Abstract
BackgroundThe evaluation of patients presenting with audiovestibular symptoms usually includes MRI of the internal auditory meatus, the cerebellopontine angle and the brain. A significant percentage of these scans will present unexpected, incidental findings, which could have important clinical significance.ObjectiveTo determine the frequency and clinical significance of incidental findings on MRI scans of patients with audiovestibular symptoms.Materials and methodsA retrospective analysis of 200 serial MRI scans.ResultsGender distribution: equal. Age range: 17-82 years. One-hundred and four scans (52%) were normal and 1 scan (0.5%) demonstrated a unilateral vestibular schwannoma. Ninety-five scans (47.5%) demonstrated incidental findings. Sixty-six of these (33%) were considered of ishaemic origin and did not require further action. Five (2.5%) scans demonstrated significant findings which warranted appropriate referral; Two Gliomas (1%), 2 cases of extensive White Matter Lesions (1%), 1 lipoma (0.5%). The remaining scans demonstrated various other findings.ConclusionInvestigation of patients with audiovestibular symptoms with MRI scans revealed incidental findings in a significant percentage (47.5%). The majority of these findings were benign warranting no further action and only 2.5% required further referral. It is the responsibility of the referring Otolaryngologist to be aware of these findings, to be able to assess their significance, to inform the patient and if needed to refer for further evaluation.
Highlights
The evaluation of patients presenting with audiovestibular symptoms usually includes Magnetic Resonance Imaging (MRI) of the internal auditory meatus, the cerebellopontine angle and the brain
We retrospectively reviewed 200 serial MRI scans requested for patients with audiovestibular symptoms
[12] FLAIR (Fluid attenuation inversion recovery) sequences have been shown to be able to demonstrate inflammation of the inner ear, making MRI imaging an effective tool for the investigation of inflammatory conditions causing sudden sensorineural hearing loss [13,14]
Summary
The evaluation of patients presenting with audiovestibular symptoms usually includes MRI of the internal auditory meatus, the cerebellopontine angle and the brain. A significant percentage of these scans will present unexpected, incidental findings, which could have important clinical significance. Patients frequently present to the otorhinolaryngologist with audiovestibular symptoms such as; asymmetrical hearing loss, unilateral tinnitus, sudden sensorineural hearing loss and vertigo. Investigation of these patients includes thorough clinical examination, audiological evaluation and frequently Magnetic Resonance Imaging (MRI) of the Internal Auditory Meatus (IAM), cerebellopontine angle (CPA) and brain. A small percentage of these scans reveal some form of causative pathology. A significant percentage will present unexpected findings which may have clinical significance. MRI findings which are unrelated to the purpose of the examination are considered incidental findings [4]
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