The clinical value of 4-hour delayed-enhanced 3D-FLAIR MR images in sudden hearing loss

Hayoung Byun; Jae Ho Chung; Seung Hwan Lee; Chul Won Park; Dong Woo Park; Tae Yoon Kim

doi:10.1111/coa.13305

The clinical value of 4-hour delayed-enhanced 3D-FLAIR MR images in sudden hearing loss

Clin Otolaryngol. 2019 May;44(3):336-342. doi: 10.1111/coa.13305. Epub 2019 Feb 22.

Authors

Hayoung Byun¹, Jae Ho Chung¹, Seung Hwan Lee¹, Chul Won Park¹, Dong Woo Park², Tae Yoon Kim²

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery College of Medicine, Hanyang University, Hanyang University, Seoul, Korea.
² Department of Radiology, College of Medicine, Hanyang University, Seoul, Korea.

PMID: 30729710
DOI: 10.1111/coa.13305

Abstract

Objective: The aim of this study was to investigate the clinical significance of 4-hour delayed-enhanced 3.0 Tesla (3T) 3D-fluid-attenuated inversion recovery (FLAIR) MR imaging in sudden sensorineural hearing loss (SSNHL).

Study design: Case series with comparisons.

Setting: Tertiary referral centre.

Participants: Eighty-seven idiopathic SSNHL patients were enrolled between January 2015 and December 2016 and received high dose steroid therapy and intratympanic steroid injections as salvage treatment.

Intervention: Pre-contrast, 10-minute and 4-hour delayed-enhanced 3D-FLAIR MR images were obtained using double-dose IV gadolinium.

Main outcome measures: The results of treatment were evaluated according to Siegel's criteria 3 months after the start of treatment. Where possible lesion-side laterality of the inner ear was identified based on the MR images, the associations between MR findings and other clinical parameters were analysed, and the relationships between hearing recovery and MR image findings were assessed.

Results: Lesion-side laterality was identified on MRI in 52 (59.7%), 18 (20.1%) and 8 (9.2%) patients, based on 4-hour delayed, 10-minute delayed, and pre-contrast images, respectively. The hearing recovery rate was significantly lower in the patients with lesion-side laterality on 4-hour delayed images (P < 0.001). In a multivariate analysis, lesion-side laterality on 4-hour delayed images was associated with poor prognosis (OR = 5.6) after adjusting other prognostic factors including initial hearing level, lesion-side laterality on 10-min delayed images and presence of vertigo. In addition, as the extent of enhancement in the inner ear increased the probability of hearing recover decreased (P = 0.001).

Conclusions: Contrast enhancement of inner ear structures can be seen on 4-hour delayed-enhanced 3T 3D-FLAIR MR images in idiopathic SSNHL. Asymmetric lesion-side enhancement of the inner ear may be associated with a poor prognosis.

Keywords: fluid-attenuated inversion recovery; hearing loss; magnetic resonance imaging; sudden sensorineural hearing loss.

Publication types

Observational Study

MeSH terms

Ear, Inner / pathology*
Female
Follow-Up Studies
Hearing / physiology*
Hearing Loss, Sensorineural / diagnosis*
Hearing Loss, Sensorineural / physiopathology
Hearing Loss, Sudden / diagnosis*
Hearing Loss, Sudden / physiopathology
Humans
Imaging, Three-Dimensional / methods*
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Prognosis
Prospective Studies
Reproducibility of Results
Time Factors