This comprehensive review article seeks to establish how useful is MRI in the evaluation of patients with a history of smell loss or distortion. Interestingly, while some studies found the imaging unhelpful, one paper described found a 25% rate of pathology on the MRI scans reported with pathology including olfactory meningioma, olfactory atrophy or old infarcts. A review article had a detection rate of intracranial abnormalities of just 0.8%. Olfactory bulb (OB) volume seems to be a useful marker which often correlates with olfactory function, whereby a smaller volume of OB is often seen with olfactory loss and, conversely, as olfactory recovery occurs, so does the volume of the valve. There may therefore also be a predictive value for prognosis in OB size. Functional MRI scans are also discussed and, although the results are mixed, there appears to be a definite correlation between olfactory function and activity within the olfactory centres in the brain which is reproducible. In summary, there are some merits to MRI scanning in all cases, however the cost effectiveness is more uncertain as the pickup rate of abnormalities is likely to be very low.
To scan or not to scan?
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