Clinical value of 4-hour delayed gadolinium-Enhanced 3D FLAIR MR Images in Acute Vestibular Neuritis

Abstract

Objective: To investigate the clinical significance of 4-hour delayed-enhanced 3.0 Tesla three-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging in acute vestibular neuritis.Study Design: A prospective observational study.Methods: Twenty-nine vestibular neuritis patients were enrolled between January 2017 and June 2017. Vestibular function tests, comprising the caloric and video head impulse tests and vestibular-evoked myogenic potential measurements, were performed. Precontrast, 10-minute, and 4-hour delayed-enhanced 3D-FLAIR MR images using double-dose IV gadolinium were obtained. After laterality and extent of inner ear enhancement were defined, the patients were divided into groups based on the patterns of enhancement, and clinical parameters were analyzed according to the groups.Results: Twenty patients (20 of 29, 69.0%) had obviously asymmetric enhancement of the affected inner ear structures on 4-hour delayed images, whereas only three patients (10.3%) had marked enhancement on 10-minute delayed images. The duration of spontaneous nystagmus (DurSN) was significantly longer in the patients with enhancement, especially with enhancement of the whole inner ear, including the vestibule and semicircular canals (P<0.033). Spontaneous nystagmus resolved within 12 days in patients without laterality of enhancement, and within 16 days in ipsilesional enhancement confined to the inner auditory canal and fundus. Other results of vestibular function tests did not reveal any significant associations with MR enhancement.Conclusions: Contrast enhancement of the vestibular nerve and inner ear structures can be identified on 4-hour delayed-enhanced 3T 3D-FLAIR MR images in acute vestibular neuritis. The extent of inner ear enhancement may be associated with the DurSN.