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Chen W, Yu S, Xiao H, Lin N, Wang X, Li B, Sha Y. A novel radiomics nomogram based on T2-sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) images for predicting cochlear and vestibular endolymphatic hydrops in Meniere's disease patients. Eur Radiol 2024; 34:6082-6091. [PMID: 38457037 DOI: 10.1007/s00330-024-10670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To construct and validate a radiomics nomogram based on T2-sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) images for predicting cochlear and vestibular endolymphatic hydrops (EH) in Meniere's disease patients. METHODS A total of 156 patients (312 affected ears) with bilateral definite Meniere's disease who underwent delayed enhancement MRI scans were enrolled in this study. All ears of the patients were divided into a training set (n = 218) and an internal validation set (n = 94). A radiomics nomogram was constructed from radiomics features extracted from the T2-SPACE images, and a radiomics score was calculated. Performance of the radiomics nomogram was assessed using receiver operating characteristics analysis. RESULTS Five features were selected for the construction of the cochlear radiomics nomogram, and seven features for the vestibular radiomics nomogram. The radiomics nomograms exhibited robust performance in differentiating between EH-positive and EH-negative statuses in both training and validation cohorts, with the area under the receiver operating characteristics curve values for cochlear and vestibular radiomic nomograms being 0.703 and 0.728 in the training set, and 0.718 and 0.701 in the validation set, respectively. CONCLUSION The novel radiomics nomograms based on T2-SPACE images were successfully constructed to predict cochlear and vestibular EH in Meniere's disease. The models showed a solid and superior performance and may play an important role in the EH prediction. CLINICAL RELEVANCE STATEMENT We constructed a novel radiomics nomogram, which can be a very useful tool for predicting cochlear and vestibular endolymphatic hydrops in Meniere's disease patients. KEY POINTS • This is the first T2-SPACE-based nomogram to predict cochlear and vestibular endolymphatic hydrops. • The nomogram is of great value to patients who are unable to undergo delayed enhancement MRI scans.
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Affiliation(s)
- Wei Chen
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
- Department of Interventional Radiology, Zhongshan Hospital of Fudan University, Shanghai, China
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Sihui Yu
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Hanyu Xiao
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Naier Lin
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Xiaolin Wang
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
- Department of Interventional Radiology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Bingrong Li
- Department of Radiology, Lishui Central Hospital, Lishui, China.
| | - Yan Sha
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China.
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Theodorou DJ, Theodorou SJ, Ahnoula E, Mitsios V. Simplified MR imaging of the inner ear in patients with Ménière's disease. Front Neurol 2023; 14:1289357. [PMID: 37869151 PMCID: PMC10585251 DOI: 10.3389/fneur.2023.1289357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
| | | | - Ekaterini Ahnoula
- Department of Radiology, General Hospital of Ioannina, Ioannina, Greece
| | - Vasilios Mitsios
- Department of Neurotology and Otolaryngology, Head and Neck Surgery Unit, General Hospital of Ioannina, Ioannina, Greece
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Suárez-Vega V, Manrique-Huarte R, Dominguez P, Blanco M, Alonso-Burgos A, Pérez-Fernández N. Magnetic Resonance Volumetric Quantification of Vestibular Endolymphatic Hydrops in Patients with Unilateral Definite Meniere's Disease Using 3D Inversion Recovery with Real Reconstruction (3D-REAL-IR) Sequence. J Clin Med 2023; 12:5965. [PMID: 37762906 PMCID: PMC10532400 DOI: 10.3390/jcm12185965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The 3D-REAL-IR MRI sequence allows for an in vivo visualization of endolymphatic hydrops. Qualitative assessment methods of the severity of vestibular and cochlear hydrops are the most commonly used. METHODS A quantitative volumetric measurement of vestibular EH in patients with definite unilateral Ménière's disease using the 3D-REAL-IR sequence and the calculation of the endolymphatic ratio (ELR) was intended. RESULTS Volumetric calculations of the vestibules, vestibular endolymph and vestibular ELR are performed in 96 patients with unilateral Ménière's disease and correlated with classic qualitative grading scales. CONCLUSIONS Quantitative volumetric measurement of vestibular hydrops using the 3D-REAL-IR sequence is feasible and reproducible in daily clinical practice. Vestibular ELR values exceeding 60% defined radiologically significant vestibular hydrops, while values below 30% defined radiologically non-significant vestibular hydrops.
