Incidental findings on magnetic resonance imaging of the internal auditory meatus performed to investigate audiovestibular symptoms

Abstract

Objective: To determine the frequency of incidental findings found on magnetic resonance imaging scans of the internal auditory meatus performed to investigate audiovestibular symptoms, and to determine how to best manage these when found.Method: A retrospective review was conducted of internal auditory meatus magnetic resonance imaging scans during a three-month period in the radiology department at a UK district general hospital.Results: A total of 109 scans were reviewed. Of these, 92.7 per cent showed no retrocochlear pathology, 0.9 per cent showed vestibular schwannoma, 6.4 per cent revealed vascular loops, and 2.8 per cent showed incidental findings that warranted further action and investigation. Of the scans, 40.4 per cent showed other incidental pathologies such as age-related ischaemic changes, and sinus disease that required no further intervention. Of the magnetic resonance imaging scans reviewed, 49.5 per cent were entirely normal.Conclusion: Almost half of the scans investigating audiovestibular symptoms showed incidental findings. Otolaryngologists should have an understanding of the significance of the most commonly encountered incidental findings, and should counsel patients appropriately and refer them onward when necessary.

Frequency and clinical significance of incidental findings detected in Internal Acoustic Canal MRIs of patients with audiovestibular symptoms

“…MRI is superior to examination methods such as auditory brain stem response in terms of cost-effectiveness and accuracy. [ 2 , 10 ] Intravenous contrast-enhanced MRI is the imaging method of choice in patients with audiovestibular symptoms, and it has been accepted as the gold standard in the detection of PCA pathologies such as acoustic neuroma, Bell’s palsy/vestibular neuritis, and vascular loop. [ 1 , 2 , 4 , 5 , 10 - 12 ] In our study, the detection rate of these PCA pathologies was as follows: Acoustic neuroma in 5 cases (1.34%), Bell’s palsy/vestibular neuritis in 11 cases (2.94%), and vascular loop in 57 (%15.24) cases.…”

“…Magnetic resonance imaging (MRI) is preferred because of its cost effectivity, accuracy, and superiority compared to other imaging methods. [ 2 - 5 ] The most common tumoral pathology encountered in PCA is acoustic neuroma. [ 5 ] Since the symptoms seen in PCA pathologies are general audiovestibular symptoms, they can be easily overlooked.…”

“…[ 1 ] In the literature, there are studies investigating IFs in cranial MRIs in various patient groups, and white matter hyperintensities (WMH), signal changes associated with mastoiditis and rhinosinusitis, vascular loop, intracranial masses, vascular anomalies, and empty sella have been reported as the most common IFs. [ 1 , 2 , 7 , 8 ] However, specific guidelines for these IFs showing how to approach or deal with are not sufficient. [ 9 ]…”

Oropharyngeal carcinoma, incidental findings on magnetic resonance imaging scans for audiovestibular symptoms, penetrating neck trauma and myringoplasty

“…2,3 The wide range of audiovestibular symptoms leading to a request for magnetic resonance imaging (MRI) means that most ENT surgeons will find much of their time responding to investigation results and dealing with the fall-out from incidental findings and the ensuing diagnostic chase. The quantification of this aspect of clinical practice was well done in a paper from Blackpool; 4 this study indicates that 40 per cent or so of scans show some incidental finding, which might be vascular (such as microvascular change with age: how much is too much? ), and so raising questions in need of answers.…”

Recent Advances in the Diagnosis of Audio-vestibular DisordersRunning head-Advances in the Diagnosis of Audio-vestibular Disorders

“…The cochlea-vestibular dysfunction generally progresses asymmetrically without any left-right asymmetry on MRI. There are incidental findings in 50.5% of 109 MRI scans of the internal auditory meatus for audiovestibular symptoms performed in a radiology department at a UK district general hospital (14).…”