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Just curious whether standard practice is to get updated MRIs before implant selection?  I had my first and only MRI 16 years ago to rule out an acoustic neuroma for my SSD.  The surgeon hasn't seen the old MRI yet but thinks this would likely be sufficient to review and is not planning on ordering another MRI.

It has been a long road but I finally have insurance approval and have a surgery scheduled for January.

Is cochlear anatomy stable enough that a very old MRI is able to answer the needed questions?  Also seems odd when I also have a bone conduction abutment to work around. 

 

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I’m no expert on this but I’m under the impression that, even though MRIs are possible with MED-EL implants, that the magnets interfere with imaging over a radius of several centimeters, which includes much of the brain. If I’m right about this and you’d like a current MRI of your head, I’d suggest doing it.

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Thanks.  I don't have a cochlear implant yet so I don't have to worry about MRI restrictions or being blocked by the metal.  I was actually asking if surgeons are likely to find a very old MRI sufficient to tell about anatomical restrictions that might affect an implant choice.  I was a little surprised that they didn't want a new one.  

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Tim — I misunderstood. I was thinking you were considering a brain MRI for some other reason while it was still possible. I am a bit surprised your surgeon wouldn’t want a more recent one, but I assume there’s a solid reason why it’s not needed. 

FWIW, the University of North Carolina Hospital used a pre-op CT scan rather than an MRI for my surgery. They used the same image for both sides, 14 months apart.

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This article with photos explains the pros of each imaging technique… CT and MRI

https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00902-6#Fig3

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Just to get closure on the thread, my doctor decided to get a fresh CT scan.

He said the new image looked good and nothing out of the ordinary. 

By the way, hospital had two different CT scanners - the technician changed which CT scanner to use when he realized that I had a bone conduction abutment near where the imaging would occur.  He said that the other machine would be better at handling the back scattering from the titanium.

 

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Just to keep responding to my own thread:  Updating based on surgery yesterday. 

The new CT image was sent to Med-El by the doctor and their 3D analysis said that my cochlea would work with their longest array, the FlexSoft 31mm.  The surgeon normally uses the 28mm as a more conservative option but with this information he felt comfortable giving me the choice of going longer.  We went longer and he got a full insertion! 

The audi at the surgery said that all electrodes are triggering the auditory nerve and have good impedances. 

Seems like a good win for Med-El's Otoplan software. 

I'm hoping the full-length electrode will mean a smoother activation experience due to minimizing pitch/placement mismatch.

Tim

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