Post-contrast 3D-FLAIR in idiopathic sudden sensorineural hearing loss

Wang, Jiali; Ren, Tongli; Sun, Wenfang; Wang, Wuqing; Wang, Wuqing

doi:10.1007/s00405-019-05285-z

Cited by 15 publications

(13 citation statements)

References 26 publications

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“…One study reported a correlation between increased signal in the diseased ear and poorer prognosis, but the association was only observed for pre-contrast imaging ( 44 ). Another study described a poorer prognosis when increased signal was observed on MRI performed 4 h after contrast administration ( 69 ). A third study reported a correlation between enhancement seen on MRI taken shortly after contrast injection and poorer initial hearing level but did not find a correlation with prognosis for hearing recovery ( 54 ).…”

Section: Resultsmentioning

confidence: 99%

MRI With Gadolinium as a Measure of Blood-Labyrinth Barrier Integrity in Patients With Inner Ear Symptoms: A Scoping Review

et al. 2021

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Objective: Capillaries within the inner ear form a semi-permeable barrier called the blood-labyrinth barrier that is less permeable than capillary barriers elsewhere within the human body. Dysfunction of the blood-labyrinth barrier has been proposed as a mechanism for several audio-vestibular disorders. There has been interest in using magnetic resonance imaging (MRI) with intravenous gadolinium-based contrast agents (GBCA) as a marker for the integrity of the blood labyrinth barrier in research and clinical settings. This scoping review evaluates the evidence for using intravenous gadolinium-enhanced MRI to assess the permeability of the blood-labyrinth barrier in healthy and diseased ears.Methods: A systematic search was conducted of three databases: PubMed, EMBASE, CINAHL PLUS. Studies were included that used GBCA to study the inner ear and permeability of the blood-labyrinth barrier. Data was collected on MRI protocols used and inner ear enhancement patterns of healthy and diseased ears in both human and animal studies.Results: The search yielded 14 studies in animals and 53 studies in humans. In healthy animal and human inner ears, contrast-enhanced MRI demonstrated gradual increase in inner ear signal intensity over time that was limited to the perilymph. Signal intensity peaked at 100 min in rodents and 4 h in humans. Compared to controls, patients with idiopathic sudden sensorineural hearing loss and otosclerosis had increased signal intensity both before and shortly after GBCA injection. In patients with Ménière's disease and vestibular schwannoma, studies reported increased signal at 4 h, compared to controls. Quality assessment of included studies determined that all the studies lacked sample size justification and many lacked adequate control groups or blinded assessors of MRI.Conclusions: The included studies provided convincing evidence that gadolinium crosses the blood-labyrinth barrier in healthy ears and more rapidly in some diseased ears. The timing of increased signal differs by disease. There was a lack of evidence that these findings indicate general permeability of the blood-labyrinth barrier. Future studies with consistent and rigorous methods are needed to investigate the relationship between gadolinium uptake and assessments of inner ear function and to better determine whether signal enhancement indicates permeability for molecules other than gadolinium.

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Section: Resultsmentioning

confidence: 99%

MRI With Gadolinium as a Measure of Blood-Labyrinth Barrier Integrity in Patients With Inner Ear Symptoms: A Scoping Review

et al. 2021

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“…Meanwhile, post-contrast 3D FLAIR MRI findings showed high sensitivity and encouraging prognostic value in several studies. 20,21) An enhancement in the post-contrast 3D FLAIR MRI can demonstrate loosening of the BLB. Although both pre-contrast 3D FLAIR MRI and post-contrast 3D FLAIR MRI can reflect on the integrity of BLB, care should be taken to differentiate between them since the visualized pathology is different.…”

Section: Discussionmentioning

confidence: 99%

3D FLAIR Cochlear Abnormality Does Not Predict on Sudden Sensorineural Hearing Loss Prognosis: A Retrospective Cohort Study

