AC Portal
Document Navigator

Hearing Loss and/or Vertigo

Variant: 1   Acquired conductive hearing loss in absence of clinically evident mass in the middle ear. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
CT temporal bone without IV contrast Usually Appropriate ☢☢☢
MRA head without and with IV contrast Usually Not Appropriate O
MRA head without IV contrast Usually Not Appropriate O
MRI head and internal auditory canal without and with IV contrast Usually Not Appropriate O
MRI head and internal auditory canal without IV contrast Usually Not Appropriate O
MRV head without IV contrast Usually Not Appropriate O
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone with IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone without and with IV contrast Usually Not Appropriate ☢☢☢
CTA head with IV contrast Usually Not Appropriate ☢☢☢

Variant: 2   Acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning.
Procedure Appropriateness Category Relative Radiation Level
MRI head and internal auditory canal without and with IV contrast Usually Appropriate O
CT temporal bone without IV contrast Usually Appropriate ☢☢☢
MRI head and internal auditory canal without IV contrast May Be Appropriate O
CT temporal bone with IV contrast May Be Appropriate ☢☢☢
CTA head with IV contrast May Be Appropriate (Disagreement) ☢☢☢
MRA head without and with IV contrast Usually Not Appropriate O
MRA head without IV contrast Usually Not Appropriate O
MRV head with IV contrast Usually Not Appropriate O
MRV head without IV contrast Usually Not Appropriate O
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone without and with IV contrast Usually Not Appropriate ☢☢☢

Variant: 3   Acquired sensorineural hearing loss. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
MRI head and internal auditory canal without and with IV contrast Usually Appropriate O
MRI head and internal auditory canal without IV contrast Usually Appropriate O
CT temporal bone with IV contrast May Be Appropriate ☢☢☢
CT temporal bone without IV contrast May Be Appropriate ☢☢☢
MRA head without and with IV contrast Usually Not Appropriate O
MRA head without IV contrast Usually Not Appropriate O
MRV head with IV contrast Usually Not Appropriate O
MRV head without IV contrast Usually Not Appropriate O
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone without and with IV contrast Usually Not Appropriate ☢☢☢
CTA head with IV contrast Usually Not Appropriate ☢☢☢

Variant: 4   Mixed conductive and sensorineural hearing loss. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
MRI head and internal auditory canal without and with IV contrast Usually Appropriate O
MRI head and internal auditory canal without IV contrast Usually Appropriate O
CT temporal bone without IV contrast Usually Appropriate ☢☢☢
MRA head without and with IV contrast Usually Not Appropriate O
MRA head without IV contrast Usually Not Appropriate O
MRV head with IV contrast Usually Not Appropriate O
MRV head without IV contrast Usually Not Appropriate O
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone with IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone without and with IV contrast Usually Not Appropriate ☢☢☢
CTA head with IV contrast Usually Not Appropriate ☢☢☢

Variant: 5   Congenital hearing loss or total deafness or cochlear implant candidate. Surgical planning.
Procedure Appropriateness Category Relative Radiation Level
MRI head and internal auditory canal without and with IV contrast Usually Appropriate O
MRI head and internal auditory canal without IV contrast Usually Appropriate O
CT temporal bone without IV contrast Usually Appropriate ☢☢☢
MRA head without and with IV contrast Usually Not Appropriate O
MRA head without IV contrast Usually Not Appropriate O
MRV head with IV contrast Usually Not Appropriate O
MRV head without IV contrast Usually Not Appropriate O
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone with IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone without and with IV contrast Usually Not Appropriate ☢☢☢
CTA head with IV contrast Usually Not Appropriate ☢☢☢

Variant: 6   Episodic vertigo with or without associated hearing loss or aural fullness (peripheral vertigo). Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
MRI head and internal auditory canal without and with IV contrast Usually Appropriate O
MRI head and internal auditory canal without IV contrast Usually Appropriate O
CT temporal bone without IV contrast Usually Appropriate ☢☢☢
MRA head and neck without and with IV contrast May Be Appropriate O
CTA head and neck with IV contrast May Be Appropriate ☢☢☢
MRA head and neck without IV contrast Usually Not Appropriate O
MRV head with IV contrast Usually Not Appropriate O
MRV head without IV contrast Usually Not Appropriate O
CT head with IV contrast Usually Not Appropriate ☢☢☢
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT head without IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone with IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone without and with IV contrast Usually Not Appropriate ☢☢☢

