Diagnostic accuracy of screening MR imaging using unenhanced axial CISS and coronal T2WI for detection of small internal auditory canal lesions

• Published in: American journal of neuroradiology : AJNR Vol. 35; no. 12; pp. 2366 - 2370
• Main Authors: Abele, T A, Besachio, D A, Quigley, E P, Gurgel, R K, Shelton, C, Harnsberger, H R, Wiggins, 3rd, R H
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01-12-2014
• Subjects: Adult; Aged; Editor's Choice; Female; Head & Neck; Humans; Image Interpretation, Computer-Assisted - methods; Labyrinth Diseases - diagnosis; Magnetic Resonance Imaging - methods; Male; Mass Screening; Middle Aged; Neuroma, Acoustic - diagnosis; Observer Variation; Retrospective Studies; Semicircular Canals - pathology; Sensitivity and Specificity
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a4041

While enhanced T1WI is considered the "gold standard" for detection of internal auditory canal pathology, unenhanced fluid-sensitive sequences have shown high sensitivity for lesion identification. Our purpose was to evaluate the diagnostic accuracy of an unenhanced MR imaging protocol using axial CISS and coronal T2WI for detection of small (10 mm or less) internal auditory canal lesions.
Twenty-three patients with small internal auditory canal lesions and 13 patients without lesions who had undergone MR imaging using the screening protocol and confirmatory gadolinium-enhanced thin section T1WI were identified. Two blinded neuroradiologists retrospectively evaluated all examinations using 1) only axial CISS, 2) only coronal T2WI, and 3) axial and coronal sequences together. Accuracy, specificity, sensitivity, and interobserver agreement were assessed.
Median maximum lesion dimension was 4 mm (range, 2-10 mm). Accuracy, specificity, and sensitivity for axial CISS alone were 0.94, 0.96, and 0.91 for observer 1 and 0.94, 0.92, and 1.00 for observer 2. The data for the coronal T2WI sequence only were 0.94, 0.96, and 0.91 for observer 1, and 0.99, 1.00, and 0.96 for observer 2. Using axial and coronal sequences, the data were 0.97, 0.96, and 1.00 for observer 1, and 0.99, 0.98, and 1.00 for observer 2. κ coefficients were 0.84 for the axial sequence only, 0.90 for coronal only, and 0.91 for axial and coronal both.
Screening noncontrast MR imaging using a combination of axial CISS and coronal T2WI sequences can detect small internal auditory canal lesions with 100% sensitivity and excellent interobserver agreement.