Relationship between Signal Intensity of the Labyrinth and Cochleovestibular Testing and Morphologic Features of Vestibular Schwannoma

Abstract

Objectives The aim of this article was to evaluate the relationship between signal intensity of the labyrinth and vestibulocochlear function and morphologic features of vestibular schwannoma (VS).

Design Cross-sectional Study.

Setting Tertiary referral center.

Participants Fifty-four patients with sporadic, untreated VS.

Main Outcome Measure Signal intensity of the cochlea and vestibule (SIRc and SIRv: signal intensity of cochlea/vestibule compared with cerebellar signal intensity; AURc and AURv: SIRc/SIRv of the affected side compared with the unaffected side) in 1.5T T2-weighted images was correlated with size (Hannover classification), cystic status, distance from the fundus of the internal auditory canal, video head impulse test (vHIT), and audiometry.

Results Signal intensity of the vestibule was higher than that of the cochlea (p < 0.01). Large tumors had lower SIRc than smaller tumors (p = 0.03); Hannover T1 tumors had higher SIRc (p < 0.01), SIRv (p < 0.01), AURc (p < 0.01) and AURv (p < 0.01) than the rest; heterogenous and cystic tumors had higher SIRv than solid large tumors (p = 0.02); superior vestibular nerve pattern on vHIT had higher SIRv and AURv than inferior vestibular nerve and mixed patterns (p = 0.03 and 0.004, respectively); and there was a weak correlation between AURv and speech discrimination (r = 0.33, p = 0.04).

Conclusion A more abnormal signal intensity of the labyrinth is associated with larger size and solid status of VS. There was a positive relationship between signal intensity of the labyrinth and speech discrimination scores on audiogram.

Keywords

vestibular schwannoma - video head impulse test - magnetic resonance imaging - vestibulo-ocular reflex - perilymph - vestibular function tests