Variant: 7   Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
MRI head and internal auditory canal without and with IV contrast Usually Appropriate O
MRI head and internal auditory canal without IV contrast Usually Appropriate O
MRA head and neck without and with IV contrast May Be Appropriate O
MRA head and neck without IV contrast May Be Appropriate O
CT head with IV contrast May Be Appropriate ☢☢☢
CT head without IV contrast May Be Appropriate ☢☢☢
CTA head and neck with IV contrast May Be Appropriate ☢☢☢
MRV head with IV contrast Usually Not Appropriate O
MRV head without IV contrast Usually Not Appropriate O
CT head without and with IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone with IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone without and with IV contrast Usually Not Appropriate ☢☢☢
CT temporal bone without IV contrast Usually Not Appropriate ☢☢☢

Panel Members
Aseem Sharma, MDa; Claudia F. E. Kirsch, MDb; Joseph M. Aulino, MDc; Santanu Chakraborty, MBBS, MScd; Asim F. Choudhri, MDe; Isabelle M. Germano, MDf; A. Tuba Karagulle Kendi, MDg; H Jeffrey. Kim, MDh; Ryan K. Lee, i; David S. Liebeskind, MDj; Michael D. Luttrull, MDk; Toshio Moritani, MD, PhDl; Gregory J A. Murad, MDm; Lubdha M. Shah, MDn; Robert Y. Shih, MDo; Sophia C. Symko, MD, MSp; Julie Bykowski, MDq.
Summary of Literature Review
Introduction/Background
Discussion of Procedures by Variant
Variant 1: Acquired conductive hearing loss in absence of clinically evident mass in the middle ear. Initial imaging.
Variant 1: Acquired conductive hearing loss in absence of clinically evident mass in the middle ear. Initial imaging.
A. CT head
Variant 1: Acquired conductive hearing loss in absence of clinically evident mass in the middle ear. Initial imaging.
B. CT temporal bone with IV contrast
Variant 1: Acquired conductive hearing loss in absence of clinically evident mass in the middle ear. Initial imaging.
C. CTA head
Variant 1: Acquired conductive hearing loss in absence of clinically evident mass in the middle ear. Initial imaging.
D. MRA head without and with IV contrast
Variant 1: Acquired conductive hearing loss in absence of clinically evident mass in the middle ear. Initial imaging.
E. MRI head and internal auditory canal
Variant 1: Acquired conductive hearing loss in absence of clinically evident mass in the middle ear. Initial imaging.
F. MRV head
Variant 2: Acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning.
Variant 2: Acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning.
A. CT head
Variant 2: Acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning.
B. CT temporal bone
Variant 2: Acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning.
C. CTA head
Variant 2: Acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning.
D. MRA head
Variant 2: Acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning.
E. MRI head and internal auditory canal
Variant 2: Acquired conductive hearing loss secondary to cholesteatoma or neoplasm with suspected intracranial or inner ear extension. Surgical planning.
F. MRV head
Variant 3: Acquired sensorineural hearing loss. Initial imaging.
Variant 3: Acquired sensorineural hearing loss. Initial imaging.
A. CT head
Variant 3: Acquired sensorineural hearing loss. Initial imaging.
B. CT temporal bone
Variant 3: Acquired sensorineural hearing loss. Initial imaging.
C. CTA head
Variant 3: Acquired sensorineural hearing loss. Initial imaging.
D. MRA head
Variant 3: Acquired sensorineural hearing loss. Initial imaging.
E. MRI head and internal auditory canal
Variant 3: Acquired sensorineural hearing loss. Initial imaging.
F. MRV head
Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging.
Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging.
A. CT head
Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging.
B. CT temporal bone
Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging.
C. CTA head
Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging.
D. MRA head
Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging.
E. MRI head and internal auditory canal
Variant 4: Mixed conductive and sensorineural hearing loss. Initial imaging.
F. MRV head
Variant 5: Congenital hearing loss or total deafness or cochlear implant candidate. Surgical planning.
Variant 5: Congenital hearing loss or total deafness or cochlear implant candidate. Surgical planning.
A. CT head
Variant 5: Congenital hearing loss or total deafness or cochlear implant candidate. Surgical planning.
B. CT temporal bone
Variant 5: Congenital hearing loss or total deafness or cochlear implant candidate. Surgical planning.
C. CTA head
Variant 5: Congenital hearing loss or total deafness or cochlear implant candidate. Surgical planning.
D. MRA head
Variant 5: Congenital hearing loss or total deafness or cochlear implant candidate. Surgical planning.
E. MRI head and internal auditory canal
Variant 5: Congenital hearing loss or total deafness or cochlear implant candidate. Surgical planning.
F. MRV head
Variant 6: Episodic vertigo with or without associated hearing loss or aural fullness (peripheral vertigo). Initial imaging.
Variant 6: Episodic vertigo with or without associated hearing loss or aural fullness (peripheral vertigo). Initial imaging.
A. CT head
Variant 6: Episodic vertigo with or without associated hearing loss or aural fullness (peripheral vertigo). Initial imaging.
B. CT temporal bone
Variant 6: Episodic vertigo with or without associated hearing loss or aural fullness (peripheral vertigo). Initial imaging.
C. CTA head and neck
Variant 6: Episodic vertigo with or without associated hearing loss or aural fullness (peripheral vertigo). Initial imaging.
D. MRA head and neck
Variant 6: Episodic vertigo with or without associated hearing loss or aural fullness (peripheral vertigo). Initial imaging.
E. MRI head and internal auditory canal
Variant 6: Episodic vertigo with or without associated hearing loss or aural fullness (peripheral vertigo). Initial imaging.
F. MRV head
Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
A. CT head
Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
B. CT temporal bone
Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
C. CTA head and neck
Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
D. MRA head and neck
Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
E. MRI head and internal auditory canal
Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
F. MRV head
Summary of Highlights
Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Names and Definitions

