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Kim KT, Park S, Lee SU, Park E, Kim B, Kim BJ, Kim JS. Four-hour-delayed 3D-FLAIR MRIs in patients with acute unilateral peripheral vestibulopathy. Ann Clin Transl Neurol 2024. [PMID: 38874375 DOI: 10.1002/acn3.52123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/20/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE Conventionally, MRI aids in differentiating acute unilateral peripheral vestibulopathy/vestibular neuritis (AUPV/VN) from mimickers. Meanwhile, the diagnostic utility of MRIs dedicated to the inner ear remains to be elucidated for diagnosing AUPV/VN. METHODS We prospectively recruited 53 patients with AUPV/VN (mean age ± SD = 60 ± 15 years, 29 men). Initial MRIs were performed with a standard protocol, and an additional axial 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence was obtained 4 h after intravenous injection of gadoterate meglumine. Abnormal enhancement was defined as a signal intensity that exceeded the mean + 2SD value on the healthy side. The findings of neurotologic evaluation and MRIs were compared. RESULTS Overall, the inter-rater agreement for gadolinium enhancement was 0.886 (Cohen's kappa coefficient). Enhancement was observed in 26 patients (49%), most frequently in the vestibule (n = 20), followed by the anterior (n = 12), horizontal (HC, n = 8), posterior canal (n = 5), and superior (n = 3) and inferior (n = 1) vestibular nerves. In multivariable logistic regression analysis, the enhancement was associated with decreased HC gain in video head-impulse tests (p = 0.036), increased interaural difference in ocular vestibular-evoked myogenic potentials (p = 0.001), and a longer onset-to-MRI time span (p = 0.024). The sensitivity and specificity were 92.3% and 81.5%, respectively, with an area under the curve of 0.90 for predicting gadolinium enhancement. INTERPRETATION Robust gadolinium enhancement was observed on 4-hour-delayed 3D-FLAIR 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.
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Affiliation(s)
- Keun-Tae Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Sangeun Park
- Department of Radiology, Korea University Medical Center, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Medical Center, Seoul, South Korea
| | - Euyhyun Park
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Medical Center, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul, South Korea
| | - Byungjun Kim
- Department of Radiology, Korea University Medical Center, Seoul, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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Ke Y, Ma X, Jing Y, Diao T, Yu L. The Breakdown of Blood-Labyrinth Barrier Makes it Easier for Drugs to Enter the Inner Ear. Laryngoscope 2024; 134:2377-2386. [PMID: 37987231 DOI: 10.1002/lary.31194] [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: 08/02/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE This study aimed to investigate dynamic change of permeability of blood-labyrinth barrier (BLB) after noise exposure and its effect on the drug delivery efficiency of systemic administration. METHODS Gadopentetate dimeglumine (Gd-DTPA) and dexamethasone (DEX) were used as tracers, and magnetic resonance imaging (MRI) and immunofluorescence were used to observe the change of the BLB after strong noise exposure in guinea pigs. High-performance liquid chromatography-mass spectrometry (LC-MS) was used to observe the effect of the breakdown of BLB after noise exposure on the drug delivery efficiency of intravenous DEX. The guinea pigs were divided into 6 groups: normal group (N), 1, 3, 5, 8, and 12 days after noise exposure groups (P1, P3, P5, P8, P12), with 5 animals in each group. RESULTS The BLB changes dynamically after noise exposure. Increased permeability of the blood-endolymph barrier, the endolymph-perilymph barrier, and the blood-nerve barrier was observed at days 1-3, 1-5, and 1-8, respectively, after noise exposure in guinea pigs. Higher drug concentration in the cochlear tissue was obtained by intravenous administration of DEX in guinea pigs during the time window of increased permeability of the BLB. CONCLUSION After noise exposure, the increased BLB permeability makes it easier for drugs to enter the inner ear from blood. In guinea pigs, 1-8 days after strong noise exposure, the drug delivery efficiency of systemic administration increased. After 8 days, the efficiency gradually returned to normal level. 1-8 days after noise exposure may be the best intervention time for systemic administration. LEVEL OF EVIDENCE NA Laryngoscope, 134:2377-2386, 2024.
