Acoustic neuroma MRI

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 * The definitive diagnostic test for patients with acoustic tumors is gadolinium-enhanced MRI.

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 * Well-performed scanning can demonstrate tumors as small as 1-2 mm in diameter. On the other hand, thin-cut CT scanning can miss tumors as large as 1.5 cm even when intravenous contrast enhancement is used.
 * Gadolinium contrast is critical because nonenhanced MRI can miss small tumors.
 * Fast-spin echo techniques do not require gadolinium enhancement and can be performed very rapidly and relatively inexpensively. However, such highly targeted techniques risk missing other important causes of unilateral sensory hearing loss, including intra-axial tumors, demyelinating disease, and infarcts.
 * MRI is contraindicated in individuals with ferromagnetic implants.
 * Fine-cut CT scanning of the internal auditory canal with contrast can rule out a medium-size or large tumor but cannot be relied upon to detect a tumor smaller than 1-1.5 cm.
 * If suspicion is high and MRI is contraindicated, air-contrast cisternography has high sensitivity and can detect relatively small intracanalicular tumors.

MRI Classification of Acoustic Neuroma:

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