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
Relative Radiation Level Information

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.

Relative Radiation Level Designations

Relative Radiation Level*

Adult Effective Dose Estimate Range

Pediatric Effective Dose Estimate Range

O

0 mSv

 0 mSv

☢

<0.1 mSv

<0.03 mSv

☢☢

0.1-1 mSv

0.03-0.3 mSv

☢☢☢

1-10 mSv

0.3-3 mSv

☢☢☢☢

10-30 mSv

3-10 mSv

☢☢☢☢☢

30-100 mSv

10-30 mSv

*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.”
References
1. Curtin HD.. Imaging of Conductive Hearing Loss With a Normal Tympanic Membrane. AJR Am J Roentgenol. 206(1):49-56, 2016 Jan.
2. Shah LM, Wiggins RH, 3rd. Imaging of hearing loss. Neuroimaging Clin N Am. 2009; 19(3):287-306.
3. Connor SE, Sriskandan N. Imaging of dizziness. [Review]. Clin Radiol. 69(2):111-22, 2014 Feb.
4. Macleod D, McAuley D. Vertigo: clinical assessment and diagnosis. Br J Hosp Med (Lond). 2008; 69(6):330-334.
5. Newman-Toker DE, Della Santina CC, Blitz AM. Vertigo and hearing loss. [Review]. Handb. clin. neurol.. 136:905-21, 2016.
6. Bakhit M, Heidarian A, Ehsani S, Delphi M, Latifi SM. Clinical assessment of dizzy patients: the necessity and role of diagnostic tests. Glob J Health Sci. 6(3):194-9, 2014 Mar 24.
7. Kutz JW, Jr. The dizzy patient. Med Clin North Am. 2010; 94(5):989-1002.
8. Belden CJ, Weg N, Minor LB, Zinreich SJ. CT evaluation of bone dehiscence of the superior semicircular canal as a cause of sound- and/or pressure-induced vertigo. Radiology. 2003; 226(2):337-343.
9. Branstetter BF 4th, Harrigal C, Escott EJ, Hirsch BE. Superior semicircular canal dehiscence: oblique reformatted CT images for diagnosis. Radiology. 2006; 238(3):938-942.
10. Lee YH, Rivas-Rodriguez F, Song JJ, Yang KS, Mukherji SK. The prevalence of superior semicircular canal dehiscence in conductive and mixed hearing loss in the absence of other pathology using submillimetric temporal bone computed tomography. J Comput Assist Tomogr. 38(2):190-5, 2014 Mar-Apr.
11. Saliba I, Maniakas A, Benamira LZ, Nehme J, Benoit M, Montreuil-Jacques V. Superior canal dehiscence syndrome: clinical manifestations and radiologic correlations. Eur Arch Otorhinolaryngol. 271(11):2905-14, 2014 Nov.
12. Stimmer H, Hamann KF, Zeiter S, Naumann A, Rummeny EJ. Semicircular canal dehiscence in HR multislice computed tomography: distribution, frequency, and clinical relevance. Eur Arch Otorhinolaryngol. 269(2):475-80, 2012 Feb.
13. Eshetu T, Aygun N. Imaging of the temporal bone: a symptom-based approach. [Review]. Semin Roentgenol. 48(1):52-64, 2013 Jan.
14. Meyer A, Bouchetemble P, Costentin B, Dehesdin D, Lerosey Y, Marie JP. Lateral semicircular canal fistula in cholesteatoma: diagnosis and management. Eur Arch Otorhinolaryngol. 273(8):2055-63, 2016 Aug.
15. Mohan S, Hoeffner E, Bigelow DC, Loevner LA. Applications of magnetic resonance imaging in adult temporal bone disorders. [Review]. Magn Reson Imaging Clin N Am. 20(3):545-72, 2012 Aug.