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Affiliation(s)
- Víctor Suárez-Vega
- Department of Radiology, Clinica Universidad de Navarra, 28027 Madrid, Spain;
| | - Raquel Manrique-Huarte
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Pablo Dominguez
- Department of Radiology, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Melissa Blanco
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, 28027 Madrid, Spain; (M.B.); (N.P.-F.)
| | | | - Nicolás Pérez-Fernández
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, 28027 Madrid, Spain; (M.B.); (N.P.-F.)
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Huang Y, Zhao P, Han Z, Xie J, Liu Y, Gong S, Wang Z. Evaluation of the relationship between endolymphatic hydrops and hearing loss in Meniere's disease based on three-dimensional real inversion recovery sequence. Braz J Otorhinolaryngol 2023; 89:101314. [PMID: 37688911 PMCID: PMC10504479 DOI: 10.1016/j.bjorl.2023.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/27/2023] [Accepted: 08/19/2023] [Indexed: 09/11/2023] Open
Abstract
OBJECTIVES The degree of endolymphatic hydrops in Meniere's disease may be related to hearing loss. However, the results of prior studies have been inconsistent. We aimed to investigate the relationship between endolymphatic hydrops and hearing loss characteristics in Meniere's disease. METHODS This study included 54 patients (62 ears) with Meniere's disease. Patients underwent three-dimensional real inversion recovery sequences for magnetic resonance imaging and pure-tone audiometry. Endolymphatic hydrops were assessed according to Gurkov's criteria (2011). Correlations between different degrees of endolymphatic hydrops and pure-tone audiometry, as well as staging, were analysed. RESULTS Pure tone audiometry and staging were higher for vestibular endolymphatic hydrops complicated by cochlear ones than isolated cochlear or vestibular hydrops (both p < 0.05). There was no significant correlation between vestibular endolymphatic hydrops and pure-tonal audiometry or staging (all p > 0.05). The degree of hydrops in the middle turn was correlated with the mid-frequency hearing threshold (p < 0.05). The degree of cochlear hydrops was correlated with the audiometry, low-frequency hearing thresholds, mid-frequency hearing thresholds and staging (p < 0.01). CONCLUSION The types and sites of endolymphatic hydrops based on a 3D-real inversion recovery sequence can be used to indicate the degree of hearing loss in patients with Meniere's disease. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yan Huang
- Capital Medical University, Beijing Friendship Hospital, Department of Radiology, Beijing, China
| | - Pengfei Zhao
- Capital Medical University, Beijing Friendship Hospital, Department of Radiology, Beijing, China.
| | - Zhihao Han
- Qingdao University, Weihai Central Hospital, Department of Imaging, Weihai, China
| | - Jing Xie
- Capital Medical University, Beijing Friendship Hospital, Department of Otolaryngology, Head and Neck Surgery, Beijing, China.
| | - Yuhe Liu
- Capital Medical University, Beijing Friendship Hospital, Department of Otolaryngology, Head and Neck Surgery, Beijing, China
| | - Shusheng Gong
- Capital Medical University, Beijing Friendship Hospital, Department of Otolaryngology, Head and Neck Surgery, Beijing, China
| | - Zhenchang Wang
- Capital Medical University, Beijing Friendship Hospital, Department of Radiology, Beijing, China.
