Original Article
Diagnostic assessment of magnetic resonance imaging for patients with intralabyrinthine schwannoma: A systematic review

https://doi.org/10.1016/j.neurad.2020.08.002Get rights and content

Highlights

  • •

    MRI is the technique of choice in detection and estimation of extent of ILS.

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    MRI is useful for pre-surgical planning and conservative monitoring of ILS.

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    MRI has acceptable diagnostic performance for ILS.

Abstract

Objectives

Recent advancements in high-resolution imaging have improved the diagnostic assessment of magnetic resonance imaging (MRI) for intralabyrinthine schwannoma (ILS). This systematic review aimed to evaluate the diagnostic performance of MRI for patients with ILS.

Methods

Ovid-MEDLINE and EMBASE databases were searched for related studies on the diagnostic performance of MRI for patients with ILS published up to February 10, 2020. The primary endpoint was the diagnostic performance of MRI for ILS. The quality of the enrolled studies was assessed using tailored questionnaires and the Quality Assessment of Diagnostic Accuracy Studies-2 criteria.

Results

Overall, 6 retrospective studies that included 122 patients with ILS from a parent population of 364 were included. The sample size, parent population and its composition, reference standard, detailed parameters of MRI, and even the diagnostic methods varied between the studies. The studies had moderate quality. The sensitivity of combination of T2WI and CE-T1WI was over 90%. Relative sensitivity of T2WI comparative to CE-T1WI ranged from 62% to 100%, and the specificity were 100%.

Conclusions

MRI has acceptable diagnostic performance for ILS. There is a need for well-organized research to reduce the factors causing heterogeneity.

Introduction

Intralabyrinthine schwannoma (ILS) originates from the perineural Schwann cell sheath in the intralabyrinthine segment of the cochleovestibular nerve.1, 2 The clinical diagnosis of ILS is challenging because it has no specific symptoms, with patients presenting with symptoms (e.g., hearing loss, vertigo, imbalance, or tinnitus) overlapping with other inflammatory labyrinthine diseases.2, 3, 4, 5, 6 In addition, the small size and structural complexity of the labyrinth also aggravate the difficulty in accurate radiologic diagnosis.7, 8

Magnetic resonance imaging (MRI) offers modality-specific benefits over computed tomography, such as the absence of ionizing radiation and improved soft-tissue contrast, and provides improved anatomical information for the head and neck area.9, 10 Thus, the radiologic evaluation of ILS is usually performed via MRI.2, 11 Advancements in three dimensional (3D)-high resolution (HR)-MRI have improved the detection and differential diagnosis of ILS, mostly focusing detection of nodular tumor enhancement on contrast-enhanced T1-weighted imaging (CE-T1WI), and visualization of loss of high signal intensity of labyrinthine perilymphatic space resulting in filling defect on T2-weighted imaging (T2WI) based sequences.20, 26

Therefore, this systematic review accordingly aimed to evaluate the diagnostic performance of MRI for ILS diagnosis.

Section snippets

Materials and methods

This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.12

Literature search

The article selection process is described in detail in Fig. 1. Initially, we identified 404 articles. After eliminating 171 duplicates, the titles and abstracts of the remaining 233 articles were screened, and 15 potentially eligible articles were identified. No additional article was identified after reviewing the references of these articles. After full-text reviews of the 15 articles,2, 6, 8, 11,14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 9 were excluded because they had insufficient data to

Discussion

This systematic review evaluated the diagnostic performance of MRI for ILS in 6 studies involving 122 patients with ILS. The sample size, parent population and its composition, reference standard, detailed parameters of MRI, and even the diagnostic methods varied between the studies. The sensitivity of combination of T2WI and CE-T1WI was ranged from 90% to 96%. Relative performance of T2WI was similar to that of CE-T1WI. These findings show acceptable diagnostic performance of MRI for ILS;

Declarations of interest

None.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) [grant number2019R1F1A1063771] and by the SNUBH Research Fund of Korea [grant number09-2019-003].

CRediT authorship contribution statement

Se Jin Cho: Conceptualization, Data curation, Investigation, Methodology, Resources, Software, Visualization, Validation, Writing - original draft, Writing - review & editing. Byung Se Choi: Project administration, Supervision, Conceptualization, Data curation, Investigation, Methodology, Resources, Software, Visualization, Validation, Writing - original draft, Writing - review & editing. Yun Jung Bae: Conceptualization, Data curation, Investigation, Methodology, Resources, Software,

Acknowledgements

We would like to thank Editage (www.editage.co.kr) for English language editing.

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