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Loop characteristics and audio-vestibular symptoms or hemifacial spasm: is there a correlation? A multiplanar MRI study

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Abstract

Aim

We investigated if loop characteristics correlate with audio-vestibular symptoms or hemifacial spasm in patients with a vascular loop in the root entry zone (VII and VIII) and in the internal auditory canal.

Materials and methods

A retrospective, multicenter study analyzed 2622 consecutive magnetic resonance imaging (MRI) scans of the cerebellopontine angle of patients with asymmetric audio-vestibular symptom or hemifacial spasm; patients’ symptoms were confirmed by clinical tests. MRIs displaying vascular loops visible in the axial view were analyzed using multiplanar reconstruction. We evaluated (1) depth of penetration of the loop into the internal auditory canal (IAC); (2) largest diameter of the vessel; (3) nerve(s) involved in the vascular impingement, position of the loop relative to such nerve(s) and number of contacts between vessel and nerve(s); (4) length of such contact. The loop metrics described above were correlated with the patients’ audio-vestibular symptoms and hemifacial spasm.

Results

Three hundred ninety-nine patients displayed a loop visible in the MRI axial view and out of them only 118 displayed a direct contact between loop and nerve. The cochlear nerve was involved in a contact in 57.7%. Loops in direct nerve contact had a calibre > 0.85 mm, were located in the middle portion of the IAC, and correlated with vertigo (p = 0.002), tinnitus (p = 0.003), and hemifacial spasm (p < 0.001). Asymmetric sensorineural hearing loss (SNHL) correlated with number of contacts (p < 0.001) and length of contact (p < 0.05). The contact was asymptomatic in 41.5% of patients.

Conclusion

Loop characteristics may help predict whether a vascular impingement is responsible for a symptom and guide the physician to select the best treatment.

Key Points

• A vascular loop in the internal auditory canal was observed in 18–20% of the patients in this study; whether a loop can be responsible for a compressive syndrome is still unclear in particular referred to the vestibulocochlear nerve.

• Compression by a loop on the facial nerve causes hemifacial spasm; compression by a loop on the cochlear or vestibular nerve may cause audio-vestibular symptoms.

• In patients with a loop, the loop calibre, the loop position, and the number of loop-nerve(s) assessed via the multiplanar MRI reconstruction technique may help assess whether the patient will manifest audio-vestibular symptoms or hemifacial spasm.

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Abbreviations

CI:

Confidence interval

CISS:

Constructive interference steady state

CPA:

Cerebellum-pontine angle

FOV:

Field of view

FT:

Fourier transformation

IAC:

Internal auditory canal

IRB:

Institutional Review Board

MRI:

Magnetic resonance imaging

NEX:

Number of excitations

PTA:

Pure tone average

REZ:

Root entry zone

SD:

Standard deviation

SNHL:

Sensorineural hearing loss

TE:

Echo time

TR:

Repetition time

v-HIT:

Video head impulse test

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Otolaryngology Department, University of Perugia, Perugia, Italy

    Arianna Di Stadio & Giampietro Ricci

  2. Highland Instruments, Cambridge, MA, USA

    Laura Dipietro

  3. Department of Sense Organs, Sapienza University of Rome, Rome, Italy

    Massimo Ralli

  4. Vestibular Center Otolaryngology Department, Silvestrini Hospital, Perugia, Italy

    Mario Faralli

  5. Otology and Cochlear Implant Unit, Santobono-Pausilipon Hospital, Naples, Italy

    Antonio della Volpe

  6. Radiology, Oncology, and Anatomopathological Department, Sapienza University of Rome, Rome, Italy

    Daniela Messineo

Authors
  1. Arianna Di Stadio
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  2. Laura Dipietro
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  3. Massimo Ralli
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  4. Mario Faralli
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  5. Antonio della Volpe
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  6. Giampietro Ricci
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  7. Daniela Messineo
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Corresponding author

Correspondence to Arianna Di Stadio.

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Guarantor

The scientific guarantor of this publication is Dr. Arianna Di Stadio.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because this is a retrospective study and all patients previously signed a written consent before performing their tests and exams.

Ethical approval

Institutional Review Board approval was obtained without the release of a number because this is a retrospective study.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Multicenter study

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Di Stadio, A., Dipietro, L., Ralli, M. et al. Loop characteristics and audio-vestibular symptoms or hemifacial spasm: is there a correlation? A multiplanar MRI study. Eur Radiol 30, 99–109 (2020). https://doi.org/10.1007/s00330-019-06309-2

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  • DOI: https://doi.org/10.1007/s00330-019-06309-2

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