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Niu Y, Chen W, Lin M, Sha Y. Vestibular hydrops in patients with semicircular canal malformation. Auris Nasus Larynx 2023:S0385-8146(23)00029-9. [PMID: 36740469 DOI: 10.1016/j.anl.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/22/2022] [Accepted: 01/24/2023] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the vestibular endolymphatic hydrops in patients with semicircular canal malformation. METHODS We searched 7864 patients who underwent MR Imaging after contrast injection and found 21 patients with semicircular canal malformations. Another 9 non-malformed patients with unilateral hearing loss were randomly included. We asked patients about their medical history and measured the volume of total vestibular fluid space and endolymphatic space. The vestibular volume ratio = endolymphatic space/total fluid space × 100. RESULTS Hearing loss was observed in 18 of 30 malformed ears and in 7 of 12 non-malformed ears. Statistical analysis showed no association between semicircular canal malformation and hearing loss. In the semicircular canal malformation group, the average vestibular volume ratio (22.6%) in the ears with hearing loss was higher than that in the ears without hearing loss (11.4%). There was no statistically significant difference in the average vestibular %EL in ears with hearing loss between the malformed inner ear group (22.6%) and non-malformed group (28.2%) (P>0.05). CONCLUSION There was no correlation between semicircular canal malformation and hearing loss. The mean vestibular hydrops volume ratio of the semicircular canal deformed ears with hearing loss was about 22.6%, which was not different from that of normal ears.
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Affiliation(s)
- Yue Niu
- Eye, Ear, Nose and Throat (EENT) Hospital of Fudan University, Shanghai, China, No. 83, Fenyang Road, Xuhui District, Shanghai, China
| | - Wei Chen
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China, No. 83, Fenyang Road, Xuhui District, Shanghai, China
| | - Mengyan Lin
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China, No. 83, Fenyang Road, Xuhui District, Shanghai, China
| | - Yan Sha
- Eye, Ear, Nose and Throat (EENT) Hospital of Fudan University, Shanghai, China, No. 83, Fenyang Road, Xuhui District, Shanghai, China.
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Zhao M, Jiang H, Zhang S, Liu Z, Li Q, Wen X, Hu J, Zeng M, Xie X, Lin J. Comparison of an optimized 3D-real IR and a 3D-FLAIR with a constant flip angle in the evaluation of endolymphatic hydrops. Eur J Radiol 2023; 158:110614. [PMID: 36423365 DOI: 10.1016/j.ejrad.2022.110614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/09/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate an optimized 3D-real IR sequence with a longer TR (16,000 ms) based on the modulated flip angle technique in refocused imaging with extended echo train (MATRIX) for the endolymphatic hydrops (EH) after intravenous (IV) single-dose gadolinium (Gd) administration, and compare it with a heavily T2-weighted 3D-FLAIR sequence with a constant flip angle. METHOD The 3D-FLAIR and 3D-real IR sequences were performed in forty patients with definite Meniere's disease (MD) four hours after IV Gd administration. Image qualities of the two sequences were rated and compared. Contrast-to-noise ratios (CNRs) and signal-to-noise ratios (SNRs) of the two sequences were measured for quantitative comparison. EH was graded on the images of the two sequences by two radiologists. RESULTS Scores and CNRs of the 3D-real IR were significantly higher than those of the 3D-FLAIR (P < 0.05). SNRs of the two sequences were comparable between the two groups. 3D-real IR had a higher inter- and intra-observer reliability for the grading of cochlear and vestibular EH than 3D-FLAIR. Using 3D-real IR sequence, the detection rate of EH of the whole labyrinth was higher than using 3D-FLAIR (86.6 % vs 73.3 %, p = 0.031). In the patients with unilateral MD, SNRs in the affected sides were significantly higher than the unaffected sides (P < 0.05). CONCLUSIONS The optimized 3D-real IR with a longer TR is a robust sequence with an improved depiction of EH after IV administration of single-dose Gd. Compared with 3D-FLAIR, it may allow a more precise evaluation and grading of EH.
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Affiliation(s)
- Menglong Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Huaili Jiang
- Otolaryngology Head and Neck Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shujie Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Zhuang Liu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qin Li
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Xixi Wen
- United Imaging Healthcare, Shanghai 201807, China
| | - Junpu Hu
- United Imaging Healthcare, Shanghai 201807, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Xiaofeng Xie
- Otolaryngology Head and Neck Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai 200032, China.
