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Everest S, Monteith G, Gaitero L, Samarani F. Suppression of inner ear signal intensity on fluid-attenuated inversion recovery magnetic resonance imaging in cats with vestibular disease. J Feline Med Surg 2023; 25:1098612X231168001. [PMID: 37102785 PMCID: PMC10811974 DOI: 10.1177/1098612x231168001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES Otitis media/interna (OMI) is the most common cause of peripheral vestibular disease in cats. The inner ear contains endolymph and perilymph, with perilymph being very similar in composition to cerebrospinal fluid (CSF). As a very-low-protein fluid, it would be expected that normal perilymph should suppress on fluid-attenuated inversion recovery (FLAIR) MRI sequences. Based on this, we hypothesized that MRI FLAIR sequences should provide a non-invasive way of diagnosing inflammatory/infectious diseases such as OMI in cats, something that has previously been demonstrated in humans and, more recently, in dogs. METHODS This was a retrospective cohort study in which 41 cats met the inclusion criteria. They were placed into one of four groups, based on presenting complaint: clinical OMI (group A); inflammatory central nervous system (CNS) disease (group B); non-inflammatory structural disease (group C); and normal brain MRI (control group; group D). Transverse T2-weighted and FLAIR MRI sequences at the level of the inner ears bilaterally were compared in each group. The inner ear was selected as a region of interest using Horos, with a FLAIR suppression ratio calculated to account for variability in signal intensity between MRIs. This FLAIR suppression ratio was then compared between groups. Statistical analyses were performed by an experienced statistician, with a general linear model used to compare mean FLAIR suppression ratio, CSF nucleated cell count and CSF protein concentration between groups. RESULTS The OMI group (group A) had significantly lower FLAIR suppression scores compared with all other groups. The CSF cell count was also significantly increased in the OMI (group A) and inflammatory CNS disease (group B) groups compared with the control group (group D). CONCLUSIONS AND RELEVANCE This study demonstrates the utility of MRI FLAIR sequences in diagnosing presumptive OMI in cats, similarly to in humans and dogs. This study is relevant to practicing veterinary neurologists and radiologists in interpreting MRI findings in cats with suspected OMI.
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Affiliation(s)
- Stephen Everest
- Ontario Veterinary College Health Science Centre, University of Guelph, Guelph, ON, Canada
| | - Gabrielle Monteith
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Luis Gaitero
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Francesca Samarani
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
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Unilateral decrease in inner ear signal in fluid-attenuated inversion recovery sequences in previously suspected canine idiopathic vestibular syndrome. Vet J 2021; 277:105748. [PMID: 34537343 DOI: 10.1016/j.tvjl.2021.105748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 12/27/2022]
Abstract
The aetiology of canine idiopathic vestibular syndrome (IVS) remains unclear. In human medicine, characteristic magnetic resonance imaging (MRI) techniques are used to demonstrate differences in endolymph composition between affected and unaffected inner ears. The purpose of this study was to determine whether similar MRI techniques could help to detect changes in the inner ears of canine IVS patients. Medical records from two veterinary referral clinics were reviewed retrospectively. Dogs were included if they had a diagnosis of IVS, obvious lateralisation of clinical signs, and an MRI of the vestibular system. A region of interest (ROI) was manually outlined by defining the anatomical area of the inner ear in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. In order to calculate the ratio of FLAIR suppression of each ear, the mean grey value of the ROI was determined in both sequences. If a unilateral decrease in suppression was identified, it was compared with the direction of clinical signs. In total, 80 dogs were included in the study. There was a significantly lower degree of suppression on the affected compared to the unaffected side (0.8886 vs. 0.9348, respectively; P = 0.0021). In 92.5% of cases, there was agreement between the most suppressed side on MRI and the direction of clinical signs. This study provides preliminary evidence about the appearance of endolymph on MRI of dogs with IVS. Further studies are needed to investigate associations between the severity of MRI changes and prognosis.
