Three-Dimensional Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Sudden Sensorineural Hearing Loss

Ryu, In Sun; Yoon, Tae Hyun; Ahn, Joong Ho; Kang, Woo Seok; Choi, Byung Se; Lee, Jeong Hyun; Shim, Myung Joo

doi:10.1097/mao.0b013e31822e969f

Cited by 40 publications

(60 citation statements)

References 14 publications

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“…In a total of 638 patients, pre‐contrast 3D‐FLAIR images were obtained of which 29% (n = 186) revealed high signal intensity in the labyrinth (Table ). In seven of the eight studies, data were also available on post‐contrast 3D‐FLAIR and/or T1‐weighted imaging . Contrast enhancement was found in 96 of 518 patients (19%).…”

Section: Resultsmentioning

confidence: 99%

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The prognostic value and pathophysiologic significance of three‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging in idiopathic sudden sensorineural hearing loss: A systematic review and meta‐analysis

Lammers

Young

Fenton

et al. 2019

Clinical Otolaryngology

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Background The underlying pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unknown. However, an increasing number of observational studies report intralabyrinthine signal alterations in patients with ISSNHL using three‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging (MRI). These findings warrant a meta‐analysis. Objective of review To conduct a meta‐analysis assessing the value of 3D‐FLAIR MRI in identifying possible underlying labyrinthine pathophysiologic mechanisms and prognostication in patients with ISSNHL. Search strategy Two reviewers independently searched the Pubmed, Embase and Cochrane Library from inception until October 10, 2018 and evaluated eligibility based on titles and abstracts of all retrieved studies. All studies reporting on 3D‐FLAIR imaging in ISSNHL were included. Subsequently, the full text of eligible studies were evaluated. Evaluation method Adhering to the MOOSE guideline, two independent reviewers extracted data, assessed risk of bias and evaluated the relevance and quality of evidence. Data on the number of patients and events were extracted and hearing levels were converted to standardised mean differences (SMD) for conducting meta‐analyses. Random effects models for meta‐analyses were applied. Results Eight observational studies met our inclusion criteria (n = 638 patients). In 29%, high signal intensity was found on 3D‐FLAIR imaging, suggesting labyrinthine pathology (labyrinthitis [79%], intralabyrinthine haemorrhage [21%]). High signal intensity on 3D‐FLAIR was associated with poorer hearing (SMD: 14 dB, 95% CI 5.67‐22.94) and vertigo (RR: 1.92, 95% CI 1.16‐3.17) at baseline. Multivariate analyses demonstrated that patients with high 3D‐FLAIR signal intensity had 21 dB lower final hearing pure‐tone averages (SMD: 21 dB, 95% CI 9.08‐33.24). Conclusions Three‐dimensional fluid‐attenuated inversion recovery MR imaging can identify an underlying labyrinthine condition in up to 29% of patients with sudden hearing loss in whom previously no cause could be identified. Their final pure‐tone averages are more than 20 dB worse than 3D‐FLAIR–negative patients, suggesting more severe labyrinthine damage. Findings such as these may contribute to our understanding of pathophysiologic mechanisms of ISSNHL.

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Section: Resultsmentioning

confidence: 99%

“…Contrast enhancement was found in 96 of 518 patients (19%). From six studies, the number of patients with 3D‐FLAIR, T1‐weighted imaging and contrast‐enhanced images could be extracted . In 21% of 112 patients with a positive pre‐contrast 3D‐FLAIR, T1‐weighted images also revealed high signal intensity in the labyrinth (Table ).…”

Section: Resultsmentioning

confidence: 99%

The prognostic value and pathophysiologic significance of three‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging in idiopathic sudden sensorineural hearing loss: A systematic review and meta‐analysis

Lammers

Young

Fenton

et al. 2019

Clinical Otolaryngology

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“…Because unaffected ears do not show an abnormal signal [4][5][6][7][8], we used the unaffected ear as the normal standard. The standard of judgment for positive and negative outcomes was as follows: patients were identified as positive if the affected ear showed higher signals than unaffected inner ear at any time point measured: precontrast, 10 min and 4 h after the intravenous Gd injection.…”

Section: Imaging Studiesmentioning

confidence: 99%

“…Four hours after intravenous Gd injection, the signal intensity in the affected ear is higher than that in the unaffected ear. High signal intensity is correlated with poor hearing prognosis [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A comparison of inner ear imaging features at different time points of sudden sensorineural hearing loss with three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

Zhu

et al. 2014

Eur Arch Otorhinolaryngol

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It has been reported that about half of patients with sudden sensorineural hearing loss (SSNHL) show high signals in the affected inner ear on three-dimensional, fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI). These signals may reflect minor hemorrhage or an increased concentration of protein in the inner ear, which has passed through blood vessels with increased permeability. Our objective was to compare the positive ratio of the high signal in affected inner ears at different time points to determine the suitable imaging time point for 3D-FLAIR MRI in SSNHL. 3D-FLAIR MRI images were taken at three times, precontrast and approximately 10 min and 4 h after intravenous injection of a single dose of gadodiamide (Gd) (0.1 mmol/kg), in 46 patients with SNHL. We compared the positive findings of the high signals in the inner ear of patients with SNHL as well as the signal intensity ratio (SIR) between the affected cochleae and unaffected cochleae at three time points. The positive ratios of the high signals in the affected inner ear at the time points of precontrast and 10 min and 4 h after the intravenous Gd injection were 26.1, 32.6, and 41.3%, respectively. The high signal intensity ratios of affected inner ears at the three time points were 1.28, 1.31, and 1.48, respectively. The difference between the positive ratios precontrast and at 10 min after the intravenous Gd injection was statistically significant (P = 0.006); the differences between the positive ratios at 4 h after the intravenous Gd injection and precontrast and between the ratios at 4 h and 10 min after the intravenous Gd injection were not statistically significant. The time effects of the median value of SIR were not significant (P = 0.064). We do not recommend 4 h after intravenous Gd injection as a time point to image the inner ear in SNHL. We believe that imaging precontrast and at 10 min after the intravenous Gd injection are suitable time points.

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“…Increased precontrast FLAIR signal has been described on 3D images of patients with sudden sensorineural hearing loss (17,18) and has also been associated with poor hearing recovery in these patients (19,20). Increased postcontrast FLAIR signal was described in a case of cochlear otosclerosis (21), and increased cochlear FLAIR signal has also been described in cases of labyrinthine fistula associated with cholesteatoma (22).…”

Section: Discussionmentioning

confidence: 99%

Hearing Preservation and Vestibular Schwannoma

Miller

Mafee

Bykowski

et al. 2014

Otology &Amp; Neurotology

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Three-Dimensional Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Sudden Sensorineural Hearing Loss

Abstract: High signals in the affected inner ear on 3D-FLAIR MRI closely correlate with vestibular dysfunction and poor hearing recovery in patients with SSNHL, especially when the vestibular apparatus is involved.

Cited by 40 publications

References 14 publications

The prognostic value and pathophysiologic significance of three‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging in idiopathic sudden sensorineural hearing loss: A systematic review and meta‐analysis

The prognostic value and pathophysiologic significance of three‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging in idiopathic sudden sensorineural hearing loss: A systematic review and meta‐analysis

A comparison of inner ear imaging features at different time points of sudden sensorineural hearing loss with three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

Hearing Preservation and Vestibular Schwannoma

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