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Reliability of Endolymphatic Hydrops Qualitative Assessment in Magnetic Resonance Imaging. J Clin Med 2022; 12:jcm12010202. [PMID: 36615003 PMCID: PMC9821015 DOI: 10.3390/jcm12010202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
The study aimed to compare the consistency of MRI interpretation of endolymphatic hydrops qualitative assessment of inner ear structures performed by independent observers. MRI with a delayed post-contrast 3D-FLAIR sequence was performed to visualize EH in patients suspected of having or diagnosed with MD. The scans were analyzed independently by three observers. In total, 220 ears were evaluated and, of these, 75 had definite MD, five probable MD, 67 with other Menieriform symptoms, and 73 were asymptomatic. Significant differences in cochlear endolymphatic hydrops (CoEH) grading between all observers were observed. On the Barath scale of vestibular endolymphatic hydrops (VEH), differences were found between the radiologists and otorhinolaryngologist in grading. No differences were noted in VEH on the Bernaerts scale and increased perilymphatic enhancement. Our study showed that evaluation of vestibular endolymphatic hydrops is repeatable between observers and easy to learn. It proved that Bernaerts' modification increased the sensitivity of EH diagnosis. Both parameters, CoEH and VEH, may serve as a differentiation method of EH from normal ears. The distinction between normal and hydropic ears is much easier to perform than EH grading. Therefore, it may be used to diagnose MD rather than EH staging.
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Deng W, Lin X, Su Y, Cai Y, Zhong J, Ou Y. Comparison between 3D-FLAIR and 3D-real IR MRI sequences with visual classification method in the imaging of endolymphatic hydrops in Meniere's disease. Am J Otolaryngol 2022; 43:103557. [PMID: 35994892 DOI: 10.1016/j.amjoto.2022.103557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/05/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Clinically, the evidence of endolymphatic hydrops (EH) in Meniere's disease (MD) primarily relies on audiological examinations, such as glycerol tests and electrocochleography, to suggest the presence of EH indirectly. However, these techniques lack sensitivity and specificity, and they do not sufficiently assess the degree of EH. This study aims to explore the application of three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and three-dimensional real inversion recovery (3D-real IR) sequence imaging of EH in MD and to assess the image quality and grading of EH. METHODS The study included 50 patients with definite MD. The 3D-FLAIR and 3D-real IR sequence images were performed 24 h after bilateral intratympanic injection of gadolinium. The image quality of both sequences was reviewed by two experienced radiologists. The vestibular and cochlear EH grades of both sequences were reviewed by two experienced otologists using a visual grading method. The Cohen's kappa and Pearson tests were used to analyze the data. RESULTS The reliability of image quality between the two radiologists was excellent (0.7 < kappa < 0.9). There were significant statistical differences in the image quality between the 3D-real IR and 3D-FLAIR sequences (p = 0.023 and p = 0.035, respectively). The reliability for the grading of vestibular and cochlear EH between the two otologists was excellent (0.7 < kappa < 0.9). The 3D-real IR sequence detected more severe hydrops than did the 3D-FLAIR sequence (p < 05). CONCLUSION The image quality of the 3D-real IR sequence is better than that of the 3D-FLAIR sequence, and there are differences in the vestibular and cochlear EH grades of both sequences. The sensitivity of the 3D-real IR sequence in the cochlea is higher. The method of visual grading can be applied to both technologies when combined with 3D-real IR.
