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MRI screening of the internal auditory canal: Is gadolinium necessary to detect intralabyrinthine schwannomas?
- Source :
- American Journal of Otolaryngology. 39:133-137
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Objective Non-contrast MRI of the internal auditory canal (IAC) using high-resolution T2WI (T2 weighted image) has been proposed as the primary screening study in patients with sudden or asymmetric sensorineural hearing loss (ASNHL). However, there are concerns that non-contrast MRI may not detect labyrinthine pathology, specifically intralabyrinthine schwannomas (ILSs). The purpose of this study was to determine if non-contrast high-resolution T2WI alone are adequate to exclude these uncommon intralabyrinthine tumors. Methods 31 patients with ILSs and 36 patients without inner ear pathology that had dedicated MRI of the IAC performed with both non-contrast T2WI and post-contrast T1WI (T1 weighted image) were identified. Three board-certified neuroradiologists reviewed only the T2WI from these 67 cases. When an ILS was identified, its location and size were recorded. Sensitivity, specificity, and accuracy were calculated using the post-contrast T1WI as the “gold standard.” A consensus review of cases with discordant results was conducted. Results The sensitivity, specificity, and accuracy were 1.0, 1.0, and 1.0 for Observer 1; 0.84, 1.0, and 0.96 for Observer 2; 0.90, 1.0, and 0.98 for Observer 3. The 5 ILSs with discordant results were correctly identified upon consensus review. The median size of the ILSs was 4.4 mm (± 2.9 mm) and most (18/31) were intracochlear in location. Conclusion Non-contrast high-resolution T2WI alone can detect ILSs with 84–100% sensitivity, suggesting that gadolinium may be unnecessary to exclude ILSs on screening MRI. These findings have implications for reducing cost, time, and adverse events associated with gadolinium administration in patients presenting with sudden or ASNHL. Level of evidence 4
- Subjects :
- Adult
Male
medicine.medical_specialty
Hearing Loss, Sensorineural
Gadolinium
Labyrinth Diseases
chemistry.chemical_element
Mri screening
030218 nuclear medicine & medical imaging
Auditory canal
Diagnosis, Differential
Young Adult
03 medical and health sciences
Imaging, Three-Dimensional
0302 clinical medicine
Predictive Value of Tests
medicine
Humans
In patient
Aged
Retrospective Studies
Asymmetric sensorineural hearing loss
Aged, 80 and over
medicine.diagnostic_test
business.industry
Magnetic resonance imaging
Neuroma, Acoustic
Middle Aged
medicine.disease
Magnetic Resonance Imaging
ROC Curve
Otorhinolaryngology
chemistry
Female
Sensorineural hearing loss
Radiology
business
T2 weighted
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 01960709
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- American Journal of Otolaryngology
- Accession number :
- edsair.doi.dedup.....d3ffa23505ac38f605ed4ac4eaefcda9