Labyrinthine Enhancement on Gadolinium-Enhanced Magnetic Resonance Imaging in Sudden Deafness and Vertigo: Correlation with Audiologic and Electronystagmographic Studies

Abstract

Sudden deafness with or without vertigo presents a difficult diagnostic problem. This article describes 12 patients with enhancement of the cochlea and/or vestibule on gadolinium-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (MRI), correlating the enhancement with the auditory and vestibular function. All patients were studied with T2-weighted axial images taken through the whole brain, enhanced 3-mm axial T1-weighted images taken through the temporal bone, and enhanced T1-weighted sagittal images taken through the whole brain. Cochlear enhancement on the side of hearing loss was found in all the patients. The vestibular enhancement correlated with both subjective vestibular symptoms and objective measures of vestibular function on electronystagmography. In 2 patients, the resolution of symptoms 4 to 6 months later correlated with resolution of the enhancement on MRI. No labyrinthine enhancement was seen in a series of 30 control patients studied with the same MRI protocol. Labyrinthine enhancement in patients with auditory and vestibular symptoms is a new finding and is indicative of labyrinthine disease. While abnormalities on electronystagmograms and audiograms are nonspecific and only indicate a sensorineural problem, enhanced MRI may separate patients with retrocochlear lesions, such as acoustic neuromas, from those in whom the abnormal process is in the labyrinth or the brain.

Value of Magnetic Resonance Imaging and Audiology in the Emergency Department in Differential Diagnosis of Peripheral and Central Vertigo

“…However, Mark AS et al reported in their study that pathologies with central origin were found in some cases in which MRI was not required. 11 In our study, MRI of 6 out of 33 patients with peripheral vestibulopathy revealed a central lesion associated with vertigo. Although the difference between pathologies identified with MRI and abnormal audiovestibular tests was not significant, there was clinical significance.…”

Sudden Sensorineural Hearing Loss

“…Following resolution of hearing loss in two of 12 patients with initial enhancement in the cochlea or labyrinth, the inner ear enhancement on MRI was lost (Mark et al, 1992). Animal experiments have given further support to a viral etiology for idiopathic SSNHL.…”

Intratympanic Contrast in the Evaluation of Meniere Disease: Understanding the Limits

“…14 Since Mark et al 23 reported asymmetric labyrinthine enhancement after IV contrast in patients with sudden deafness and vertigo, continued technologic advances have improved our ability to resolve the delicate structures of the inner ear. Different methods have been used to assess the membranous labyrinth, with inherent variations among scanner vendors, protocols, coils, and contrast agents.…”