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Affiliation(s)
- Wenting Deng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xijun Lin
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yun Su
- Radiology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yuexin Cai
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jinglian Zhong
- Radiology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
| | - Yongkang Ou
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
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Chen W, Geng Y, Niu Y, Lin M, Lin N, Sha Y. Endolymphatic Hydrops Magnetic Resonance Imaging in Menire's Disease Patients on a Vertigo Attack. Otol Neurotol 2022; 43:489-493. [PMID: 35184071 DOI: 10.1097/mao.0000000000003474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the characteristics of endolymphatic hydrops (EH) in Menire's disease (MD) patient on a vertigo attack. STUDY DESIGN Prospective study. SETTING Tertiary referral center. PATIENTS Thirty-six MD patients underwent the enhanced magnetic resonance imaging (MRI) examinations of the inner ear on a vertigo attack were enrolled. MAIN OUTCOME MEASURES All patients met the diagnostic criteria for MD and underwent intravenous gadolinium injection 4 hours before the MRI examinations. The MRI examinations were performed in MD patients on a vertigo attack. RESULTS Various degrees of vestibular EH appeared in almost all affected ears (2 ears had no EH, 11 ears had mild EH, 26 ears had significant EH). The positive rate of vestibular EH was 37/39 (94.9%). Cochlear EH occurred in 29 ears among 39 affected ears (17 ears had mild EH, 12 ears had significant EH). CONCLUSION MRI with intravenous gadolinium injection can provide a better assessment of EH in MD patient on a vertigo attack. Vestibular EH seems to be closely related with the vertigo attacks in MD patients, which needs further study.
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Affiliation(s)
- Wei Chen
- Department of Radiology, Eye & ENT Hospital of Fudan University
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yue Geng
- Department of Radiology, Eye & ENT Hospital of Fudan University
| | - Yue Niu
- Department of Radiology, Eye & ENT Hospital of Fudan University
| | - Mengyan Lin
- Department of Radiology, Eye & ENT Hospital of Fudan University
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Naier Lin
- Department of Radiology, Eye & ENT Hospital of Fudan University
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital of Fudan University
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Chen W, Geng Y, Niu Y, Lin N, Wang X, Sha Y. Inner ear MRI enhancement based on 3D-real IR sequence in patients with Meniere's disease after intravenous gadolinium injection: comparison of different doses used and exploration of a appropriate dose. Clin Otolaryngol 2022; 47:717-723. [PMID: 35034431 DOI: 10.1111/coa.13912] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/25/2021] [Accepted: 01/09/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Three-dimensional inversion-recovery sequence with real reconstruction (3D-real IR) magnetic resonance imaging (MRI) can detect endolymphatic hydrops of the inner ear. We aimed to explore a appropriate dose for intravenous gadolinium injection. DESIGN Observational prospective study. SETTING Tertiary referral center. PARTICIPANTS We collected 90 unilateral definite Meniere's disease patients. MAIN OUTCOME MEASURES All enrolled patients were divided into three groups randomly (patients in group A, B and C received gadolinium injection in 1/1.5/2 times doses, respectively). After 4 hours, inner ear MRI scans were applied. RESULTS The signal intensities of B-affected ears and C-affected ears were significantly higher than A-affected ears (p < 0.05), however, no difference was found between B-affected ears and C-affected ears (p=0.267). The same conditions also appeared in the three unaffected-ear groups. Moreover, the signal intensities of affected-ear in group A, B and C were significantly higher than that of the corresponding unaffected-ear groups (p < 0.05). Besides, the subjective visual evaluation scores of group B and C were significantly better than that of group A (p < 0.05). CONCLUSIONS Intravenous injection of gadolinium in a single dose may be unbefitting for the inner ear imaging based on 3D-real IR MRI, both the applications of gadolinium in 1.5 times and double doses can have a good perilymphatic enhancement effect of inner ear. In order to minimize the use of dose for avoiding or mitigating the adverse reactions and renal damage, 1.5 times dose may be preferred in clinical practice.
