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1 KISEP Otology Korean J Otolaryngol 2006;49:7-12 돌발성난청환자에서촬영한자기공명영상의진단적유용성 안중호 1 이정현 2 여남경 1 배기훈 1 윤태현 1 이광선 1 정종우 1 The Diagnostic Value of Magnetic Resonance Imaging in Patients with Sudden Sensorineural Hearing Loss Joong Ho Ahn, MD 1, Jeong Hyun Lee, MD 2, Nam-Kyung Yeo, MD 1, Ki Hoon Bae, MD 1, Tae Hyun Yoon, MD 1, Kwang-Sun Lee, MD 1 and Jong Woo Chung, MD 1 1 Department of Otolaryngology 2 Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea ABSTRACT Objectives:To evaluate the diagnostic value of magnetic resonance imaging MRI of patients with sudden sensorineural hearing loss SSNHL and to analyze the various clinical aspects and treatments of the patients with abnormal MRI findings. Subjects and Method:We retrospectively reviewed medical and radiological records of patients with SSNHL over 5-year period. All consecutive patients took gadolinium-enhanced MRI including whole brain and all MRIs were evaluated by experienced independent investigators. Results:Twelve patients 8.0% had obvious etiologies of SSNHL, which consisted of 5 cases of vestibular schwannoma, 3 cases of tumors of cerebellopontine angle, 3 cases of pontine infarction, and 1 case of inflammatory granuloma of internal auditory canal. One patient 0.7% had possible etiologies of SSNHL, which was labyrinthitis ossificans. Conclusion:Gadolinium-enhanced magnetic resonance imaging MRI including whole brain seems to be an essential examination in patients with SSNHL and we recommend its application. (Korean J Otolaryngol 2006;49:7-12) KEY WORDS:Magnetic resonance imaging Sudden hearing loss. - 7

돌발성난청에서 MRI 의진단적유용성 - Table 1. Summary of etiologies of 143 patients presenting sudden sensorineural hearing loss Obvious etiology for SSNHL 12 08.

Labyrinthitis ossificans Incidental abnormal findings not related to SSNHL Aneurysms of cerebral arteries Cerebellar infarction Inflammatory change of clivus Multiple lacunar infarction Pituitary

2 돌발성난청에서 MRI 의진단적유용성 - Table 1. Summary of etiologies of 143 patients presenting sudden sensorineural hearing loss Obvious etiology for SSNHL % Vestibular schwannoma Lymphoma at the cerebellopontine angle Meningioma at the cerebellopontine angle Pontine glioma IAC inflammatory granuloma Pontine infarction Possible etiology for SSNHL Labyrinthitis ossificans Incidental abnormal findings not related to SSNHL Aneurysms of cerebral arteries Cerebellar infarction Inflammatory change of clivus Multiple lacunar infarction Pituitary adenoma % % % % % % % % % % % % % % A B Fig. 1. A case of acoustic neuroma. A 2 cm-sized well-enhanced heterogeneous mass in left cerebellopontine angle extends to left internal auditory canal on T1-enhanced images. AAxial view, BCoronal view. 8 Korean J Otolaryngol 2006;49:7-12

안중호외 - - Fig. 2. A case of cerebellopontine angle tumor.

8 cm sized, well-enhanced mass in right cerebellopontine

3 안중호외 - - Fig. 2. A case of cerebellopontine angle tumor. Axial view shows cm sized, well-enhanced mass in right cerebellopontine angle on T1-enhanced image. A B Fig. 3. A case of multiple pontine infarction. AAxial view shows low signal intensities on T1-non-enhanced image, BAxial view shows high signal intensities on T2-enhanced image. 9

