RT Journal Article
SR Electronic
T1 Functional MR Imaging of the Auditory Cortex with Electrical Stimulation of the Promontory in 35 Deaf Patients Before Cochlea Implantation
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 201
OP 207
VO 24
IS 2
A1 Schmidt, Anja M.
A1 Weber, Benno P.
A1 Vahid, Mehdi
A1 Zacharias, Rene
A1 Neuburger, Jürgen
A1 Witt, Myriam
A1 Lenarz, Thomas
A1 Becker, Hartmut
YR 2003
UL http://www.ajnr.org/content/24/2/201.abstract
AB BACKGROUND AND PURPOSE: Promontory testing is used for preoperative assessment of the auditory pathway before cochlear implantation. This method depends on patient cooperation and cannot be used in children or disabled persons. Promontory stimulation during functional MR imaging (fMRI) provides a new and objective method to test the integrity of the auditory pathway. To evaluate the method, we performed this prospective study in deaf adult patients.METHODS: fMRI of the auditory pathway with electrical stimulation of the promontory was performed in 35 profoundly deaf patients, bilaterally in seven. For safe stimulation inside the MR environment, a specially designed nerve stimulator was used. We acquired nine sections parallel to the sylvian fissure by using an echo-planar pulse sequence (1.5 T). To evaluate the number of pixels in the auditory cortex, areas were counted and the minimum confidence level (pst value) was determined. The auditory pathway was called intact when the minimal pst value was 10−5 or when the minimal pst value was 10−4 in at least five activated pixels.RESULTS: Images in 85% of patients reporting an auditory sensation showed activation of the contralateral auditory cortex. In the group of patients reporting no hearing sensation, images in 75% did not show activation.CONCLUSION: This method can prove the intactness of the auditory pathway and help the surgeon in decision making before cochlear implantation. However, a negative finding should not be interpreted as indicating a nonfunctioning auditory pathway. Additional technical refinements and experience are needed to further improve this method.