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Affiliation(s)
- Wei Chen
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.,Department of Interventional Radiology, Zhongshan Hospital of Fudan University, Shanghai, China.,Department of Radiology, ENT Hospital of Fudan University, Eye &, Shanghai, China
| | - Yue Geng
- Department of Radiology, ENT Hospital of Fudan University, Eye &, Shanghai, China
| | - Yue Niu
- Department of Radiology, ENT Hospital of Fudan University, Eye &, Shanghai, China
| | - Naier Lin
- Department of Radiology, ENT Hospital of Fudan University, Eye &, Shanghai, China
| | - Xiaolin Wang
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.,Department of Interventional Radiology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yan Sha
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.,Department of Radiology, ENT Hospital of Fudan University, Eye &, Shanghai, China
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Guajardo-Vergara C, Suárez-Vega V, Dominguez P, Manrique-Huarte R, Arbizu L, Pérez-Fernández N. Endolymphatic hydrops in the unaffected ear of patients with unilateral Ménière's disease. Eur Arch Otorhinolaryngol 2022; 279:5591-5600. [PMID: 35578137 PMCID: PMC9649467 DOI: 10.1007/s00405-022-07412-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/19/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Current studies show that frequency tuning modification is a good marker for the detection of endolymphatic hydrops (EH) employing magnetic resonance imaging (MRI) in patients with Ménière's disease (MD). The purpose of the present study is to analyze the auditory and vestibular function with audiometric and vestibular-evoked myogenic potentials (VEMP) responses, respectively, in both the affected and unaffected ears of patients with unilateral MD using MRI as diagnostic support for the degree of EH. METHODS We retrospectively reviewed the medical records of 76 consecutive patients with unilateral definite MD (age 55 (28-75); 39 women, 37 men). MRI was used through intravenous gadolinium administration, audiometry, and VEMPs. Functional tests were performed up to a week after the MRI. All were followed up one year after imaging utilizing clinical, auditory, and vestibular testing to rule out bilateral involvement. RESULTS In the unaffected ear, the mean pure-tone average is normal even in cases with hydrops and, for a similar severity of hydrops is significantly lower than in the affected ear. Significant differences for the amplitude of the response at 0.5 kHz, at 1 kHz between the affected and unaffected ears were found to be lower in the affected ears. The relative amplitude ratio (1 Kz-0.5 kHz) was significantly lower in the affected ear and in the case of the oVEMP response depends on the degree of EH. The response in the unaffected ear was not modified by the presence or the degree of hydrops. CONCLUSION In the unaffected ear, hydrops is not associated with hearing deterioration. For a similar degree of hydrops, hearing loss is significantly greater in the affected ear. The endolymphatic hydrops in the vestibule induces a frequency bias in the VEMP response only in the affected ear and not in the unaffected ear. Because of these findings we consider that hydrops does not represent an active disorder in the unaffected ear.
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Affiliation(s)
- Carlos Guajardo-Vergara
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain ,Escuela de Fonoaudiología, Universidad Austral de Chile, Sede Puerto Montt, Los Lagos, Chile
| | | | - Pablo Dominguez
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Lorea Arbizu
- Department of Otorhinolaryngology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Nicolás Pérez-Fernández
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain ,Department of Otorhinolaryngology, Clínica Universidad de Navarra, Marquesado de Santa Marta 1, 28027 Madrid, Spain
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Jasińska-Nowacka A, Lachowska M, Wnuk E, Niemczyk K. Changes in endolymphatic hydrops after vestibular neurectomy observed in magnetic resonance imaging - A pilot study. Auris Nasus Larynx 2021; 49:584-592. [PMID: 34949488 DOI: 10.1016/j.anl.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim was to evaluate endolymphatic hydrops in patients with Ménière's disease before and after vestibular neurectomy to verify if the endolymphatic space dilatation, observed in magnetic resonance imaging, regressed within several months after surgery. METHODS Magnetic resonance imaging was performed after intravenous gadolinium injection in four patients with unilateral definite Ménière's disease before and eight months after vestibular neurectomy. Clinical symptoms, audiovestibular tests, and endolymphatic hydrops in magnetic resonance imaging were evaluated. RESULTS Endolymphatic hydrops was visualized in preoperative magnetic resonance imaging in three out of four analyzed patients. In the remaining one, an asymmetrical contrast enhancement in the affected ear was found. After the vestibular neurectomy, all four patients presented a complete resolution of vertigo episodes and improved functional level. Significant postoperative hearing deterioration was found in two patients. In the follow-up magnetic resonance imaging, no reduction of the endolymphatic hydrops was visualized. A reduction of asymmetrical contrast enhancement in one patient was found. CONCLUSIONS Magnetic resonance imaging of the inner ear is a helpful diagnostic tool for Menière's disease. Vestibular neurectomy is an effective treatment for intractable vertigo; however, there is no endolymphatic hydrops regression evidence within several months after the surgery. Therefore, further studies with a long follow-up period and repeated magnetic resonance imaging are needed to assess the vestibular neurectomy's impact on endolymphatic hydrops. Nevertheless, magnetic resonance imaging supports the clinical diagnosis of Ménière's disease and may help understand its pathophysiology.
