An observational study of T2-weighted white matter hyperintensities on magnetic resonance imaging of the internal auditory meatus and brain: ignore or not?

Abstract

Background Magnetic resonance imaging of the internal auditory meatus frequently detects incidental white matter hyperintensities. This study investigated the association between these and the risk of stroke and transient ischaemic attack, or myocardial infarction. Methods The records of patients with incidental white matter hyperintensities were reviewed, and data were collected on: age, sex, cardiovascular risk factors, and incidence of stroke and transient ischaemic attack, or myocardial infarction, five years later. The risk factors associated with vascular events were explored. Results Of 6978 patients, 309 (4.4 per cent) had incidental white matter hyperintensities. Of these, 20 (6.5 per cent) had a stroke or transient ischaemic attack within five years, and 5 (1.7 per cent) had a myocardial infarction. The number of cardiovascular risk factors was significantly associated with the incidence of stroke and transient ischaemic attack (p = 0.004), and myocardial infarction (p = 0.023). Conclusion The number of cardiovascular risk factors predicts the likelihood of vascular events; appropriate risk factor management is recommended for patients with incidental white matter hyperintensities of presumed vascular origin.

Incidental findings on magnetic resonance imaging of the internal auditory meatus for vestibular schwannoma: a systematic review

“…At present, we could only recommend that the identification of multiple high signal white matter changes should prompt a clinical review to further define the likely underlying cause of the white matter changes. 23 If the changes are deemed to be because of small vessel ischaemia, evaluation and treatment of vascular risk factors would confer a benefit to patients.…”

“…The most common incidental finding that was identified in our review was small vessel disease or multiple T2-weighted high signal areas within white matter (a more accurate radiological term as it also includes non-specific white matter changes). 23 Several studies discussed the significance of these findings. Changes related to small vessel ischaemia become increasingly common in older populations, particularly in older adults where their prevalence can approach 95 per cent of the population.…”

Telehealth for tinnitus treatment, incidental findings on magnetic resonance imaging of the internal auditory meatus and predictive factors for recurrence following functional endoscopic sinus surgery

“…Following their prize-winning 2021 paper, the same group have gone on to publish, in this month's issue, a systematic review of incidental findings on magnetic resonance imaging (MRI) of the internal auditory meatus (IAM). 5,6 In their review, involving 10 666 patients, the overall detection rate of vestibular schwannoma was 0.87 per cent; 21 per cent of the study population had incidental findings on MRI of the IAM, and 9.56 per cent had clinically significant incidental findings. A similarly high rate of 'incidentalomas' was found in the MRI investigation of patients with unilateral non-pulsatile tinnitus (incidental finding rate of 24 per cent).…”

Thank you to our reviewers and editorial team

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