The value of enhanced magnetic resonance imaging in the evaluation of endocochlear disease.
BACKGROUND
Gadolinium-enhanced magnetic resonance imaging (GdMRI) is routinely used in the evaluation and management of suspected retrocochlear pathology such as vestibular schwannoma. However, its value in the evaluation and diagnosis of cochlear pathology associated with sensorineural hearing loss (SNHL) has been less clear.


METHODS
Retrospective review of case histories and imaging studies of patients with SNHL and cochlear enhancement on GdMRI diagnosed between 1998 and 2000.


RESULTS
Five patients with SNHL who required gadolinium administration to establish the diagnosis of endocochlear disease were identified. Diagnosed lesions included an intralabyrinthine schwannoma, intracochlear hemorrhage, radiation-induced ischemic change, autoimmune labyrinthitis, and meningogenic labyrinthitis. In these illustrative cases, the GdMRI demonstrated intrinsic high signal or contrast enhancement within the cochlea and labyrinth in the absence of a retrocochlear mass. In one patient with meningogenic labyrinthitis, cochlear enhancement on MRI led to prompt cochlear implantation before the potential development of cochlear ossification.


CONCLUSIONS
Our experience suggests that GdMRI plays a crucial role in the diagnosis of cochlear pathology associated with sensorineural hearing loss and may directly impact patient management.
Hegarty
Joseph L
JL
Department of Otolaryngology-Head & Neck Surgery, University of California, 400 Parnassus Avenue, San Francisco, CA 94143-0342, U.S.A.
Patel
Sandy
S
Fischbein
Nancy
N
Jackler
Robert K
RK
Lalwani
Anil K
AK
D000328:Adult; D001301:Audiometry, Pure-Tone; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000209:etiology; D003051:Cochlea / Q000473:pathology / Q000528:radiation effects; D015834:Cochlear Diseases / Q000175:diagnosis*; D019929:Cochlear Implantation; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation; D003639:Hearing Loss, Sudden / Q000209:etiology; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007089:Image Enhancement; D007762:Labyrinthitis / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000175:diagnosis; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology