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Abstract
Focal hyperintensity (FHI) in the dorsal brain stem on T2-weighted images of patients with cerebellopontine angle (CPA) tumor was thought to indicate degeneration of the vestibular nucleus and to be specific to vestibular schwannoma. The purpose of this study was to evaluate FHI by using high-resolution 3 Tesla magnetic resonance imaging (3 T MRI) and the relation to clinical characteristics. We retrospectively reviewed the clinical data and MRI of 45 patients with CPA tumors (34 vestibular schwannomas and 11 other tumors). FHI in the dorsal brain stem was found in 25 (55.6%) patients (20 vestibular schwannomas and 5 other tumors). For the vestibular schwannomas, the factors contributing to positive FHI were age (p = 0.025), max CPA (p = < 0.001), hearing ability (P = 0.005), and canal paresis (p = < 0.001) in the univariate analysis. Multivariate regression analysis showed that max CPA (p = 0.029) was a significant factor of positive FHI. In other CPA tumors, these factors were not significant predictors. With the use of 3 T MRI, FHI was observed more frequently than previously reported. Our results suggest that FHI is not a specific indicator of vestibular schwannoma and is related to not only vestibular function but also other factors.
Highlights
The cerebellopontine angle (CPA) cistern is a subarachnoid space containing many cranial nerves and vessels, and is bounded by the brain stem, the cerebellum and the petrous bone[1]
focal hyperintensity (FHI) was observed as a tiny dot, but there were a few cases with FHI extending along a line from the posteromedial to the anterolateral dorsal brain stem
Okamoto et al reported that some patients (14.6%) with vestibular schwannoma showed a tiny area of hyperintensity in the dorsal brain stem on T2-weighted images and that the location of this area coincided with the vestibular nuclear complex[4]
Summary
The cerebellopontine angle (CPA) cistern is a subarachnoid space containing many cranial nerves and vessels, and is bounded by the brain stem, the cerebellum and the petrous bone[1]. In 2006, Okamoto reported that some patients with vestibular schwannoma showed a tiny area of hyperintensity in the dorsal brain stem on T2-weighted images[4]. This area was observed in 14.6% of the patients with vestibular schwannomas larger than 2 cm, and was not found in patients with other kinds of CPA tumors. They concluded that the presence of this area of hyperintensity indicated degeneration of the vestibular nucleus. Our hypothesis is that if the finding of FHI is related to the degeneration of nucleus, the correlation with clinical characteristics of these nucleus would be provided
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