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Meanwhile, the diagnostic utility of MRIs dedicated to the inner ear remains to be elucidated for diagnosing AUPV\/VN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively recruited 53 patients with AUPV\/VN (mean age\u2009\u00b1\u2009SD\u2009=\u200960\u2009\u00b1\u200915\u2009years, 29 men). Initial MRIs were performed with a standard protocol, and an additional axial 3D\u2010fluid\u2010attenuated inversion recovery (3D\u2010FLAIR) sequence was obtained 4\u2009h after intravenous injection of gadoterate meglumine. Abnormal enhancement was defined as a signal intensity that exceeded the mean\u2009+\u20092SD value on the healthy side. The findings of neurotologic evaluation and MRIs were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, the inter\u2010rater agreement for gadolinium enhancement was 0.886 (Cohen's kappa coefficient). Enhancement was observed in 26 patients (49%), most frequently in the vestibule (<jats:italic>n<\/jats:italic>\u2009=\u200920), followed by the anterior (<jats:italic>n<\/jats:italic>\u2009=\u200912), horizontal (HC, <jats:italic>n<\/jats:italic>\u2009=\u20098), posterior canal (<jats:italic>n<\/jats:italic>\u2009=\u20095), and superior (<jats:italic>n<\/jats:italic>\u2009=\u20093) and inferior (<jats:italic>n<\/jats:italic>\u2009=\u20091) vestibular nerves. In multivariable logistic regression analysis, the enhancement was associated with decreased HC gain in video head\u2010impulse tests (<jats:italic>p<\/jats:italic>\u2009=\u20090.036), increased interaural difference in ocular vestibular\u2010evoked myogenic potentials (<jats:italic>p<\/jats:italic>\u2009=\u20090.001), and a longer onset\u2010to\u2010MRI time span (<jats:italic>p<\/jats:italic>\u2009=\u20090.024). The sensitivity and specificity were 92.3% and 81.5%, respectively, with an area under the curve of 0.90 for predicting gadolinium enhancement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Robust gadolinium enhancement was observed on 4\u2010hour\u2010delayed 3D\u2010FLAIR images in nearly half of the patients with AUPV\/VN, with a good correlation with the results of neurotologic evaluation. The positivity may be determined by the extent of vestibular deficit, timing of imaging acquisition, and possibly by the underlying etiology causing AUPV\/VN. MRIs may aid in delineating the involved structures in AUPV\/VN.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.52123","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T12:48:50Z","timestamp":1718369330000},"page":"2030-2039","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Four\u2010hour\u2010delayed <scp>3D<\/scp>\u2010<scp>FLAIR MRIs<\/scp> in patients with acute unilateral peripheral vestibulopathy"],"prefix":"10.1002","volume":"11","author":[{"given":"Keun\u2010Tae","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurology Korea University Medical Center  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangeun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Radiology Korea University Medical Center  Seoul South 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