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Affiliation(s)
| | - Magdalena Lachowska
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Poland.
| | - Emilia Wnuk
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Poland
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de Pont LMH, van Steekelenburg JM, Verhagen TO, Houben M, Goeman JJ, Verbist BM, van Buchem MA, Bommeljé CC, Blom HM, Hammer S. Hydropic Ear Disease: Correlation Between Audiovestibular Symptoms, Endolymphatic Hydrops and Blood-Labyrinth Barrier Impairment. Front Surg 2021; 8:758947. [PMID: 34805261 PMCID: PMC8601159 DOI: 10.3389/fsurg.2021.758947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/12/2021] [Indexed: 01/23/2023] Open
Abstract
Research Objective: To investigate the correlation between clinical features and MRI-confirmed endolymphatic hydrops (EH) and blood-labyrinth barrier (BLB) impairment. Study Design: Retrospective cross-sectional study. Setting: Vertigo referral center (Haga Teaching Hospital, The Hague, the Netherlands). Methods: We retrospectively analyzed all patients that underwent 4 h-delayed Gd-enhanced 3D FLAIR MRI at our institution from February 2017 to March 2019. Perilymphatic enhancement and the degree of cochlear and vestibular hydrops were assessed. The signal intensity ratio (SIR) was calculated by region of interest analysis. Correlations between MRI findings and clinical features were evaluated. Results: Two hundred and fifteen patients with MRI-proven endolymphatic hydrops (EH) were included (179 unilateral, 36 bilateral) with a mean age of 55.9 yrs and median disease duration of 4.3 yrs. Hydrops grade is significantly correlated with disease duration (P < 0.001), the severity of low- and high-frequency hearing loss (both P < 0.001), and the incidence of drop attacks (P = 0.001). Visually increased perilymphatic enhancement was present in 157 (87.7%) subjects with unilateral EH. SIR increases in correlation with hydrops grade (P < 0.001), but is not significantly correlated with the low or high Fletcher index (P = 0.344 and P = 0.178 respectively). No significant differences were found between the degree of EH or BLB impairment and vertigo, tinnitus or aural fullness. Conclusion: The degree of EH positively correlates with disease duration, hearing loss and the incidence of drop attacks. The BLB is impaired in association with EH grade, but without clear contribution to the severity of audiovestibular symptoms.