Shin¹,

Cho²,

Jeong³

et al. 2022

Korean J Otorhinolaryngol-Head Neck Surg

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Background and Objectives Previous studies reported abnormalities in MRI as a poor prognostic indicator of sudden sensorineural hearing loss (SSNHL). Since abnormalities in three-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) are strongly correlated with the initial hearing function, the prognostic value of the 3D FLAIR images should be carefully evaluated to avoid collinearity. We aimed to evaluate abnormalities on the 3D FLAIR images as an independent prognostic factor in the matched SSNHL groups. Subjects and MethodWe retrospectively reviewed medical records of 179 patients with SSNHL who underwent temporal MRI, including the 3D FLAIR sequence, between January 2015 and December 2019. Patients were divided based on the presence of cochlear abnormalities on the 3D FLAIR images. Hearing prognosis was evaluated with and without matching for initial hearing and treatment interval. Results The groups were similar in sex (p=0.091), age (p=0.925), treatment interval (p= 0.216), and MRI interval (p=0.828). Notably, patients with cochlear abnormalities on the 3D FLAIR images showed distinctly more severe hearing loss (p<0.001) at the initial pure tone average (PTA) assessment and poorer outcomes (p<0.001) compared to those without abnormality. After matching for initial hearing and treatment interval, the hearing outcome, measured by PTA, was similar between the groups (p=0.681). Conclusion Cochlear signal abnormality in 3D FLAIR MRI was associated with poor initial hearing. However, it did not affect hearing recovery outcomes when the groups were matched.

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“…However, three-dimensional-FLAIR still has the advantage of superior sensitivity for detecting low Gd concentrations in CSF over T1-weighted imaging. 46,89,90 Fast Scan Techniques Several efforts have been made to reduce scan time. Singleshot echo planar imaging-based two-dimensional-FLAIR reduces the scan time.…”

Section: Meningeal Lymphatic Vessel Enhancement Andmentioning

confidence: 99%

“…The comparison of sensitivity regarding low Gd concentration between two‐dimensional and three‐dimensional has not been explored. However, three‐dimensional‐FLAIR still has the advantage of superior sensitivity for detecting low Gd concentrations in CSF over T1‐weighted imaging 46,89,90 …”

Section: Relationship Between Flair and Gd Concentration: Physics And...mentioning

confidence: 99%

Contrast‐Enhanced Fluid‐Attenuated Inversion Recovery in Neuroimaging: A Narrative Review on Clinical Applications and Technical Advances

Ahn

Taoka

Moon

et al. 2022

Magnetic Resonance Imaging

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While contrast‐enhanced fluid‐attenuated inversion recovery (FLAIR) has long been regarded as an adjunct sequence to evaluate leptomeningeal disease in addition to contrast‐enhanced T1‐weighted imaging, it is gradually being used for more diverse pathologies beyond leptomeningeal disease. Contrast‐enhanced FLAIR is known to be highly sensitive to low concentrations of gadolinium within the fluid. Accordingly, recent research has suggested the potential utility of contrast‐enhanced FLAIR in various kinds of disease, such as Meniere's disease, seizure, stroke, traumatic brain injury, and brain metastasis, in addition to being used for visualizing glymphatic dysfunction. However, its potential applications have been reported sporadically in an unorganized manner. Furthermore, the exact mechanism for its superior sensitivity to low concentrations of gadolinium has not been fully understood. Rapidly developing magnetic resonance technology and unoptimized parameters for FLAIR may challenge its accurate application in clinical practice. This review provides the fundamental mechanism of contrast‐enhanced FLAIR, systematically describes its current and potential clinical application, and elaborates on technical considerations for its optimization.Level of Evidence3Technical Efficacy Stage5

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Post-contrast 3D-FLAIR in idiopathic sudden sensorineural hearing loss

Cited by 15 publications

References 26 publications

MRI With Gadolinium as a Measure of Blood-Labyrinth Barrier Integrity in Patients With Inner Ear Symptoms: A Scoping Review

MRI With Gadolinium as a Measure of Blood-Labyrinth Barrier Integrity in Patients With Inner Ear Symptoms: A Scoping Review

3D FLAIR Cochlear Abnormality Does Not Predict on Sudden Sensorineural Hearing Loss Prognosis: A Retrospective Cohort Study

Contrast‐Enhanced Fluid‐Attenuated Inversion Recovery in Neuroimaging: A Narrative Review on Clinical Applications and Technical Advances

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