Diagnostic Yield of MRI for Sensorineural Hearing Loss – An Audit

Abstract

Purpose: Contrast-enhanced magnetic resonance imaging (CEMRI) of the head is frequently employed in investigations of sensorineural hearing loss (SNHL). The yield of these studies is perceptibly low and seemingly at odds with the aims of wise resource allocation and risk reduction within the Canadian healthcare system. The purpose of our study was to audit the use and diagnostic yield of CEMRI for the clinical indication of SNHL in our institution and to identify characteristics that may be leveraged to improve yield and optimize resource utilization. Materials and methods: The charts of 500 consecutive patients who underwent CEMRI of internal auditory canal for SNHL were categorized as cases with relevant positive findings on CEMRI and those without relevant findings. Demographics, presenting symptoms, interventions and responses, ordering physicians, and investigations performed prior to CEMRI testing were recorded. Chi-squared test and t-test were used to compare proportions and means, respectively. Results: CEMRI studies revealed relevant findings in 20 (6.2%) of 324 subjects meeting the inclusion criteria. Pre-CEMRI testing beyond audiometry was conducted in 35% of those with relevant positive findings compared to 7.3% of those without (p < 0.001). Auditory brainstem response/vestibular-evoked myogenic potentials were abnormal in 35% of those with relevant CEMRI findings compared to 6.3% of those without (p < 0.001). Conclusion: CEMRI is a valuable tool for assessing potential causes of SNHL, but small diagnostic yield at present needs justification for contrast injection for this indication. Our findings suggest preferred referral from otolaryngologists exclusively, and implementation of a non-contrast MRI for SNHL may be a better diagnostic tool.

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

“…Two of the included studies did not include sino-nasal disease as an incidental finding (Hoekstra et al and Wong et al ), and two studies did not include multiple high signal white matter changes or small vessel disease as an incidental finding (Ahsan et al and Wong et al ). 1,9,20 A detailed breakdown of the results is shown in Table 2. A complete breakdown of all specific incidental findings is included in Table 1 in the supplementary material, and the conclusions of each included study are shown in Table 2 in the supplementary material, both available on The Journal of Laryngology & Otology website.…”

“…Magnetic resonance imaging of the internal auditory meatus (MRI IAM) or the head enhanced with intravenous gadolinium administration has revolutionised the diagnosis of vestibular schwannoma. Magnetic resonance imaging of the IAM or the head has a sensitivity and specificity approaching 100 per cent 1 for the identification of this rare but potentially life-threatening condition. As such, this imaging technique is now considered the ‘gold standard’ for the diagnosis of vestibular schwannoma.…”

“…7 Although MRI IAM has a high specificity and sensitivity, it is not without its disadvantages, mainly the associated cost and waiting times for scanning. 1,3,8 Another significant aspect to consider is the rate of incidental findings that MRI IAM can identify. Previous studies have quoted that rates of incidental findings in patients meeting criteria for MRI IAM are as high as 40–45 per cent.…”

Analysis of Changes in Brain Region and Connectomics in the Acute Stage of Sudden Sensorineural Hearing Loss in the Resting State via Functional Magnetic Resonance Imaging

“…Te functional network of the human brain is a complex and real network between a random network and a regular network, and its small-world attributes can ensure that the brain can efciently integrate and separate information under relatively low energy consumption [23]. Tis study found that at all thresholds, the fMRI parameters C p and L p of the patient group were dramatically superior to those of the control group.…”