A young man presented with symptoms of acoustic neuroma. Investigation of choice in this patient is:
Magnetic resonance imaging (MRI) with gadolinium contrast is the gold standard for the diagnosis or exclusion of vestibular schwannoma (VS, acoustic neuroma). An MRI scan also allows for surgical planning. The MRI characteristics of a VS include a hypointense globular mass centered over the IAC on a T1-weighted image with enhancement when gadolinium is added. VS are iso- to hypointense on T2-weighted images. When MRI scans cannot be used or are not accessible, a computed tomography (CT) scan with iodine contrast or an auditory brainstem response (ABR) offers a reasonable alternate screening modality.
CT without contrast
CT with contrast
MRI without contrast
MRI with contrast