Diagnostic accuracy of high‐resolution T2‐weighted MRI vs contrast‐enhanced T1‐weighted MRI to screen for cerebellopontine angle lesions in symptomatic patients

Objective To evaluate diagnostic accuracy of high‐resolution T2‐weighted MRI (T2w) for detecting cerebellopontine angle (CPA) lesions compared to a combined protocol including gadolinium enhanced T1‐weighted MRI (GdT1w). Setting Department of Radiology & Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands. Participants A random sample of MRIs from 350 patients (700 CPAs) with asymmetrical audiovestibular complaints was used, acquired between 2013 and 2016. Main outcome measures Sensitivity, specificity, positive and negative predictive values of T2w results compared to GdT1w and, in patients with any suggestion of CPA pathology, to the complete examination (T1w, GdT1w and T2w). Inter‐rater agreement between an experienced neuroradiologist and a less experienced observer was calculated. Results Results of 678 CPAs in 340 patients were analysed. On T2w, the neuroradiologist identified all 27 lesions >2 mm in size out of a total of 30 CPA lesions (sensitivity: 90% [95% CI: 73.5%‐97.9%]). Negative predictive value reached 99.5% (95% CI: 98.7‐99.9). One missed lesion of 2 mm would have been detected in clinical practice, as this was one of 14 patients for which additional GdT1w would have been ordered based on T2w alone, increasing sensitivity to 93% (95% CI: 77.9%‐99.2%) and negative predictive value to 99.7% (95% CI: 98.9%‐100%). Inter‐rater agreement for T2w was 98% (95% CI: 96.4‐98.8). Conclusion T2w has a very high diagnostic accuracy for the presence of CPA lesions in patients with asymmetrical audiovestibular complaints. However, in a screening protocol with T2w only, smallest vestibular schwannomas as well as rare differential diagnoses that probably only would be detected on GdT1w may remain unnoticed.