MAGNETIC RESONANCE 3D-Flair sequence at 3T in cochlear otosclerosis Francesco Lombardo 1 & Sara De Cori 1 & Gayane Aghakhanyan 1 & Domenico Montanaro 1 & Daniele De Marchi 1 & Francesca Frijia 1 & Susanna Fortunato 2 & Francesca Forli 2 & Dante Chiappino 3 & Stefano Berrettini 2 & Raffaello Canapicchi 1 Received: 28 May 2015 /Revised: 16 September 2015 /Accepted: 14 December 2015 # European Society of Radiology 2016 Abstract Purpose To assess the capability of three-dimensional fluid- attenuated inversion recovery (3D-FLAIR) sequences in de- tecting signal alterations of the endolabyrinthine fluid in pa- tients with otosclerosis. Materials and methods 3D-FLAIR before and after (-/+) gad- olinium (Gd) administration was added to the standard MR protocol and acquired in 13 patients with a clinical/ audiological diagnosis of severe/profound hearing loss in otosclerosis who were candidates for cochlear im- plantation and in 11 control subjects using 3-T magnetic resonance imaging (MRI) equipment. The MRI signal of the fluid-filled cochlea was assessed both visually and calculating the signal intensity ratio (SIR = signal inten- sity cochlea/brainstem). Results We revealed no endocochlear signal abnormalities on T1-weighted –/+ Gd images for either group, while on 3D- FLAIR we found bilateral hyperintensity with enhancement after Gd administration in eight patients and bilateral hyperintensity without enhancement in one patient. No endocochlear signal abnormalities were detected in other patients or the control group. Conclusion Using 3-T MRI equipment, the 3D-FLAIR -/+ Gd sequence is able to detect the blood-labyrinth barrier (BLB) breakdown responsible for alterations of the endolabyrinthine fluid in patients with cochlear otosclerosis. We believe that 3D-FLAIR +/- Gd is an excellent imaging modality to assess the intra-cochlear damage in otosclerosis patients. Key Points • Gd-enhanced T1-weighted MRI has limited application to detect intra-cochlear damage. • 3D-FLAIR is less sensitive to flux artefacts and allows multiplanar reconstruction. • Post-Gd 3D-FLAIR is advantageous as it may highlight the BLB breakdown. • Using 3D-FLAIR -/+ Gd, we were able to identify intra- cochlear signal hyperintensities. • 3D-FLAIR might be applied for monitoring disease progres- sion and treatment response. Keywords 3D imaging . 3D-FLAIR . MRI . Otosclerosis . Temporal bone Abbreviations BLB Blood-labyrinth barrier CSF Cerebrospinal fluid CT Computed tomography Gd Gadolinium FLAIR Fluid-attenuated inversion recovery FIESTA Fast-inflow steady-state acquisition * Francesco Lombardo flombardo2@inwind.it 1 Fondazione CNR Regione Toscana BG. Monasterio^, Neuroradiology Unit, Via Moruzzi, 1, 56124 Pisa, Italy 2 ENT Audiology Phoniatry Unit, Department of Neuroscience, University of Pisa, Pisa, Italy 3 Fondazione CNR Regione Toscana BG. Monasterio^, Department of Radiology, Massa, Italy Eur Radiol DOI 10.1007/s00330-015-4170-9