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Answer: Vestibular schwannomaImaging CharacteristicsMRI images demonstrate an avidly enhancing, T1-isointense, T2-hypointense lesion in the basal turn of the cochlea, characteristic of schwannoma. The T2 hypointesity appears as a filling defect within the surrounding hyperintense perilymph fluid.Acute labyrinthitis is characterized by T1 hyperintense signal secondary to permeability of the blood-labyrinth barrier and accumulation in the intralabyrinthine compartment.
Makariou, MD 65-year-old male presents with left sensorineural hearing loss.Click on the images to enlarge.
Post-gadolinium T1-weighted images demonstrate diffuse, but faint, enhancement of the labyrinth.

Intravestibular lipomas are nonenhancing and demonstrate T1 hyperintense, T2-iso, or hypointense signal with complete saturation on fat-saturation images. Intralabyrinthine hemorrhage is  characterized by both T1- and T2-hyperintense signal on precontrast sequences.DiscussionVestibular schwannoma is a benign nerve sheath neoplasm derived from perineural Schwann cells. They are similar in pathology to peripheral schwannomas and comprise approximately 8% of adult intracranial tumors.
Median age at diagnosis is 50, and they are rare in children unless associated with neurofibromatosis type 2 (NF2).

The majority of these tumors (90%) are unilateral, with bilateral involvement characteristic of NF2.  In sporadic cases, there is often biallelic inactivation of the NF2 gene, which produces schwannomin and serves as a tumor suppressor.

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