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Kurihara YY, Fujikawa A, Tachizawa N, Takaya M, Ikeda H, Starkey J. Temporal Bone Trauma: Typical CT and MRI Appearances and Important Points for Evaluation. Radiographics 2020; 40:1148-1162. [DOI: 10.1148/rg.2020190023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yoshiko Y. Kurihara
- From the Department of Radiology, Machida Municipal Hospital, 2-15-41 Asahi-cho, Machida, Tokyo 194-0023, Japan (Y.Y.K., N.T., M.T.); Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan (A.F., H.I.); and Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (J.S.)
| | - Astuko Fujikawa
- From the Department of Radiology, Machida Municipal Hospital, 2-15-41 Asahi-cho, Machida, Tokyo 194-0023, Japan (Y.Y.K., N.T., M.T.); Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan (A.F., H.I.); and Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (J.S.)
| | - Natsuki Tachizawa
- From the Department of Radiology, Machida Municipal Hospital, 2-15-41 Asahi-cho, Machida, Tokyo 194-0023, Japan (Y.Y.K., N.T., M.T.); Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan (A.F., H.I.); and Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (J.S.)
| | - Mamiko Takaya
- From the Department of Radiology, Machida Municipal Hospital, 2-15-41 Asahi-cho, Machida, Tokyo 194-0023, Japan (Y.Y.K., N.T., M.T.); Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan (A.F., H.I.); and Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (J.S.)
| | - Hirotaka Ikeda
- From the Department of Radiology, Machida Municipal Hospital, 2-15-41 Asahi-cho, Machida, Tokyo 194-0023, Japan (Y.Y.K., N.T., M.T.); Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan (A.F., H.I.); and Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (J.S.)
| | - Jay Starkey
- From the Department of Radiology, Machida Municipal Hospital, 2-15-41 Asahi-cho, Machida, Tokyo 194-0023, Japan (Y.Y.K., N.T., M.T.); Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan (A.F., H.I.); and Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (J.S.)
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Castillo G, Parmentier T, Monteith G, Gaitero L. Inner ear fluid-attenuated inversion recovery MRI signal intensity in dogs with vestibular disease. Vet Radiol Ultrasound 2020; 61:531-539. [PMID: 32564460 DOI: 10.1111/vru.12876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/23/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022] Open
Abstract
The inner ear contains endolymph and perilymph. The second is comparable and in continuity with the cerebrospinal fluid (CSF) so it is expected to suppress in fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) if normal. Even though inner ear FLAIR abnormalities have been extensively described in humans with inner ear disease, its diagnostic value in dogs is yet to be proven. The goal of this retrospective cohort study was to investigate the diagnostic utility of FLAIR MRI in dogs with vestibular disease. A review of medical records identified 101 dogs that had brain MRI performed because of vestibular signs. Based on the final diagnosis, patients were allocated to three groups: otitis media/interna, idiopathic vestibular disease, and central vestibular disease. Additionally, a control group (n = 73) included dogs with normal MRI and without vestibular signs. Inner ears were delineated using a region of interest, and signal intensity was measured in FLAIR and T2-weighted images. The percentages of suppression in FLAIR were calculated and compared between affected and unaffected sides of each individual and between groups using a general linear mixed model. Correlation between suppression and CSF cell count and protein concentration was assessed. Affected inner ears in dogs with otitis media/interna had decreased suppression in FLAIR compared to the unaffected side (P < .001), and all other groups (P < .01). No significant correlation was detected between CSF results and suppression. These results show the diagnostic value of FLAIR in otitis media/interna due to lack of suppression in the affected inner ear.