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Affiliation(s)
- Yujie Ke
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Tongxiang Diao
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
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Zhang W, Xie J, Liu H, Wang M. Blood-labyrinth barrier breakdown in Meniere's disease. Eur Arch Otorhinolaryngol 2024; 281:2327-2332. [PMID: 38057488 DOI: 10.1007/s00405-023-08353-7] [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: 08/07/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE We compared the signal intensity ratio (SIR) of the cochlear basal turn between Meniere's disease and healthy controls to investigate potential damage of the blood-labyrinth barrier in Meniere's disease. METHODS Thirty patients diagnosed with unilateral definite Meniere's disease and 24 healthy controls were enrolled. 3D-FLAIR scan was conducted to assess the grades of endolymphatic hydrops in Meniere's patients while measuring the SIR of cochlear basal turns in both groups. The differences of bilateral SIR between Meniere's disease and healthy control were compared, and the correlation between the SIR on affected ear in Meniere's disease and the grades of cochlear and vestibular hydrops were analyzed. RESULTS SIR of affected ear in Meniere's disease exhibited significant increase compared to that of unaffected ear. No significant difference was observed in SIR between the two ears in the healthy control. Furthermore, the SIR of unaffected side in Meniere's disease was higher than that of both ears in healthy controls. The SIR in affected ear of Meniere's disease exhibited positive correlation with hydrops in both cochlea and vestibula. CONCLUSION The permeability of blood-labyrinth barrier is increased in Meniere's disease, in combination with the typical criteria of Meniere's disease it may be a good biological marker. Destruction of blood-labyrinth barrier may be one of the causes of endolymphatic hydrops in Meniere's disease.
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Affiliation(s)
- Weidong Zhang
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450000, China
| | - Jiapei Xie
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450000, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Hongjian Liu
- Department of Otorhinolaryngology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450000, China
| | - Meiyun Wang
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450000, China.
- Laboratory of Brain Science and Brain-Like Intelligence Technology, Institute for Integrated Medical Science and Engineering, Henan Academy of Sciences, Zhengzhou, China.
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Connor S, Grzeda MT, Jamshidi B, Ourselin S, Hajnal JV, Pai I. Delayed post gadolinium MRI descriptors for Meniere's disease: a systematic review and meta-analysis. Eur Radiol 2023; 33:7113-7135. [PMID: 37171493 PMCID: PMC10511628 DOI: 10.1007/s00330-023-09651-8] [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: 12/14/2022] [Revised: 01/12/2023] [Accepted: 02/22/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Delayed post-gadolinium magnetic resonance imaging (MRI) detects changes of endolymphatic hydrops (EH) within the inner ear in Meniere's disease (MD). A systematic review with meta-analysis was conducted to summarise the diagnostic performance of MRI descriptors across the range of MD clinical classifications. MATERIALS AND METHODS Case-controlled studies documenting the diagnostic performance of MRI descriptors in distinguishing MD ears from asymptomatic ears or ears with other audio-vestibular conditions were identified (MEDLINE, EMBASE, Web of Science, Scopus databases: updated 17/2/2022). Methodological quality was evaluated with Quality Assessment of Diagnostic Accuracy Studies version 2. Results were pooled using a bivariate random-effects model for evaluation of sensitivity, specificity and diagnostic odds ratio (DOR). Meta-regression evaluated sources of heterogeneity, and subgroup analysis for individual clinical classifications was performed. RESULTS The meta-analysis included 66 unique studies and 3073 ears with MD (mean age 40.2-67.2 years), evaluating 11 MRI descriptors. The combination of increased perilymphatic enhancement (PLE) and EH (3 studies, 122 MD ears) achieved the highest sensitivity (87% (95% CI: 79.92%)) whilst maintaining high specificity (91% (95% CI: 85.95%)). The diagnostic performance of "high grade cochlear EH" and "any EH" descriptors did not significantly differ between monosymptomatic cochlear MD and the latest reference standard for definite MD (p = 0.3; p = 0.09). Potential sources of bias were case-controlled design, unblinded observers and variable reference standard, whilst differing MRI techniques introduced heterogeneity. CONCLUSIONS The combination of increased PLE and EH optimised sensitivity and specificity for MD, whilst some MRI descriptors also performed well in diagnosing monosymptomatic cochlear MD. KEY POINTS • A meta-analysis of delayed post-gadolinium magnetic resonance imaging (MRI) for the diagnosis of Meniere's disease is reported for the first time and comprised 66 studies (3073 ears). • Increased enhancement of the perilymphatic space of the inner ear is shown to be a key MRI feature for the diagnosis of Meniere's disease. • MRI diagnosis of Meniere's disease can be usefully applied across a range of clinical classifications including patients with cochlear symptoms alone.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.
