Aïna Venkatasamy1,2,3, Ziad Al Ohraini4, Anne Karol4, Aurélie Karch-Georges4, Sophie Riehm4, Dominique Rohmer5, Anne Charpiot5, Francis Veillon4. 1. Service de Radiologie 1, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. aina.venkatasamy@chru-strasbourg.fr. 2. Laboratory Stress Response and Innovative Therapies "Streinth", Université de Strasbourg, Inserm IRFAC UMR_S1113, Strasbourg, France. aina.venkatasamy@chru-strasbourg.fr. 3. Medizin Physik, Universitatsklinikum, Freiburg, Germany. aina.venkatasamy@chru-strasbourg.fr. 4. Service de Radiologie 1, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 5. Service de Chirurgie ORL, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Abstract
BACKGROUND: We evaluated the usefulness of CT and MRI for the diagnosis of perilymphatic fistula (PLF) of the round (RW) and/or oval (OW) windows, with surgery as gold standard. METHODS: We retrospectively enrolled 17 patients who presented a surgically confirmed PLF of the round (RW) or oval (OW) windows. All patients were imaged by CT + MRI (T2W SSFP without contrast) prior to surgery (= gold standard). Two radiologists, analyzed the RW and OW on the side of the clinical symptoms and sensitivity (Se) + Specificity (Sp) were calculated. RESULTS: Round window fistula was the most frequent (71%). The best sign of PLF on imaging was a fluid filling of the window niches, which had good Se (83-100% for RW, 66-83% for OW) and Sp (60% for RW, 91-100% for OW). Disorientation of the footplate and pneumolabyrinth were also only observed in 50% of OW PLF. CONCLUSION: The combination of CT and MRI is a reliable tool for a fast and accurate diagnosis of round and oval window perilymphatic fistula, with good sensitivity (> 80%). The most common sign of PLF on imaging is the presence of a fluid-filling in the RW (especially if > 2/3 of the RW niche) or in the OW niches on both CT and MRI. A disorientation of the footplate or the presence of a pneumolabyrinth are clearly in favor of an oval window perilymphatic fistula.
BACKGROUND: We evaluated the usefulness of CT and MRI for the diagnosis of perilymphatic fistula (PLF) of the round (RW) and/or oval (OW) windows, with surgery as gold standard. METHODS: We retrospectively enrolled 17 patients who presented a surgically confirmed PLF of the round (RW) or oval (OW) windows. All patients were imaged by CT + MRI (T2W SSFP without contrast) prior to surgery (= gold standard). Two radiologists, analyzed the RW and OW on the side of the clinical symptoms and sensitivity (Se) + Specificity (Sp) were calculated. RESULTS: Round window fistula was the most frequent (71%). The best sign of PLF on imaging was a fluid filling of the window niches, which had good Se (83-100% for RW, 66-83% for OW) and Sp (60% for RW, 91-100% for OW). Disorientation of the footplate and pneumolabyrinth were also only observed in 50% of OW PLF. CONCLUSION: The combination of CT and MRI is a reliable tool for a fast and accurate diagnosis of round and oval window perilymphatic fistula, with good sensitivity (> 80%). The most common sign of PLF on imaging is the presence of a fluid-filling in the RW (especially if > 2/3 of the RW niche) or in the OW niches on both CT and MRI. A disorientation of the footplate or the presence of a pneumolabyrinth are clearly in favor of an oval window perilymphatic fistula.
Authors: Johannes Taeger; Franz Tassilo Müller-Graff; Lukas Ilgen; Phillip Schendzielorz; Rudolf Hagen; Tilman Neun; Kristen Rak Journal: OTO Open Date: 2021-09-24