# Decoding Temporal Bone Carcinoma: The Role of CT and MRI in Precision Staging
## 1 Introduction  
Primary squamous cell carcinoma (SCC) of the temporal bone is an exceedingly rare malignancy, constituting only about 0.2% of all head and neck cancers. This anatomical site presents unique challenges for diagnosis and management due to its proximity to critical structures such as the cochlea, vestibular system, and the facial nerve. No universally adopted staging system for temporal bone tumors exists, complicating prognostication and treatment decisions. This study assesses the clinical utility of a previously proposed staging system (the Pittsburgh system) in patients with primary temporal bone SCC [1]. Additionally, the study seeks to identify prognostic factors linked to both patient and tumor characteristics, evaluate clinical outcomes, and share the institutional experience with this rare and aggressive malignancy [1].  
In the literature currently available, some authors have proposed various staging systems, reviews, and case series of patients. The main issues in developing a unique classification and staging system are, in addition to the rarity of the tumor and the narrowness in the number of patients, the use of non-standardized surgical nomenclature in the case studies, which prevents a comprehensive analysis and comparison of outcomes, the wide variability in histological type of the neoplasm, which creates a disparity in classification criteria, and the difficulty in assessing the extent, subsite of origin, and spread vectors of the tumor in an anatomical site where several structures coexist in very narrow spaces, with complex anatomical relationships [2].  
Imaging techniques have revolutionized the diagnostic and therapeutic approach to this pathology. In the early decades of the 20 th century, conventional radiography (X-ray) was the only available tool. Still, it offered limited visualization of the intricate structures of the temporalis, allowing only for the recognition of advanced bony changes. As technology has progressed, the introduction of methods such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and, more recently, positron emission tomography (PET) has significantly expanded diagnostic capabilities, allowing for more detailed analysis of both bone components and surrounded soft tissues [2].  
Among these methods, multidetector CT stands out for its high resolution in evaluating bone structures and detecting post-treatment bone destruction or necrosis. At the same time, MRI offers an excellent definition of soft tissues, allowing tumor extension into adjacent tissues and neurovascular structures to be characterized. The addition of molecular imaging techniques, such as PET-CT, allows not only morphologic assessment but also functional and metabolic analysis of tumors, making it an indispensable tool for assessing recurrence and metastasis [3].  
Some studies have highlighted the superiority of CT in delineating bone erosion and structural details, while MRI excels in characterizing soft tissue involvement and identifying perineural or dural extension. [PERSON] et al. demonstrated that while CT remains critical for staging advanced disease (T3/T4), MRI significantly improves diagnostic accuracy by detecting subtle soft tissue changes, particularly in early-stage tumors (T1/T2) [4].  
Despite these advances, staging the primary SCC of SUE (Superior External Ear) remains a challenge. The Pittsburgh staging system, proposed in the 1990s, is a widely accepted model for classifying the extent of disease and guiding treatment. Still, gaps in understanding therapeutic outcomes persist due to the limited number of patients and lack of prospective randomized trials [5].  
This retrospective study aims to analyze the use and accuracy of different imaging modalities in staging primary SCC of the SUE and evaluate their prognostic and therapeutic role in a group of patients treated at a referral hospital.