Diagnostic Yield of MRI for Pediatric Hearing Loss: A Systematic Review

Abstract

Objective To perform a systematic review to analyze the diagnostic yield of magnetic resonance imaging (MRI) for pediatric hearing loss, including comparison to computed tomography (CT) and subgroup evaluation according to impairment severity and specific diagnostic findings (cochlear anomalies, enlarged vestibular aqueduct, cochlear nerve abnormalities, and brain findings). Data Sources Pubmed, EMBASE, and the Cochrane library were assessed from their inception through December 2013. Manual searches were also performed, and topic experts were contacted. Review Methods Data from studies describing the use of MRI with or without comparison to CT in the diagnostic evaluation of pediatric patients with hearing loss were evaluated, according to a priori inclusion/exclusion criteria. Two independent evaluators corroborated the extracted data. Heterogeneity was evaluated according to the I2 statistic. Results There were 29 studies that evaluated 2434 patients with MRIs and 1451 patients with CTs that met inclusion/exclusion criteria. There was a wide range of diagnostic yield from MRI. Heterogeneity among studies was substantial but improved with subgroup analysis. Meta-analysis of yield differences demonstrated that CT had a greater yield than MRI for enlarged vestibular aqueduct (yield difference 16.7% [95% CI, 9.1%–24.4%]) and a borderline advantage for cochlear anomalies (4.7% [95% CI, 0.1%–9.5%]). Studies were more likely to report brain findings with MRI. Conclusions These data may be utilized in concert with that from studies of risks of MRI and risk/yield of CT to inform the choice of diagnostic testing.

Abnormal Cochleovestibular Anatomy and Hearing Outcomes: Pediatric Patients with a Questionable Cochleovestibular Nerve Status May Benefit from Cochlear Implantation and/or Hearing Aids

“…Given the high degree of discordance between imaging finding interpretations in our series, we further recommend that these children be imaged and evaluated at centers with a neuroradiologist experienced with the complexities of these children. Our data also show that a dual imaging workup, e.g., HD CT and sMRI, allows acquisition of the most complete information on the status of the inner ear and nerve, as others have suggested [Westerhof et al, 2001;Sakina et al, 2006;Adunka et al, 2007;Miyasaka et al, 2010;Vlastarakos et al, 2010;Kachniarz et al, 2015]. In a comparison of CT with MRI for detecting clinically significant abnormalities, one imaging modality was not able to identify an abnormality detected by the other modality in 31% of the cases [Simons et al, 2006].…”

Temporal bone congenital anomalies and variatons

“…The bony margins of the stenotic/atretic canal can be demonstrated by CT. The bony deformity may compress the vestibulocochlear nerves (VCNs) [2,12,18,19] .…”

“…Three types of vestibulocochlear nerve hypoplasia and aplasia can be distinguished, as follows: type 1 displays stenotic IAC and VCN aplasia; type 2A involves a common VCN with aplasia/hypoplasia of the cochlear branch and labyrinthine malformation; type 2B shows normal labyrinthine structures [2,12,18] . Also, facial nerve hypoplasia may be seen with middle ear anomalies.…”

“…Identification of the position of the facial nerve is a crucial part of preoperative planning [2,12,18,19] .…”

Diagnosis and Treatment of Congenital Sensorineural Hearing Loss

“…Systematic reviews concluded that the diagnostic yield of imaging studies is approximately 30% for CT and 26% for MRI, respectively. 40,41 Imaging studies provide important information about anatomic variation in patients and can guide surgical planning for cochlear implantation; however, decision regarding timing of imaging must take into account risks attributable to either radiation exposure or sedation. If no significant management alterations would derive from imaging findings, one may consider deferring imaging until the child is old enough to undergo MRI without sedation, unless a non-sedated MRI protocol is available.…”