10-Minute vs. 4-Hour Post-Gadolinium 3D-FLAIR MRI for Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis

The purpose of this study was to perform a meta-analysis comparing the performance of 10-minute and 4-hour delayed-enhanced Three-Dimensional Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging (3D-FLAIR MRI) for the detection of inner ear abnormalities in sudden sensorineural hearing loss (SSNHL).

A comprehensive literature search was performed independently by two researchers, covering databases including PubMed, Web of Science, Science Direct and CNKI up to June 4, 2025. Original research studies comparing 10-minute and 4-hour delayed-enhanced 3D-FLAIR MRI in evaluating SSNHL were included. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data (JBI) was used for quality assessment. All literature was independently screened and data were extracted, followed by meta-analysis and subgroup analysis using RevMan 5.4 to compare the performance of 10-minute and 4-hour delayed-enhanced 3D-FLAIR MRI.

Four studies including 211 affected ears in 210 SSNHL patients met inclusion criteria for the systematic review. All patients underwent 10-minute and 4-hour delayed-enhanced 3D-FLAIR MRI scanning. The meta-analysis showed a statistically significant difference in detection rates between the 10-minute and 4-hour delays (risk difference [RD], -0.24; 95% CI, -0.38 to -0.10; I²=63%; p=0.0006). Subgroup analyses indicated that study type, region and Gd dose may be the sources of heterogeneity.

A 4-hour delay reveals 24% more abnormal findings than a 10-minute delay in Gd-enhanced 3D-FLAIR MRI. Therefore, we recommend a 4-hour delay for the clinical evaluation of SSNHL patients.