Inner Ear Enhancement With Delayed 3D-FLAIR MRI Imaging in Vestibular Schwannoma

作者：Andrew J. Bowen, Matthew L. Carlson, John Ignatius Lane · 发表于：Otology & Neurotology · 年份：2020 · DOI：10.1097/mao.0000000000002768 · 被引用次数：18 · 研究领域：Meningioma and schwannoma management、Vestibular and auditory disorders、Brain Metastases and Treatment

OBJECTIVES: To evaluate blood-labyrinth barrier permeability using delayed gadolinium enhanced three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) in patients with untreated sporadic vestibular schwannoma (VS) to interrogate the etiopathogenesis of progressive sensorineural hearing loss. DESIGN: Prospective case series. SETTING: Single institution tertiary care center. PARTICIPANTS: Patients with previously untreated small to medium-sized unilateral VS undergoing 3D-FLAIR imaging 10 minutes (immediate) and 5 to 8 hours (delayed) after administration of intravenous gadolinium. MAIN OUTCOME MEASURES: Comparison of cochlear and vestibular signal intensity ratios (SIRs) across immediate and delayed images and across the tumor and nontumor ear. RESULTS: Six of eight (75%) patients demonstrated asymmetric enhancement of inner ear structures on delayed contrast-enhanced imaging. Delayed mean cochlea and vestibule SIRs were significantly greater than immediate SIRs (cochlea: 1.91 versus 1.21 [p = 0.02]; vestibule 1.74 versus 1.15 [p = 0.02]). A higher vestibule SIR was statistically significantly associated with poorer pure-tone average and word recognition scores (p = 0.001). CONCLUSION: Ears with VS exhibited increased enhancement on delayed 3D FLAIR imaging. These findings suggest that alterations in blood-labyrinth barrier permeability may explain progressive sensorineural hearing loss in a subset of patients with untreated VS.