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Affiliation(s)
- Gibrann Castillo
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Thomas Parmentier
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Gabrielle Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Luis Gaitero
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Breen JT, Edwards CR, Cornelius RS, Hazenfield JM, Kohlberg GD, Samy RN, Pensak ML. Utility of Magnetic Resonance Imaging in Differentiating Cerebrospinal Fluid Leak from Middle Ear Effusion. Otolaryngol Head Neck Surg 2019; 161:493-498. [DOI: 10.1177/0194599819847153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ObjectiveTo demonstrate the clinical utility, sensitivity, and specificity of standard magnetic resonance imaging (MRI) sequences in differentiating temporal bone cerebrospinal fluid leaks from all other middle ear effusions.Study DesignRetrospective imaging review.SettingAcademic medical center.SubjectsPatients with cerebrospinal fluid leaks or other middle ear effusions who also underwent MRI.MethodsPatients were assigned to cerebrospinal fluid leak and other effusion cohorts based on clinical course, findings at surgery/myringotomy, and beta-2 transferrin fluid analysis. Reviewers blinded to the clinical outcome examined T1-weighted, T2-weighted, diffusion-weighted, fluid-attenuated inversion recovery (FLAIR), and 3-dimensional (3D) acquired T2-weighted MRI sequences. For each sequence, fluid imaged in the temporal bone was graded as either similar or dissimilar in signal intensity to cerebrospinal fluid in the adjacent subarachnoid space. Signal similarity was interpreted as being diagnostic of a leak. Test characteristics in predicting the presence of a leak were calculated for each series.ResultsEighty patients met criteria (41 leaks, 39 other effusions). The 3D T2 series was 76% sensitive and 100% specific in diagnosing a leak, and FLAIR was 44% sensitive and 100% specific. The T1-weighted (73% sensitive, 69% specific), T2-weighted (98% sensitive, 5.1% specific), and diffusion-weighted (63% sensitive, 66% specific) series were less useful.ConclusionsMRI, with attention to 3D T2 and FLAIR series, is a noninvasive and highly specific test for diagnosing cerebrospinal fluid leak in the setting of an indeterminate middle ear effusion.
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Affiliation(s)
- Joseph T. Breen
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Colin R. Edwards
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rebecca S. Cornelius
- Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - J. Michael Hazenfield
- Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gavriel D. Kohlberg
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ravi N. Samy
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Myles L. Pensak
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Cochlear FLAIR Signal Changes in Hearing Preservation Vestibular Schwannoma Surgery. Otol Neurotol 2019; 40:375-383. [DOI: 10.1097/mao.0000000000002102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Seroussi J, Hautefort C, Gillibert A, Kania R, Guichard JP, Vitaux H, Herman P, Houdart E, Attyé A, Eliezer M. Postoperative MR imaging features after superior semicircular canal plugging in Minor syndrome. Diagn Interv Imaging 2018; 99:679-687. [PMID: 30220585 DOI: 10.1016/j.diii.2018.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/03/2018] [Accepted: 08/19/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To report the postoperative magnetic resonance imaging (MRI) features after superior semicircular canal plugging in patients with Minor syndrome. MATERIALS AND METHODS The MRI examinations with 3D T2-weighted SPACE sequence of 12 patients with superior semicircular canal dehiscence syndrome (SCDS) were retrospectively assessed. Two radiologists independently evaluated the presence of a filling defect of the superior semicircular canal above the superior ampulla and the common crus using an oblique plane parallel to the superior semicircular canal (Pöschl's plane). RESULTS Postoperative MRI showed a filling defect above the ampulla of the superior semicircular canal and the common crus in 8/12 patients (67%). Three patients (3/12; 25%) had a filling defect involving also the superior ampulla that caused postoperative labyrinthitis with labyrinthine enhancement on MRI in 2 patients. One patient (1/12; 8%) had incomplete plugging of superior semicircular canal with abnormal functional tests and remaining symptoms. CONCLUSION Postoperative MRI shows a normal plugging aspect of the superior semicircular canal in 67% of patients. MRI can reveal complications that may have therapeutic implications.
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Affiliation(s)
- J Seroussi
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France
| | - C Hautefort
- Department of Head and Neck Surgery, Lariboisière University Hospital, 75010 Paris, France
| | - A Gillibert
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France
| | - R Kania
- Department of Head and Neck Surgery, Lariboisière University Hospital, 75010 Paris, France
| | - J-P Guichard
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France
| | - H Vitaux
- Department of Head and Neck Surgery, Lariboisière University Hospital, 75010 Paris, France
| | - P Herman
- Department of Head and Neck Surgery, Lariboisière University Hospital, 75010 Paris, France
| | - E Houdart
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France
| | - A Attyé
- Department of Neuroradiology and MRI, Grenoble Alpes University Hospital, SFR RMN Neurosciences, 38000 Grenoble, France
| | - M Eliezer
- Department of Neuroradiology, Lariboisière University Hospital, 75010 Paris, France.
