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Sarcoidosis is an idiopathic multisystem disorder characterized by noncaseating granulomas. The article focuses on the typical imaging manifestations of sarcoid and the common differentials that need to be included when appropriate. Mistaking a sarcoid-mimicking disease for sarcoid can result in increased patient morbidity and mortality. The pulmonary system is the most common system involved and is typically the best understood by the radiologist, however a deeper knowledge of the pulmonary findings and features of sarcoid in other organ systems is critical. There is a myriad of sarcoid imaging manifestations that can involve every organ system. Often a confidant diagnosis of sarcoid can be made, however a broad differential may need to be considered- differential diagnoses include primary neoplasm, metastatic disease, infectious, and inflammatory etiologies. Radiologist familiarity with the multimodality multisystem imaging findings of sarcoid can help guide clinical management and optimize patient care.

Objective: The aim of this study was to determine the incidence of cochlear fibrosis after vestibular schwannoma (VS) resection via middle cranial fossa (MCF) approach. Design: A retrospective case review was conducted. Setting: The review was conducted in a tertiary care academic medical center. Participants: Patients who (1) underwent resection of VS via MCF approach between 2013 and 2018, (2) had complete pre- and post-audiometric testing, and (3) had clinical follow-up with magnetic resonance imaging (MRI) for at least 1 year after surgery were included. Main Outcome Measure(s): The main outcome of this study was cochlear fibrosis as assessed by MRI 1 year after surgery. Results: Fifty-one patients underwent VS resection via MCF technique during the study period. Of 31 patients with AAO-HNS class A or B preoperative hearing ability, 18 (58.0%) maintained class A, B, or C hearing postoperatively. Of 16 patients who lost hearing and had MRI 1 year after surgery, 11 (61.1%) had MRI evidence of fibrosis in at least some portion of the labyrinth and 4 (22.2%) showed evidence of cochlear fibrosis. Of 16 patients with preserved hearing and MRI 1 year after surgery, 4 (25%) had fibrosis in some portion of the labyrinth, with no fibrosis in the cochlea. Conclusions: In patients who lose hearing during VS resection with the MCF approach, there is usually MRI evidence of fibrosis in the labyrinth 1 year after surgery. However, there is also, but less commonly, fibrosis involving the cochlea. It is unclear if this will affect the ability to insert a cochlear implant electrode array.