Publication History

Received: 31 October 2020

Accepted: 27 December 2020

Article published online:
08 March 2021

• References

• 1 Silverstein H. Inner ear fluid proteins in acoustic neuroma, Menière's disease and otosclerosis. Ann Otol Rhinol Laryngol 1971; 80 (01) 27-35
• 2 O'Connor AF, Luxon LM, Shortman RC, Thompson EJ, Morrison AW. Electrophoretic separation and identification of perilymph proteins in cases of acoustic neuroma. Acta Otolaryngol 1982; 93 (1-6): 195-200
• 3 Palva T, Raunio V. Cerebrospinal fluid and acoustic neurinoma specific proteins in perilymph. Acta Otolaryngol 1982; 93 (1-6): 201-203
• 4 Silverstein H. Labyrinthine tap as a diagnostic test for acoustic neurinoma. Otolaryngol Clin North Am 1973; 6 (01) 229-244
• 5 Bhadelia RA, Tedesco KL, Hwang S. et al. Increased cochlear fluid-attenuated inversion recovery signal in patients with vestibular schwannoma. AJNR Am J Neuroradiol 2008; 29 (04) 720-723
• 6 Lee IH, Kim H-J, Chung WH. et al. Signal intensity change of the labyrinth in patients with surgically confirmed or radiologically diagnosed vestibular schwannoma on isotropic 3D fluid-attenuated inversion recovery MR imaging at 3 T. Eur Radiol 2010; 20 (04) 949-957
• 7 Naganawa S, Kawai H, Sone M, Nakashima T, Ikeda M. Endolympathic hydrops in patients with vestibular schwannoma: visualization by non-contrast-enhanced 3D FLAIR. Neuroradiology 2011; 53 (12) 1009-1015
• 8 Kim DY, Lee JH, Goh MJ. et al. Clinical significance of an increased cochlear 3D fluid-attenuated inversion recovery signal intensity on an MR imaging examination in patients with acoustic neuroma. AJNR Am J Neuroradiol 2014; 35 (09) 1825-1829
• 9 Yamazaki M, Naganawa S, Kawai H, Nihashi T, Fukatsu H, Nakashima T. Increased signal intensity of the cochlea on pre- and post-contrast enhanced 3D-FLAIR in patients with vestibular schwannoma. Neuroradiology 2009; 51 (12) 855-863
• 10 Ishikawa K, Haneda J, Okamoto K. Decreased vestibular signal intensity on 3D-FIESTA in vestibular schwannomas differentiating from meningiomas. Neuroradiology 2013; 55 (03) 261-270
• 11 Eliezer M, Poillon G, Maquet C. et al. Sensorineural hearing loss in patients with vestibular schwannoma correlates with the presence of utricular hydrops as diagnosed on heavily T2-weighted MRI. Diagn Interv Imaging 2019; 100 (05) 259-268
• 12 Venkatasamy A, Le Foll D, Karol A. et al. Differentiation of vestibular schwannomas from meningiomas of the internal auditory canal using perilymphatic signal evaluation on T2-weighted gradient-echo fast imaging employing steady state acquisition at 3T. Eur Radiol Exp 2017; 1 (01) 8
• 13 von Kirschbaum C, Gürkov R. Audiovestibular function deficits in vestibular schwannoma. BioMed Res Int 2016; 2016: 4980562 DOI: 10.1155/2016/4980562.
• 14 Tatagiba M, Acioly MA. Vestibular Schwannoma: Current State of the Art. In: Ramina R, de Aguilar PR, Tatagiba M. eds. Samii's Essentials in Neurosurgery. 2nd edition. Berlin Heidelberg: Springer-Verlag; 2014: 265-283
• 15 Constanzo F, Teixeira BCA, Sens P, Ramina R. Video head impulse test in vestibular schwannoma: relevance of size and cystic component on vestibular impairment. Otol Neurotol 2019; 40 (04) 511-516
• 16 McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS. The video head impulse test (vHIT) of semicircular canal function - age-dependent normative values of VOR gain in healthy subjects. Front Neurol 2015; 6: 154 DOI: 10.3389/fneur.2015.00154.
• 17 Constanzo F, Sens P, Teixeira BCA, Ramina R. Video head impulse test to preoperatively identify the nerve of origin of vestibular schwannomas. Oper Neurosurg (Hagerstown) 2019; 16 (03) 319-325
• 18 Monsell E, Balkany T, Gates G, Goldenberg RA, Meyerhoff WL, House JW. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113 (03) 179-180
• 19 Rogg JM, Ahn SH, Tung GA, Reinert SE, Norén G. Prevalence of hydrocephalus in 157 patients with vestibular schwannoma. Neuroradiology 2005; 47 (05) 344-351
• 20 Bamford CR, Labadie EL. Reversal of dementia in normotensive hydrocephalus after removal of a cauda equina tumor. Case report. J Neurosurg 1976; 45 (01) 104-107
• 21 Charabi S. Acoustic neuroma/vestibular schwannoma in vivo and in vitro growth models. A clinical and experimental study. Acta Otolaryngol Suppl 1997; 530 (suppl): 1-27
• 22 Naganawa S, Satake H, Iwano S, Sone M, Nakashima T. Communication between cochlear perilymph and cerebrospinal fluid through the cochlear modiolus visualized after intratympanic administration of Gd-DTPA. Radiat Med 2008; 26 (10) 597-602
• 23 Rask-Andersen H, Schrott-Fischer A, Pfaller K, Glueckert R. Perilymph/modiolar communication routes in the human cochlea. Ear Hear 2006; 27 (05) 457-465
• 24 Blödow A, Helbig R, Wichmann N, Wenzel A, Walther LE, Bloching MB. [Video head impulse test or caloric irrigation? Contemporary diagnostic tests for vestibular schwannoma]. HNO 2013; 61 (09) 781-785
• 25 Silverstein H, Makimoto K. Superior vestibular and “singular nerve” section--animal and clinical studies. Laryngoscope 1973; 83 (09) 1414-1432
• 26 Gurgel RK, Jackler RK, Dobie RA, Popelka GR. A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg 2012; 147 (05) 803-807