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Differentiation Between Intralabyrinthine Schwannoma and Contrast-enhancing Labyrinthitis on MRI: Quantitative Analysis of Signal Intensity Characteristics. Otol Neurotol 2018; 39:1045-1052. [DOI: 10.1097/mao.0000000000001901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Imagen de la hipoacusia postraumática. RADIOLOGIA 2018; 60:119-127. [DOI: 10.1016/j.rx.2017.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 11/18/2022]
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Mazón M, Pont E, Albertz N, Carreres-Polo J, Más-Estellés F. Imaging of post-traumatic hearing loss. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Post traumatic deafness: a pictorial review of CT and MRI findings. Insights Imaging 2016; 7:341-50. [PMID: 27085885 PMCID: PMC4877355 DOI: 10.1007/s13244-016-0490-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED Hearing loss is a common functional disorder after trauma, and radiologists should be aware of the ossicular, labyrinthine or brain lesions that may be responsible. After a trauma, use of a systematic approach to explore the main functional components of auditory pathways is essential. Conductive hearing loss is caused by the disruption of the conductive chain, which may be due to ossicular luxation or fracture. This pictorial review firstly describes the normal 2-D and 3-D anatomy of the ossicular chain, including the incudo-malleolar and incudo-stapedial joints. The role of 3-D CT in the post-traumatic evaluation of injury to the temporal bone is then evaluated. In the case of sensorineural hearing loss, CT can detect pneumolabyrinth and signs of perilymphatic fistulae but fails to detect subtle lesions within the inner ear, such as labyrinthine haemorrhage or localized brain axonal damage along central auditory pathways. The role that MRI with 3-D-FLAIR acquisition plays in the detection of inner ear haemorrhage and post-traumatic lesions of the brain parenchyma that may lead to auditory agnosia is also discussed. KEY POINTS • The most common middle ear injuries are incudo-malleolar and incudo-stapedial joint luxation. • In patients with SNHL, CT can detect pneumolabyrinth or perilymphatic fistula • 3-D-FLAIR MRI appears the best sequence to highlight labyrinthine haemorrhage • Axonal damage and brain hematoma may lead to deafness.
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Ernst A. Perspectives in vestibular diagnostics and therapy. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc05. [PMID: 22558055 PMCID: PMC3341582 DOI: 10.3205/cto000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vestibular diagnostics and therapy ist the mirror of technological, scientific and socio-economics trends as are other fields of clinical medicine. These trends have led to a substantial diversification of the field of neurotology.The improvements in diagnostics have been characterized by the introduction of new receptor testing tools (e.g., VEMPs), progress in imaging (e.g., the endolymphatic hydrops) and in the description of central-vestibular neuroplasticity. The etiopathology of vestibular disorders has been updated by geneticists (e.g., the description of the COCH gene mutations), the detection of structural abnormalities (e.g., dehiscence syndromes) and related disorders (e.g. migraine-associated vertigo). The therapeutic options were extended by re-evaluation of techniques known a long time ago (e.g., saccus exposure), the development of new approaches (e.g., dehiscence repair) and the introduction of new drug therapy concepts (e.g., local drug delivery). Implantable, neuroprosthetic solutions have not yet reached experimental safety and validity and are still far away. However, externally worn neuroprosthetic solution were introduced in the rehab of vestibular disorders (e.g., VertiGuard system).These and related trends point into a medical future which is characterized by presbyvertigo as classical sign of the demographic changes ahead, by shortage of financial resources and a medico-legally over-regulated, even hostile environment for physicians in clinical medicine.
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Endolympathic hydrops in patients with vestibular schwannoma: visualization by non-contrast-enhanced 3D FLAIR. Neuroradiology 2011; 53:1009-15. [DOI: 10.1007/s00234-010-0834-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
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