Which imaging modality is best for evaluating suspected acoustic neuromas?

• A. MRI head
• B. CT head
• C. XR head
• D. Ultrasound

Answer: (C)

High-resolution MRI of the brain with gadolinium contrast is the imaging modality of choice when acoustic neuroma (vestibular schwannoma) is suspected. MRI provides superior soft tissue contrast and can detect small tumors within the internal auditory canal and cerebellopontine angle that CT or ultrasound may miss. It also helps define the exact size and extent of the lesion, which is important for management decisions.

CT head is much less sensitive for small intracranial tumors and is more useful for evaluating bony anatomy or acute hemorrhage. Ultrasound cannot penetrate the skull well, so it isn’t used to assess intracranial tumors like vestibular schwannomas.