusing on added value of relaxation maps to ADC. Material and Methods: In total, 64 men undergoing preoperative bi-parametric prostate MRI with synthetic sequences were retrospectively enrolled. Radiologists delineated lesions on ADC maps and synthetic MRI, matched with digitized whole-mount specimens. PCa was graded as low, intermediate, or high based on Gleason grade. Statistical analyses assessed differences in T1, T2, PD, and ADC values across grades. For significant variables, AUC curves were generated. A logistic regression model evaluated the added diagnostic value of relaxation maps to ADC. Results: Of the 95 PCa foci, 11 were low-grade, 45 intermediate-grade, and 39 high-grade. T1 ( P = 0.4) and PD ( P = 0.3) showed no significant differences, while T2 and ADC differed significantly ( P < 0.001). Median T2 values were 98 ms (low-grade), 81 ms (intermediate), and 73 ms (high-grade), and median ADC values were 1006 mm²/s, 836 mm²/s, and 721 mm²/s, respectively. ADC yielded AUCs of 0.888 (95% CI=0.794–0.963; P < 0.0001) for low- versus intermediate-to-high-grade PCa, and 0.825 (95% CI=0.724–0.901; P < 0.0001) for low-to-intermediate versus high-grade. T2 AUCs were 0.770 (95% CI=0.605–0.908; P = 0.021) and 0.755 (95% CI=0.648–0.864; P = 0.0051), respectively. A logistic regression model combining T2 and ADC showed no significant improvement over ADC alone in differentiating low- versus intermediate-to-high-grade and low-to-intermediate versus high-grade PCa ( P > 0.05). Conclusion: T1 and PD maps from synthetic MRI showed limited utility in grading PCa. Although T2 values were effective, ADC values were superior in assessing PCa aggressiveness. The addition of T2 to ADC did not significantly improve diagnostic performance.

Objectives: Congenital hearing loss is a significant health concern, with diverse etiologies encompassing cochlear and cochleovestibular pathologies. Preoperative radiological evaluation in cochlear implant candidates is pivotal for treatment planning. We aim to elucidate the spectrum of radiological findings in patients with congenital hearing loss undergoing cochlear implant assessment. Methods: An analysis included 389 sensorineural hearing loss (SNHL) patients who underwent cochlear implantation at a tertiary university hospital, of which 177 were congenital SNHL. Computed tomography (CT) and magnetic resonance imaging (MRI) data were meticulously assessed for diverse congenital pathologies, focusing on congenital malformations. Results: In the congenital SNHL group, comprising 177 patients (80 females and 97 males), congenital cochleovestibular malformations were evident in 56 ears of 29 cases. Different congenital cochleovestibular malformations, ranging from labyrinthine aplasia to isolated large vestibular aqueducts, were detected. Among the various anomalies, incomplete partitions and cochlear hypoplasia emerged as more frequent patterns. Conclusions: This study offers a comprehensive radiological analysis of congenital SNHL patients undergoing cochlear implantation, revealing a spectrum of anomalies. It demonstrates the diverse nature of anomalies affecting the external auditory canal, middle ear structures, and cochleovestibular system. These insights provide a deeper understanding of congenital SNHL and contribute to developing informed treatment strategies.

Greater trochanteric pain syndrome (GTPS) is a common cause of hip pain and is often associated with chronic lower back pain and lower extremity osteoarthritis. Its diagnosis is clinical; however, imaging has been shown to aid in the differential diagnosis of challenging cases. Superb microvascular imaging (SMI) is a new technique that may be more effective than power Doppler ultrasonography (PDUS) in the detection of inflammation-related vascularity in patients. In this study, we aimed to compare the diagnostic accuracies of SMI and PDUS in patients with GTPS and evaluate the usefulness of these techniques in clinical practice. We recruited 37 GTPS patients and 15 healthy volunteers for participation in this study. PDUS and SMI examinations were performed and we retrospectively reviewed the magnetic resonance imaging scans for tendinosis, tears, and edema. The PDUS and SMI were positive in 19 and 31 hips, respectively. Both techniques had low sensitivity but high specificity and positive predictive values, with SMI being slightly better. PDUS and SMI had accuracies of 75% and 82.7%, respectively, with a grade 1 vascularization threshold. Moreover, magnetic resonance imaging detected peritendinous edema with an accuracy of 60.5%, including tendinosis and partial tears but not complete tendon tears. Our study showed that PDUS is an underutilized modality in the diagnosis of GTPS and that SMI may further improve diagnostic accuracy. However, the low sensitivity of both techniques suggests that a clinical diagnosis remains essential.

Retrorectal tumors are rare and heterogeneous lesions that present significant diagnostic and surgical challenges. Owing to their low incidence, consensus on optimal management strategies is lacking, and large-scale outcome data remain limited. This study aimed to present a large, long-term, single-center experience with retrorectal tumors, focusing on surgical strategies, recurrence outcomes, and the clinical relevance of preoperative biopsy decisions. This retrospective cohort study included 58 patients who underwent surgical treatment for retrorectal tumors between 2000 and 2025. A total of 61 patients were initially enrolled; 3 were censored at their last known contact in the Kaplan–Meier survival analysis. Accordingly, descriptive and comparative analyses were performed on the remaining 58 patients with complete follow-up. Clinical data, including demographics, imaging modalities, surgical approach, histopathological diagnosis, and follow-up outcomes, were collected and analyzed. The surgical approach was determined according to the tumor’s relationship to the third sacral vertebra. Statistical analyses included Kaplan–Meier survival estimation and appropriate comparative tests to evaluate postoperative outcomes. The cohort had a mean age of 46.8 ± 14.7 years, with a marked female predominance (81%). All patients underwent preoperative cross-sectional imaging, and preoperative biopsy was performed in 12% of cases. A posterior surgical approach was employed in 91% of patients. Tailgut cysts were the most frequent histopathological subtype (46.6%). No statistically significant association was observed between preoperative biopsy and postoperative complications ( P > .05). During long-term follow-up, local recurrence occurred in 2 patients (3.4%). Although not statistically significant, a trend toward increased postoperative complications was observed in patients who underwent preoperative biopsy ( P = .067). Although rare, retrorectal tumors can be managed effectively with accurate diagnosis, individualized surgical planning, and vigilant long-term surveillance. Preoperative biopsy should not be performed routinely and should be considered on a case-by-case basis, given its potential complication risk and limited diagnostic yield. This 25-year, single-center experience provides valuable insights into the multidisciplinary management of retrorectal tumors and supports evidence-based clinical decision-making in this anatomically complex region.