(A839) Is Gadolinuim Really Essential to Exclude Acoustic Neuroma?

Introduction: MRI is prescribed by ENT specialist when patients have asymmetric hearing loss, monolateral tinnitus or vertigo relapses: 20% of cases with audiologic symptoms may need this exam (Harcourt and Vijaya-Sekaran, 1999). In 2009 However Vanderlvelde e Connor founded that in a group of 881 MRI carried out for VIII cranic nerve assestment, only 1.4% had a neuroma diagnosis. This procedure can be performed with or without paramagnetic contrast (gadolinium) injection: nowadays modern MRIs allow to detect very small lesions with T2 e CISS sequencies without contrast.
This study investigated schwannoma diagnosis frequency obtained by contrast MRI of the cerebellopontine angle and inner auditory canals, then we tried to understand if those lesions would be neglected without gadolinium injection.

Methods: We did a revision of cerebellopontine angle and inner auditory canals contrast MRIs performed in our Istitution since november 1st 2019 to october 31th 2024 in order to identify those positive for acoustic neuroma diagnosis. Then we asked two expert Radiologists to blindly evaluate all cases basing on non contrast images alone.

Results: In the last 5 years.19 acoustic neuromas out of 432 MRI were founed (4.4% of positive).
All 19 cases were diagnosed even when the Radiologists limited their analisys to contrastless images.

Conclusions: This work confirms two studies by Souliè (1999) and Hentschel (2018), in which the few false negative were about 2mm thick. Considering pazient discomfort, possible adverse effects related to gadolinium injection and increased costs, we wonder if would be more appropriate to investigate patents with audiovestibolar symptoms with a simple MRI without contrast, reserving gadolinium for selected cases.