Perilymphatic Signal Changes in Vestibular Schwannoma: A Potential Biomarker of Progressive Hearing Loss?

in Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery by Anne Renée Juliette Péporté, Benoît Gallix, Aïna Venkatasamy

TLDR

  • The study found that vestibular schwannoma is associated with decreased signal intensity ratio in the vestibular cistern and cochlea, which is significantly correlated with tumor volume and linked to progressive hearing loss.
  • This may indicate the potential for magnetic resonance imaging as a noninvasive biomarker for hearing impairment in vestibular schwannoma.

Abstract

Vestibular schwannomas influence the magnetic resonance (MR) signal intensity (SI) in the vestibular cistern and cochlear perilymph. The aim of this study is to evaluate the relationship between perilymphatic signal changes on gradient-echo T2-weighted 3 T MR sequence and the clinical symptoms. Retrospective case-control study. The study was conducted at the Institute of Image-Guided Surgery in Strasbourg, France. Patients with vestibular schwannoma who underwent magnetic resonance imaging at our institution between 2008 and 2016 were retrospectively reviewed. A control group consisted of individuals without past or present otological symptoms. The vestibular schwannomas were divided into three groups, based on the degree of internal auditory canal obstruction. The SI ratios of the vestibular cistern to cerebrospinal fluid (CSF) and cochlea to CSF were compared with clinical data. We included 172 patients with vestibular schwannoma and 61 controls. Vestibular schwannoma was associated with a significant decrease of the SI ratio of the vestibular cistern to CSF (0.716 ± 0.297 vs 1.06 ± 0.21, P = .004) and cochlea to CSF (0.66 ± 0.199 vs 0.903 ± 0.011, P = .004) compared to controls, with significant negative correlation between both the SI ratios of the vestibular cistern and cochlea to CSF with tumor volume (P < .001). Among all the symptoms studied, the SI ratio of the cistern normalized by CSF was significantly associated with progressive hearing loss (P = .003). Perilymphatic vestibular cistern and cochlear SI changes appear to be a promising noninvasive biomarker for hearing impairment in vestibular schwannoma.

Overview

  • The study aimed to evaluate the relationship between perilymphatic signal changes on gradient-echo T2-weighted 3T MR sequence and clinical symptoms in patients with vestibular schwannoma.
  • A retrospective case-control study was conducted at the Institute of Image-Guided Surgery in Strasbourg, France, reviewing 172 patients with vestibular schwannoma and 61 controls.
  • The primary objective was to identify the association of perilymphatic signal changes with clinical symptoms, particularly hearing loss.

Comparative Analysis & Findings

  • Vestibular schwannoma was associated with significant decreases in signal intensity ratio of the vestibular cistern to cerebrospinal fluid (CSF) and cochlea to CSF compared to controls.
  • There was a significant negative correlation between the signal intensity ratio of the vestibular cistern and cochlea to CSF with tumor volume (P<.001).
  • Among the studied symptoms, the signal intensity ratio of the cistern normalized by CSF was significantly associated with progressive hearing loss (P=.003).

Implications and Future Directions

  • Perilymphatic vestibular cistern and cochlear signal changes may be a promising noninvasive biomarker for hearing impairment in vestibular schwannoma.
  • Future studies can explore the relationship between these signal changes and other clinical symptoms, as well as develop methodologies to quantify and monitor these changes.
  • This study highlights the potential importance of incorporating magnetic resonance imaging into the diagnostic and monitoring algorithm for patients with vestibular schwannoma.
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