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Original Article |

Analysis of the 3-Dimensional Fluid-Attenuated Inversion-Recovery (3D-FLAIR) Sequence in Idiopathic Sudden Sensorineural Hearing Loss

Stefano Berrettini, MD; Veronica Seccia, MD, PhD; Susanna Fortunato, MD; Francesca Forli, MD, PhD; Luca Bruschini, MD; Paolo Piaggi, PhD; Raffaello Canapicchi, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(5):456-464. doi:10.1001/jamaoto.2013.2659.
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Importance The unpredictability of idiopathic sudden sensorineural hearing loss (ISSNHL) presents a challenge to preventive care. Our study confirms the potentially important role of the 3-T magnetic resonance imaging (MRI), and in particular of the 3-dimensional fluid-attenuated inversion-recovery (3D-FLAIR) sequence, in the diagnosis and prognosis of ISSNHL to guide medical treatment.

Objective To confirm the diagnostic, clinical, and prognostic role of 3D-FLAIR MRI in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

Design, Setting, and Patients Retrospective study in a tertiary referral center with a consecutive sample of 23 patients diagnosed as having unilateral ISSNHL from January 2010 to March 2011.

Exposures Patients underwent 3D-FLAIR MRI at 3 T to evaluate ISSNHL, and the MRI images were compared with those belonging to a random group of 20 age-matched healthy patients.

Main Outcomes and Measures Precontrast and postcontrast high-intensity 3D-FLAIR MRI findings in patients with ISSNHL and the correlation with clinical findings.

Results Thirteen patients showed high-intensity signals in the affected inner ear on precontrast and postcontrast 3D-FLAIR MRI (57%). From the analysis of different MRI sequences, we posited 3 radiologic patterns likely correlated with mild hemorrhage, acute inflammation, and presence or absence of blood-labyrinth or nerve barrier (BLB) breakdown. Hypersignal on 3D-FLAIR MRI was positively associated with pretreatment hearing loss (P = .04) and presence of vertigo (P = .04). A strict correlation also existed between distribution of the signal (vestibule, semicircular canals) and clinical features (vertigo) (P = .04).

Conclusions and Relevance Use of 3D-FLAIR MRI at 3 T may contribute to the elucidation of pathologic conditions in the inner ears of patients with ISSNHL and provide new radiologic indicators (mild hemorrhage, acute inflammation, presence or absence of BLB breakdown) that might assume the role of prognostic factors.

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Figure 1. Patient imaging studies from the present series. A and B, Contiguous, axial, T1 fat-suppression post gadolinium images with no enhancement in the left internal acoustic canal. C-F, Axial (C and D) and oblique sagittal (E and F) reformatted 3D-FLAIR (3-dimensional fluid-attenuated inversion-recovery) images before (C and E) and after (D and F) gadolinium administration showing enhancement of the left cochlear nerve consistent with blood-nervous barrier breakdown after gadolinium administration (white arrows).

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Figure 2. Patient imaging studies from the present series. A and B, Fast-spin echo T1 axial images before (A) and after (B) gadolinium administration with fat suppression showing mild hyperintense signal of the middle gyrus of the left cochlea without enhancement after gadolinium administration owing to methemoglobin deposition from hemorrhage. C and D, Three-dimensional FLAIR (fluid-attenuated inversion-recovery) axial images before (C) and after (D) gadolinium administration showing diffuse, nonhomogeneous hyperintense signal within the middle and apical gyrus of the cochlea on the left, without enhancement.

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Figure 3. Patient imaging studies from the present series. A and B, Fast-spin echo T1 axial images before (A) and after (B) gadolinium administration with fat suppression showing normal signal of labyrinthine fluid without enhancement. C and D, Three-dimensional FLAIR (fluid-attenuated inversion-recovery) axial images before (C) and after (D) gadolinium administration showing mild hyperintense signal of the middle and apical gyri of the cochlea on the left without enhancement after gadolinium administration.

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Figure 4. Patient imaging studies from the present series. A and B, FIESTA (fast-inflow steady-state acquisition) axial images showing normal signal of labyrinthine fluid. C and D, T1 fast-spin echo axial images before (C) and after (D) administration of gadolinium with fat suppression showing normal labyrinthine signal (C) and very doubtful mild enhancement of the cochlear fluid (D). E-H, Three-dimensional FLAIR (fluid-attenuated inversion-recovery) axial images before (E and F) and after (G and H) gadolinium administration showing hyperintense signal of the labyrinthine fluid (E and F) with strong enhancement (G and H). Note the lack of signal from the labyrinth in the unaffected side.

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