16. Braun T, Dirr F, Berghaus A, et al. Prevalence of labyrinthine ossification in CT and MR imaging of patients with acute deafness to severe sensorineural hearing loss. Int J Audiol. 52(7):495-9, 2013 Jul.
17. Kulkarni BSN, Bajwa H, Chandrashekhar M, et al. CT- and MRI-based gross target volume comparison in vestibular schwannomas. Rep. Pract. Oncol. Radiother.. 22(3):201-208, 2017 May-Jun.
18. Berrettini S, Seccia V, Fortunato S, et al. Analysis of the 3-dimensional fluid-attenuated inversion-recovery (3D-FLAIR) sequence in idiopathic sudden sensorineural hearing loss. JAMA Otolaryngol Head Neck Surg. 139(5):456-64, 2013 May.
19. Chau JK, Cho JJ, Fritz DK. Evidence-based practice: management of adult sensorineural hearing loss. [Review]. Otolaryngol Clin North Am. 45(5):941-58, 2012 Oct.
20. Cueva RA. Auditory brainstem response versus magnetic resonance imaging for the evaluation of asymmetric sensorineural hearing loss. Laryngoscope. 2004; 114(10):1686-1692.
21. Davidson HC, Harnsberger HR, Lemmerling MM, et al. MR evaluation of vestibulocochlear anomalies associated with large endolymphatic duct and sac. AJNR Am J Neuroradiol. 1999; 20(8):1435-1441.
22. Kwan TL, Tang KW, Pak KK, Cheung JY. Screening for vestibular schwannoma by magnetic resonance imaging: analysis of 1821 patients. HONG KONG MED. J.. 10(1):38-43, 2004 Feb.
23. Mafee MF. Congenital sensorineural hearing loss and enlarged endolymphatic sac and duct: role of magnetic resonance imaging and computed tomography. Top Magn Reson Imaging 2000; 11(1):10-24.
24. Valvassori GE, Clemis JD. The large vestibular aqueduct syndrome. Laryngoscope. 1978; 88(5):723-728.
25. Weissman JL, Curtin HD, Hirsch BE, Hirsch WL, Jr. High signal from the otic labyrinth on unenhanced magnetic resonance imaging. AJNR Am J Neuroradiol. 1992; 13(4):1183-1187.
26. Gebarski SS, Tucci DL, Telian SA. The cochlear nuclear complex: MR location and abnormalities. AJNR Am J Neuroradiol. 1993; 14(6):1311-1318.
27. Sharma A, Viets R, Parsons MS, Reis M, Chrisinger J, Wippold FJ 2nd. A two-tiered approach to MRI for hearing loss: incremental cost of a comprehensive MRI over high-resolution T2-weighted imaging. AJR Am J Roentgenol. 202(1):136-44, 2014 Jan.
28. Daniels RL, Swallow C, Shelton C, Davidson HC, Krejci CS, Harnsberger HR. Causes of unilateral sensorineural hearing loss screened by high-resolution fast spin echo magnetic resonance imaging: review of 1,070 consecutive cases. Am J Otol. 2000; 21(2):173-180.
29. Held P, Fellner C, Fellner F, et al. MRI of inner ear and facial nerve pathology using 3D MP-RAGE and 3D CISS sequences. Br J Radiol. 70(834):558-66, 1997 Jun.
30. Zealley IA, Cooper RC, Clifford KM, et al. MRI screening for acoustic neuroma: a comparison of fast spin echo and contrast enhanced imaging in 1233 patients. Br J Radiol. 2000; 73(867):242-247.
31. Dudau C, Salim F, Jiang D, Connor SE. Diagnostic efficacy and therapeutic impact of computed tomography in the evaluation of clinically suspected otosclerosis. Eur Radiol. 27(3):1195-1201, 2017 Mar.
