Role of MRI Versus CT Scan in Evaluation of Patient with Vertigo

Kadhum Hashim Hamzah,Osama Ayad
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Keywords : computerized tomography, MRI, crebellopontine angle, fast field echo, turbo spin echo, fluid attenuation inversion recovery.
Medical Journal of Babylon  14:3 , 2018 doi:1812-156X-14-3
Published :07 January 2018

Abstract

Vertigo is a sensation of motion when no motion . It caused by central and peripheral causes, central causes of vertigo can be life threatening when associated with stroke. The radiological imaging for evaluation patients with vertigo are CT scan and MRI. understanding the ability of MRI compared with CT scan in detection of pathological cause of vertigo would be helpful in determining the optimal imaging modality in patient with vertigo. 100 patients with vertigo evaluated by MRI and CT scan . MRI sequences was done is T1 weighted fast field echo FFE, T2 weighted turbo spin echo TSE and fluid attenuation inversion recovery FLAIR. The sections was axial , coronal and sagital. The results was 51(51%) male and 49(49%) female aged between 18-78 years we find that 85(85%) with positive finding in MRI. 43(43%) with positive finding in both MRI and CT scan. 42 (42%) with negative finding in CT scan and positive in MRI. 15 (15%) was negative in both CT scan and MRI. Ischemia was the main finding that detected by MRI and CT scan.. The sensitivity of CT scan was 50.58% for detection central causes of vertigo compared with 83% for MRI. Was MRI play an important role in evaluation of patient with vertigo and has a high ability to detect a central cause of vertigo than CT scan. MRI should be the first imaging modality if the central causes of vertigo are suggested.

Introduction

Vertigo is characterized by sensation of spinning or sensation of movement when no movement and its often associated with nausea, vomiting and imbalance [1,2]. The prevalence of vertigo is more than 30% in elderly and 1.8% among young adult, in united states of America 13-38% of patients over 65 years are suffer from vertigo[3] .no sex deference in vertigo incidence, the main age group affected between 18-80 years[3].A study find that male to female ratio is 1.32: 1 with age group 21-70 years [4]. Vertigo caused by peripheral or central causes, peripheral causes which affect the labyrinths or vestibular nerves .it is the most common and generally benign [2, 5, 6]. Causes of central vertigo which affect the central vestibular pathway can be life threatening when associated with stroke therefore distinguishing central from peripheral vertigo is important [2, 7]. While there is evidence that history and physical examination can help in distinguishing central from peripheral vertigo, many patients refer to neuro imaging when the clinical findings are uncertain [2]. the peripheral causes of vertigo are: acute labyrinthitis, benign paroxysmal vertigo, acute vestibular neuritis, -cholesteatoma, menier"s disease, herpes zoster oticus, perilymphatic fistula, osteosclerosis. The central causes are: cerebrovascular disease, cerebellopontine angle tumor, multiple sclerosis, migraine. Other cause are: cervical vertigo, drug induced, psychological [5, 8]. Imaging play very important role in the assessment of patient with vertigo, the imaging tools which available for evaluation of patient with vertigo are CT scan, MRI [8]. Using of insensitive low yield imaging modality may result in false reassurance for the physician [6, 8]. Understanding the ability of MRI compared with CT scan in detection of pathological cause in patient with vertigo would be helpful in determining the optimal imaging modality in patient with vertigo[2] Aim of my study was to explain the role of MRI versus CT scan in evaluation of patient with vertigo by detecting the causes of vertigo in patient with negative or unclear CT scan finding .

Materials and methods

This research is approved by scientific surgical committee in Babylon  university, college of medicine after verbal permission from each patient.Tthe study design was used in our study is (Observational /descriptive /crossectional  study) from December 2016 to august 2017 done on group of 100 patients consulting AL-HILLA teaching hospital suffering from vertigo according to the request paper. All request papers asked for brain CT scan accept one asked for  petrus bone. History was taken from each patient include name, age, chronic disease (HT, DM), ear disease, previous operations, history of head trauma ,drugs and then referred for CT scan and MRI which is done for each of them . the CT scan used in examination are Philips brilliance 2011 and Siemens somato definition AS ,and the section was taken is head 0.5 axial section and the MRI used in examination  is Philips Achieva 1.5 Tesla 2011.
MRI will be done for these patients in multiple sequences (T1wieghted fast field echo FFE,  T2wieghted turbo spin-Echo TSE and fluid attenuation inversion recovery FLAIR with axial/ coronal/ sagital sections and gadolinium to determine the positive finding in MRI  which is negative  or unclear in CT  scan.




