Document Type
Article
Publication Date
1-26-2026
Abstract
BACKGROUND AND OBJECTIVES: The onset of hearing loss due to vestibular schwannomas (VS) is inevitable but does not correlate with the size of the tumor. In patients with Neurofibromatosis Type 2 (NF2) and VS, we previously found an association between pre-contrast fluid-attenuated inversion recovery magnetic resonance imaging (FLAIR MRI) signal in the labyrinth and hearing loss. Here, we asked whether FLAIR hyper-intensity could serve as a predictive biomarker for hearing loss in NF2 patients with VS.
METHODS: A prospective longitudinal study (NCT00598351) of NF2 enrolled 168 subjects between 2008 and 2013. This study included 34 patients with small VS (total volume ≤ 500mm
RESULTS: From 34 eligible subjects (mean age 26.8y) with NF2 and small VS, 53 ears met inclusion criteria. Abnormal hearing was recorded in 18 ears at study entry; all 18 ears had FLAIR hyper-intensity. Of the 35 ears with normal hearing, 16 had FLAIR hyper-intensity at study entry, 6 (37.5%) of which developed new hearing loss (median time to hearing loss of 4.45 years). Conversion to FLAIR hyper-intensity occurred in 11 ears, 3 of which proceeded to hearing loss. No hearing loss developed in the eight ears that remained FLAIR negative. FLAIR conversion has high sensitivity (1·00, 95% CI 0·39–1) and negative predictive value (1·00, 95% CI 0·63–1) for new-onset hearing loss. In 4 patients undergoing middle fossa decompression surgery, we found that surgery stabilized hearing but did not reverse FLAIR hyperintensity.
CONCLUSIONS: Our findings suggest that intralabyrinthine FLAIR hyper-intensity is a sensitive, non-invasive biomarker for hearing loss related to VS. Hearing decline followed FLAIR hyper-intensity by approximately 4 years but was absent in ears with normal FLAIR signal.
TRIAL REGISTRATION: Registry: ClinicalTrials.gov, TRN: NCT00060541, Registration date: 4 June 2003.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11060-026-05422-9.
Recommended Citation
Walker, Robert L.; Laws, Maxwell T.; Kim, H. Jeffrey; Zalewski, Christopher; Asthagiri, Ashok; Ranganathan, Sruthi; Hayes, Christina; Heiss, John D.; Butman, John A.; and Chittiboina, Prashant, "Intralabyrinthine MRI FLAIR as a Predictive Marker for Hearing Loss in Vestibular Schwannomas in Neurofibromatosis Type 2" (2026). Department of Radiation Oncology Faculty Papers. Paper 227.
https://jdc.jefferson.edu/radoncfp/227
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Supplementary Material 2 Figure S2.tif (6926 kB)
Supplementary Material 3 Figure S3.tif (7228 kB)
Supplementary Material 4 Figure S4.tif (4180 kB)
PubMed ID
41586863
Language
English
Included in
Diagnosis Commons, Oncology Commons, Radiation Medicine Commons
Comments
This article is the author’s final published version in Journal of Neuro-Oncology, Volume 176, Issue 3, 2024, Article number 182.
The published version is available at https://doi.org/10.1007/s11060-026-05422-9. Copyright © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2026.