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Four-hour-delayed 3D-FLAIR MRIs in patients with acute unilateral peripheral vestibulopathy
Keun-Tae Kim1, Sangeun Park2, Sun-Uk Lee1,3
1Department of Neurology, Korea University Medical Center, Seoul, South Korea.
Objective:
Conventionally, MRI aids in differentiating acute unilateral peripheral vestibulopathy/vestibular neuritis (AUPV/VN) from mimickers. Meanwhile, the diagnostic utility of MRIs dedicated to the inner ear remains to be elucidated for diagnosing AUPV/VN.
Methods:
We prospectively recruited 53 patients with AUPV/VN (mean age ± SD = 60 ± 15 years, 29 men). Initial MRIs were performed with a standard protocol, and an additional axial 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence was obtained 4 h after intravenous injection of gadoterate meglumine. Abnormal enhancement was defined as a signal intensity that exceeded the mean + 2SD value on the healthy side. The findings of neurotologic evaluation and MRIs were compared.
Results:
Overall, the inter-rater agreement for gadolinium enhancement was 0.886 (Cohen's kappa coefficient). Enhancement was observed in 26 patients (49%), most frequently in the vestibule (n = 20), followed by the anterior (n = 12), horizontal (HC, n = 8), posterior canal (n = 5), and superior (n = 3) and inferior (n = 1) vestibular nerves. In multivariable logistic regression analysis, the enhancement was associated with decreased HC gain in video head-impulse tests (p = 0.036), increased interaural difference in ocular vestibular-evoked myogenic potentials (p = 0.001), and a longer onset-to-MRI time span (p = 0.024). The sensitivity and specificity were 92.3% and 81.5%, respectively, with an area under the curve of 0.90 for predicting gadolinium enhancement.
Interpretation:
Robust gadolinium enhancement was observed on 4-hour-delayed 3D-FLAIR images in nearly half of the patients with AUPV/VN, with a good correlation with the results of neurotologic evaluation. The positivity may be determined by the extent of vestibular deficit, timing of imaging acquisition, and possibly by the underlying etiology causing AUPV/VN. MRIs may aid in delineating the involved structures in AUPV/VN.
Insights
Delayed MRI with gadolinium enhancement shows significant findings in nearly half of patients with acute unilateral peripheral vestibulopathy/vestibular neuritis (AUPV/VN). This imaging technique correlates well with neurotologic evaluations, aiding in diagnosis.
Area of Science:
- Neurology
- Radiology
- Otolaryngology
Background:
- Magnetic Resonance Imaging (MRI) is conventionally used to differentiate acute unilateral peripheral vestibulopathy/vestibular neuritis (AUPV/VN) from similar conditions.
- The diagnostic value of specialized inner ear MRIs for AUPV/VN requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic utility of delayed, contrast-enhanced 3D-FLAIR MRI sequences in patients with AUPV/VN.
- To assess the correlation between MRI findings and neurotologic evaluations in AUPV/VN.
Main Methods:
- Prospective recruitment of 53 patients diagnosed with AUPV/VN.
- Standard MRI protocol followed by an axial 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence 4 hours post-gadolinium injection.
- Comparison of MRI findings with neurotologic assessments.
Main Results:
- Gadolinium enhancement was observed in 49% of patients, most commonly in the vestibule and vestibular nerves.
- Enhancement correlated significantly with decreased horizontal canal (HC) gain, increased interaural difference in vestibular-evoked myogenic potentials, and longer time from symptom onset to MRI.
- The imaging demonstrated high sensitivity (92.3%) and specificity (81.5%) for predicting enhancement.
Conclusions:
- Delayed 4-hour 3D-FLAIR MRI with gadolinium enhancement reveals abnormalities in nearly half of AUPV/VN patients.
- MRI findings show good correlation with neurotologic evaluation results.
- This MRI technique can help delineate affected structures in AUPV/VN, with findings potentially influenced by vestibular deficit extent, imaging timing, and etiology.