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Affiliation(s)
- Lisa M H de Pont
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Thijs O Verhagen
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, Netherlands
| | - Maartje Houben
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Claire C Bommeljé
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Henk M Blom
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, Netherlands.,Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
| | - Sebastiaan Hammer
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands
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Domínguez P, Manrique-Huarte R, Suárez-Vega V, López-Laguna N, Guajardo C, Pérez-Fernández N. Endolymphatic Hydrops in Fluctuating Hearing Loss and Recurrent Vertigo. Front Surg 2021; 8:673847. [PMID: 34136529 PMCID: PMC8202684 DOI: 10.3389/fsurg.2021.673847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Endolymphatic hydrops (EH) is the histopathological hallmark of Ménière's disease (MD) and has been found by in vivo magnetic resonance imaging (MRI) in patients with several inner ear syndromes without definite MD criteria. The incidence and relevance of this finding is under debate. Purpose: The purpose of the study is to evaluate the prevalence and characteristics of EH and audiovestibular test results in groups of patients with fluctuating audiovestibular symptoms not fulfilling the actual criteria for definite MD and compare them with a similar group of patients with definite MD and a group of patients with recent idiopathic sudden neurosensory hearing loss (ISSNHL). Material and Methods: 170 patients were included, 83 with definite MD, 38 with fluctuating sensorineural hearing loss, 34 with recurrent vertigo, and 15 with ISSNHL. The clinical variables, audiovestibular tests, and EH were evaluated and compared. Logistic proportional hazard models were used to obtain the odds ratio for hydrops development, including a multivariable adjusted model for potential confounders. Results: No statistical differences between groups were found regarding disease duration, episodes, Tumarkin spells, migraine, vascular risk factors, or vestibular tests; only hearing loss showed differences. Regarding EH, we found significant differences between groups, with odds ratio (OR) for EH presence in definite MD group vs. all other patients of 11.43 (4.5–29.02; p < 0.001). If the ISSNHL group was used as reference, OR was 55.2 (11.9–253.9; p < 0.001) for the definite MD group, 9.9 (2.1–38.9; p = 0.003) for the recurrent vertigo group, and 5.1 (1.2–21.7; p = 0.03) for the group with fluctuating sensorineural hearing loss. Conclusion: The percentage of patients with EH varies between groups. It is minimal in the ISSNHL group and increases in groups with increasing fluctuating audiovestibular symptoms, with a rate of severe EH similar to the known rate of progression to definite MD in those groups, suggesting that presence of EH by MRI could be related to the risk of progression to definite MD. Thus, EH imaging in these patients is recommended.
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Affiliation(s)
- Pablo Domínguez
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | | | - Nieves López-Laguna
- Department of Emergency Medicine, Clínica Universidad de Navarra, Madrid, Spain
| | - Carlos Guajardo
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain.,Escuela de Fonoaudiología, Universidad Austral de Chile, Sede Puerto Montt, Valdivia, Chile
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Correlation between magnetic resonance imaging classification of endolymphatic hydrops and clinical manifestations and audiovestibular test results in patients with definite Ménière's disease. Auris Nasus Larynx 2021; 49:34-45. [PMID: 33865653 DOI: 10.1016/j.anl.2021.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose was to evaluate magnetic resonance imaging (MRI) classification of endolymphatic hydrops with clinical features, audiological and vestibular tests in patients with definite unilateral Ménière's disease (MD). METHODS Thirty-eight patients were enrolled in this study. The severity of the main clinical symptoms, audiovestibular tests, and MRI, performed 4 hours after intravenous injection of gadobutrol to visualize inner ear compartments, were evaluated. Endolymphatic space dilatation was assessed using Barath and Bernaerts grading systems, and the correlation between the grade of the hydrops and clinical features was evaluated. RESULTS Using the Barath system, cochlear hydrops was visualized in 81.6% of affected ears, while vestibular was 63.2%. Sensitivity increased to 94.7% using Bernaerts' modification. Vestibular hydrops involving the utricle was present only among patients with cochlear and saccular endolymphatic space dilatation. There was a significant relationship between the hearing level and the vestibular hydrops degree in the Bernaerts scale. The grade of the hydrops correlated neither with the duration of MD nor with the severity of main clinical symptoms. Our study proved MRI to be a sensitive diagnostic tool in MD. The endolymphatic hydrops' grade correlates with the hearing level, which confirms endolymphatic space dilatation's role in hearing loss. CONCLUSIONS In our study, two similar MRI grading systems were used; however, several differences were found compared to one another. The Bernaerts scale was more sensitive than the Barath scale, and several relationships between the radiological and clinical data were found. Therefore, several MRI evaluating scales and correlating them with the clinical features are needed. The increased perilymphatic enhancement of the cochlea and an extra low-grade vestibular hydrops distinguished in the Bernaerts scale may increase MD diagnosis sensitivity. Magnetic resonance findings in MD support the clinical diagnosis and may help to understand MD pathophysiology better. This study adds to the knowledge and diagnostics in MD for healthcare to improve patients' treatment.
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