32. Quesnel AM, Moonis G, Appel J, et al. Correlation of computed tomography with histopathology in otosclerosis. Otol Neurotol. 34(1):22-8, 2013 Jan.
33. Jeong SW, Kim LS. A new classification of cochleovestibular malformations and implications for predicting speech perception ability after cochlear implantation. Audiol Neurootol. 20(2):90-101, 2015.
34. Young JY, Ryan ME, Young NM. Preoperative imaging of sensorineural hearing loss in pediatric candidates for cochlear implantation. [Review]. Radiographics. 34(5):E133-49, 2014 Sep-Oct.
35. El-Badry MM, Osman NM, Mohamed HM, Rafaat FM. Evaluation of the radiological criteria to diagnose large vestibular aqueduct syndrome. Int J Pediatr Otorhinolaryngol. 81:84-91, 2016 Feb.
36. Kim BG, Sim NS, Kim SH, Kim UK, Kim S, Choi JY. Enlarged cochlear aqueducts: a potential route for CSF gushers in patients with enlarged vestibular aqueducts. Otol Neurotol. 34(9):1660-5, 2013 Dec.
37. Glastonbury CM, Davidson HC, Harnsberger HR, Butler J, Kertesz TR, Shelton C. Imaging findings of cochlear nerve deficiency. AJNR Am J Neuroradiol. 2002; 23(4):635-643.
38. Parry DA, Booth T, Roland PS. Advantages of magnetic resonance imaging over computed tomography in preoperative evaluation of pediatric cochlear implant candidates. Otol Neurotol. 2005; 26(5):976-982.
39. Jiang ZY, Odiase E, Isaacson B, Roland PS, Kutz JW Jr. Utility of MRIs in adult cochlear implant evaluations. Otol Neurotol. 35(9):1533-5, 2014 Oct.
40. Lawhn-Heath C, Buckle C, Christoforidis G, Straus C. Utility of head CT in the evaluation of vertigo/dizziness in the emergency department. EMERG. RADIOL.. 20(1):45-9, 2013 Jan.
41. Pasaoglu L. Vertebrobasilar system computed tomographic angiography in central vertigo. Medicine (Baltimore). 96(12):e6297, 2017 Mar.
42. Fukuoka H, Takumi Y, Tsukada K, et al. Comparison of the diagnostic value of 3 T MRI after intratympanic injection of GBCA, electrocochleography, and the glycerol test in patients with Meniere's disease. Acta Otolaryngol (Stockh). 132(2):141-5, 2012 Feb.
43. Grieve SM, Obholzer R, Malitz N, Gibson WP, Parker GD. Imaging of endolymphatic hydrops in Meniere's disease at 1.5 T using phase-sensitive inversion recovery: (1) demonstration of feasibility and (2) overcoming the limitations of variable gadolinium absorption. Eur J Radiol. 81(2):331-8, 2012 Feb.
44. Hagiwara M, Roland JT Jr, Wu X, et al. Identification of endolymphatic hydrops in Meniere's disease utilizing delayed postcontrast 3D FLAIR and fused 3D FLAIR and CISS color maps. Otol Neurotol. 35(10):e337-42, 2014 Dec.
45. Hornibrook J, Flook E, Greig S, et al. MRI Inner Ear Imaging and Tone Burst Electrocochleography in the Diagnosis of Meniere's Disease. Otol Neurotol. 36(6):1109-14, 2015 Jul.
46. Karatas A, Kocak A, Cebi IT, Salviz M. Comparison of Endolymphatic Duct Dimensions and Jugular Bulb Abnormalities Between Meniere Disease and a Normal Population. J Craniofac Surg. 27(5):e424-6, 2016 Jul.
