Computed tomography and magnetic resonance imaging in the preoperative work-up for cochlear implantation

The role of CT and MRI in the evaluation of patients for possible insertion of a multichannel intracochlear hearing device was appraised. The study included 52 patients who underwent both CT and MRI examinations, 40 of whom were later operated on. Coronal and axial T2-weighted spin-echo sequences were performed in 25 volunteers with normal hearing and in 47 adult patients. In 5 patients, instead of a T2-weighted spin-echo sequence, a T2*-weighted gradient echo 3D sequence with axial presaturation was used. In 39 patients with normal appearances on CT and MRI, the implant device was successfully inserted. One patient who underwent surgery had a reduced cochlear signal on MRI but a normal CT scan; however, at surgery, the implant device could only be inserted into the first turn of the cochlea, due to fibrous obliteration. In 3 of 12 patients who were not operated upon, the results of diagnostic imaging indicated that the insertion of an intracochlear hearing device was not useful. Our experience indicates that, with reduced cochlear fluid signal intensities on MRI, fibrous obliteration of the cochlear turns is likely to be present. MRI proved to be a useful adjunct to CT, but the latter was necessary for the evaluation of bony abnormalities. Gradient echo sequences can successfully replace time-consuming T2-weighted spin-echo sequences.