Results

Distribution of patients with vertigo according to history of chronic disease which consider as risk factor was 63.3% with hypertension, 16.7% with hypertension and diabetes mellitus, 6.7% with hypertension and ischemic heart disease, 6.7% with diabetes mellitus, 3.3% with ischemic heart disease and 3.3% with hypertension and asthma (Figure 1).

Discussions

One hundred patients complaining of vertigo were screened 51(51%) male and 49(49%) female. CT scan and MRI was done for each of them, we find that: M:F ratio 1.04:1aged 18-78years. the main associated symptoms in this study was nausea and this disagree with Hanley in 2001which find that nausea and vomiting less common with central vertigo [9]. In this study ischemia was the main positive finding in patients with vertigo .and this agree with Hanley in 2001 that find the vascular diseases of brain are the main cause of vertigo. In this study all ischemia that seen by CT scan and MRI was in patient consult a private clinic or outpatient clinic after a period from feeling of vertigo to take a treatment and then send to take a date for CT scan examination and this period take at least two weeks so patient will present with chronic ischemia which is detect in 30 patient by CT scan and 32 not detected by CT scan due to a very small size or location of ischemia close to skull vault Otitis media and mastoiditis which is not listed with the causes of vertigo may be the cause of vertigo and this agree with Hanley that find the mastoiditis and otitis media may consider as a cause of vertigo which may clinically associated with tinnitus or hearing loss. multiple sclerosis also not seen by CT scan but detected by MRI. CT scan can detect large intracranial masses like cerebello-pontine angle masses. Finding in 76 patient (76%) in this study refer to a central causes of vertigo and that is mean the neurologist and otolarynologist refer patient for brain MRI or CT scan after a perfect clinical examination with higher suggestion of central causes. From the result of study the deference between MRI and CT scan was the ability to detect ischemia which is the major finding in this study in addition to multiple sclerosis in patient suffering from vertigo. Lawhn-heath in 2013 find that MRI has a high ability than CT scan to detect cause of vertigo and the superior sensitivity of non-radiating magnetic imaging resonance make it the imaging modality of choice in patient complaining of vertigo, also find that CT scan had low sensitivity 26% compared with 83% for MRI in detection of posterior fossa pathology and ischemic stroke. Chalela found that MRI is a preferred imaging modality than CT scan in diagnosis of ischemia in patient with vertigo, MRI sensitivity is higher 83% than sensitivity of CT scan 26% for detecting ischemic stroke. Hwang found that the sensitivity of CT scan is 41.8% for detection of posterior fossa infarction. OZAKIN in 2012 find that CT scan not always detect central causes of vertigo compared with high ability of MRI in detect it. Grewal in 2015 find that CT scan less sensitive to detect ischemia at posterior fossa and it is not preferred to evaluate stroke in patient with vertigo.IN this study we find that the ability of CT scan to detect central causes of vertigo is less than that of MRI and the sensitivity of CT scan was 50.58% while in above studies was 26% and 41.8% , the increased level of CT scan sensitivity in this study was due to long period of time from beginning of symptoms to the time of CT scanning in which the ischemic area become more hypo dense that increase ability of CT scan to detect it while in above studies CT scan examination was done within 36 hours. The sensitivity of MRI cannot calculated in this study because there is no false negative finding in MRI so we depend on a previous studies that calculate the sensitivity of MRI as 83% which is higher than that of CT scan , that mean MRI has higher ability than CT scan to detect central causes of vertigo and this agree with several studies [1, 6, 10, 11, 12].

Conclusions

MRI play an important role than CT scan in evaluation patients with vertigo and has a high ability to detect central causes than CT scan . MRI should be the first imaging modality if the central causes of vertigo are suggested. Ischemia was the main cause of vertigo in middle and old age group. Sensitivity of CT scan has direct relation with the time from beginning of symptoms to CT scan examination.

References


References:
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