Revisiting the relationship of three-dimensional fluid attenuation inversion recovery imaging and hearing outcomes in adults with idiopathic unilateral sudden sensorineural hearing loss

Liao, Wen-Huei; Wu, Hsiu Mei; Wu, Hau Shin; Tu, Tzong Yang; Shiao, An Suey; Castillo, Maurício; Hung, Sheng-Che

doi:10.1016/j.ejrad.2016.10.005

Cited by 23 publications

(15 citation statements)

References 24 publications

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“…Two studies noted that hyperintensity of the diseased ears was more prevalent in MRI acquired before contrast was administered, as opposed to images taken shortly after or at 4 h after GBCA injection ( 44 , 54 ). Others reported an increased prevalence of abnormal enhancement of diseased ears when MRI was performed 4 h after GBCA administration as compared to MRI performed shortly after GBCA administration ( 58 , 64 ). 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 ).…”

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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“…Except for the study by Cho et al 2017, none of the studies included patients within 1 week after the onset of hearing loss or performed MRI scan within 1 week after the first visit to the clinic. Three studies used multivariate analyses to investigate whether other prognostic factors could influence their findings . The set of covariates used in these three studies varied, but all included initial pure‐tone average, high signal on 3D‐FLAIR and age.…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…In seven of the eight studies, data were also available on post-contrast 3D-FLAIR and/or T1-weighted imaging. 5,6,8,15,16,18,19 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.…”

Section: Search Strategy and Risk Of Bias Assessmentmentioning

confidence: 99%

“…Three studies used multivariate analyses to investigate whether other prognostic factors could influence their findings. 5,9,15 The set of covariates used in these three studies varied, but all included initial pure-tone average, high signal on 3D-FLAIR and age. Cho et al 2017 used a propensity score matching strategy to identify 23 matched controls for their comparative analyses, and matched their controls on initial hearing level, neuro-otologic parameters, underlying disease, lipid levels and thyroid function.…”

Section: Search Strategy and Risk Of Bias Assessmentmentioning

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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Cochlear signal alterations using pseudo-color perceptual enhancement for patients with sensorineural hearing loss

2021

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Revisiting the relationship of three-dimensional fluid attenuation inversion recovery imaging and hearing outcomes in adults with idiopathic unilateral sudden sensorineural hearing loss

Cited by 23 publications

References 24 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

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

Cochlear signal alterations using pseudo-color perceptual enhancement for patients with sensorineural hearing loss

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