4 돌발성난청에서 MRI 의진단적유용성 Table 2. Characteristics of abnormal MRI group n=13 Sex Age Site Vertigo Tinnitus Initial PTA* Type SDS Improvement MRI findings % Treatment Case 1 F 59 R Yes Yes 120 Flat 0 No Vestibular schwannoma Observation Case 2 F 61 T No No 120 Flat 0 No Vestibular schwannoma Observation Case 3 M 52 T Yes Yes 120 Flat 0 No Vestibular schwannoma Gamma knife treatment Case 4 F 36 L No Yes 120 Flat 0 No Vestibular schwannoma Removal via translabyrinthine approach Case 5 F 53 L No Yes 120 Flat 0 Yes Vestibular schwannoma Removal via SOC Case 6 M 12 L No No 50 Flat 0 No Pontine glioma Removal via SOC Case 7 M 66 R Yes Yes 120 High 0 Yes Pontine infarction Conservative treatment Case 8 M 67 L No Yes 120 Flat 0 Yes Pontine infarction Conservative treatment Case 9 F 84 L Yes Yes 120 Flat 0 No Pontine infarction Conservative treatment Case 10 M 61 L No No 083 High 0 No Meningioma of CPA Chemotherapy after stereotactic biopsy Case 11 F 67 L Yes Yes 045 Flat 40 No Lymphoma of CPA Chemotherapy with whole brain radiation treatment Case 12 M 63 R Yes Yes 120 Flat 0 No Labyrinthitis ossificans Subtotal petrosectomy Case 13 M 60 L No Yes 120 Flat 0 No Inflammatory granuloma of IAC Observation PTA was defined as the average of threshold of 0.5, 1, and 2 khz dbhl. The presence or absence of a hearing improvement which was based on Siegel s criteria. Mmale, Ffemale, Rright, Lleft, SDSspeech discrimination score %, CPAcerebellopontine angle, IACinternal acoustic meatus, SOCsuboccipital craniotomy - 10 Korean J Otolaryngol 2006;49:7-12

5 안중호외 p - p p p p REFERENCES 1) Hughes GB, Freedman MA, Haberkamp TJ, Guay ME. Sudden sensorineural hearing loss. Otolaryngol Clin North Am 1996;29: ) Baek MJ, Hwang MS. A case of cerebellopontine angle lipoma presented as sudden hearing loss. Korean J Otolaryngol-Head Neck Surg 2002;45: ) Carrier DA, Arriaga MA. Cost-effective evaluation of asymmetric sensorineural hearing loss with focused magnetic resonance imaging. Otolaryngol Head Neck Surg 1997;116: ) Aarnisalo AA, Suoranta H, Ylikoski J. Magnetic resonance imaging findings in the auditory pathway of patients with sudden deafness. Otol Neurotol 2004;25: ) Stokroos RJ, Albers FW, Krikke AP, Casselman JW. Magnetic resonance imaging of the inner ear in patients with idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 1998;255: ) Weber PC, Zbar RI, Gantz BJ. Appropriateness of magnetic resonance imaging in sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 1997;116: ) Fitzgerald DC, Mark AS. Sudden hearing loss: Frequency of abnormal findings on contrast-enhanced MR studies. AJNR Am J Neuroradiol 1998;19: ) Jung MK, Chang KH, Yeo SW, Suh BD. Findings of magnetic resonance imaging in sudden sensorineural hearing loss. J Clin Otolaryngol Head Neck Surg 2003;10: ) Schick B, Brors D, Koch O, Schafers M, Kahle G. Magnetic resonance imaging in patients with sudden hearing loss, tinnitus and vertigo. Otol Neurotol 2001;22: ) Papadopoulos A, Vlahos L, Xenelis J, Papafragou C, Adamopoulos G. 11

6 돌발성난청에서 MRI 의진단적유용성 Value of Gd-DTPA-enhanced MR imaging of the labyrinth in patients with sudden hearing loss. Magn Reson Imaging 1995;13: ) Busaba NY, Rauch SD. Significance of auditory brain stem response and gadolinium-enhanced magnetic resonance imaging for idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 1995;113: ) Daniels RL, Shelton C, Harnsberger HR. Ultra high resolution nonenhanced fast spin echo magnetic resonance imaging: Cost-effective screening for acoustic neuroma in patients with sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 1998;119: ) Park KH, Kim BH, Lee JS, Kim SY. The significance of fast spin echo MRI in patients with sudden sensorineural hearing loss. Korean J Otolaryngol-Head Neck Surg 1997;40: ) Nageris BI, Popovtzer A. Acoustic neuroma in patients with completely resolved sudden hearing loss. Ann Otol Rhinol Laryngol 2003; 112: ) Ahn JH, Yoon TH, Chung JW. Ananlysis of prognosis in patients with sudden sensorineural hearing loss and dizziness. Korean J Otolaryngol-Head Neck Surg 2001;44: ) Siegel LG. The treatment of idiopathic sudden sensorineural hearing loss. Otolaryngol Clin North Am 1975;8: Korean J Otolaryngol 2006;49:7-12

자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 A B Fig. 1. High-contrast spatial resolution in phantom test. A. Slice 1 with three sets of hole arr

Original Article pissn 1738-2637 J Korean Soc Radiol 2012;67(2):129-134 The Survey of Magnetic Resonance Imaging Quality according to in Korea 1 자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 1 Hyun-Hae