47. Le CH, Truong AQ, Diaz RC. Novel techniques for the diagnosis of Meniere's disease. [Review]. CURR. OPIN. OTOLARYNGOL. HEAD NECK SURG.. 21(5):492-6, 2013 Oct.
48. Liu F, Huang W, Meng X, Wang Z, Liu X, Chen Q. Comparison of noninvasive evaluation of endolymphatic hydrops in Meniere's disease and endolymphatic space in healthy volunteers using magnetic resonance imaging. Acta Otolaryngol (Stockh). 132(3):234-40, 2012 Mar.
49. Liu Y, Jia H, Shi J, et al. Endolymphatic hydrops detected by 3-dimensional fluid-attenuated inversion recovery MRI following intratympanic injection of gadolinium in the asymptomatic contralateral ears of patients with unilateral Meniere's disease. Med Sci Monit. 21:701-7, 2015 Mar 06.
50. Naganawa S, Yamazaki M, Kawai H, Bokura K, Sone M, Nakashima T. Imaging of Meniere&#39;s disease after intravenous administration of single-dose gadodiamide: utility of multiplication of MR cisternography and HYDROPS image. Magn. reson. med. sci.. 12(1):63-8, 2013 Mar 25.
51. Naganawa S, Yamazaki M, Kawai H, et al. MR imaging of Meniere's disease after combined intratympanic and intravenous injection of gadolinium using HYDROPS2. Magn. reson. med. sci.. 13(2):133-7, 2014.
52. Sepahdari AR, Ishiyama G, Vorasubin N, Peng KA, Linetsky M, Ishiyama A. Delayed intravenous contrast-enhanced 3D FLAIR MRI in Meniere's disease: correlation of quantitative measures of endolymphatic hydrops with hearing. Clin Imaging. 39(1):26-31, 2015 Jan-Feb.
53. Wu Q, Dai C, Zhao M, Sha Y. The correlation between symptoms of definite Meniere's disease and endolymphatic hydrops visualized by magnetic resonance imaging. Laryngoscope. 126(4):974-9, 2016 Apr.
54. Kabra R, Robbie H, Connor SE. Diagnostic yield and impact of MRI for acute ischaemic stroke in patients presenting with dizziness and vertigo. Clin Radiol. 70(7):736-42, 2015 Jul.
55. Arai M, Higuchi A, Umekawa J, Mochimatsu Y, Itoh K. [The efficiency of magnetic resonance angiography (MRA) in the diagnosis and vertigo--prediction of vertebrobasilar insufficiency (VBI) and atherosclerosis]. [Japanese]. Nippon Jibiinkoka Gakkai Kaiho. 102(7):925-31, 1999 Jul.
56. Doijiri R, Uno H, Miyashita K, Ihara M, Nagatsuka K. How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack? J Stroke Cerebrovasc Dis 2016;25:2549-52.
57. Leker RR, Hur TB, Gomori JM, Paniri R, Eichel R, Cohen JE. Incidence of DWI-positive stroke in patients with vertigo of unclear etiology, preliminary results. Neurol Res. 35(2):123-6, 2013 Mar.
58. Schick B, Brors D, Koch O, Schafers M, Kahle G. Magnetic resonance imaging in patients with sudden hearing loss, tinnitus and vertigo. Otol Neurotol. 22(6):808-12, 2001 Nov.
59. Saber Tehrani AS, Kattah JC, Mantokoudis G, et al. Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology. 83(2):169-73, 2014 Jul 08.
60. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf.
Disclaimer

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked.  Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.