- Department of Neuroradiology, King's College Hospital, London, SE5 9RS, UK.
- Department of Radiology, Guy's Hospital and St Thomas' Hospital, London, SE1 9RT, UK.
| | - Mariusz T Grzeda
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, SE1 7EH, UK
| | - Babak Jamshidi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, SE1 7EH, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Irumee Pai
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, SE1 9RT, UK
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Sekulic M, Puche R, Bodmer D, Petkovic V. Human blood-labyrinth barrier model to study the effects of cytokines and inflammation. Front Mol Neurosci 2023; 16:1243370. [PMID: 37808472 PMCID: PMC10551159 DOI: 10.3389/fnmol.2023.1243370] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Hearing loss is one of the 10 leading causes of disability worldwide. No drug therapies are currently available to protect or restore hearing. Inner ear auditory hair cells and the blood-labyrinth barrier (BLB) are critical for normal hearing, and the BLB between the systemic circulation and stria vascularis is crucial for maintaining cochlear and vestibular homeostasis. BLB defects are associated with inner ear diseases that lead to hearing loss, including vascular malformations, inflammation, and Meniere's disease (MD). Antibodies against proteins in the inner ear and cytokines in the cochlea, including IL-1α, TNF-α, and NF-kβ, are detected in the blood of more than half of MD patients. There is also emerging evidence of inner ear inflammation in some diseases, including MD, progressive sensorineural hearing loss, otosclerosis, and sudden deafness. Here, we examined the effects of TNF-α, IL6, and LPS on human stria vascularis-derived primary endothelial cells cultured together with pericytes in a Transwell system. By measuring trans-endothelial electrical resistance, we found that TNF-α causes the most significant disruption of the endothelial barrier. IL6 had a moderate influence on the barrier, whereas LPS had a minimal impact on barrier integrity. The prominent effect of TNF-α on the barrier was confirmed in the expression of the major junctional genes responsible for forming the tight endothelial monolayer, the decreased expression of ZO1 and OCL. We further tested permeability using 2 μg of daptomycin (1,619 Da), which does not pass the BLB under normal conditions, by measuring its passage through the barrier by HPLC. Treatment with TNF-α resulted in higher permeability in treated samples compared to controls. LPS-treated cells behaved similarly to the untreated cells and did not show differences in permeability compared to control. The endothelial damage caused by TNF-α was confirmed by decreased expression of an essential endothelial proteoglycan, syndecan1. These results allowed us to create an inflammatory environment model that increased BLB permeability in culture and mimicked an inflammatory state within the stria vascularis.
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Affiliation(s)
- Marijana Sekulic
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raoul Puche
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Bodmer
- University Hospital Basel, Clinic for Otorhinolaryngology, Basel, Switzerland
| | - Vesna Petkovic
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
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Quint R, Vaussy A, Stemmer A, Hautefort C, Houdart E, Eliezer M. Iterative Denoising Accelerated 3D FLAIR Sequence for Hydrops MR Imaging at 3T. AJNR Am J Neuroradiol 2023; 44:1064-1069. [PMID: 37536733 PMCID: PMC10494947 DOI: 10.3174/ajnr.a7953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND PURPOSE 3D FLAIR sequences have become the criterion standard for identifying endolymphatic hydrops, but scan time remains an important limitation to their widespread use. Our purpose was to evaluate the diagnostic performance and image quality of an accelerated 3D FLAIR sequence combined with an iterative denoising algorithm. MATERIALS AND METHODS This was a retrospective study performed on 30 patients with clinical suspicion of endolymphatic hydrops who underwent 3T MR imaging 4 hours after gadolinium injection using two 3D FLAIR sequences. The first (conventional FLAIR) was accelerated with a conventional turbo factor of 187. The second was accelerated with an increased turbo factor of 263, resulting in a 33% scan time reduction (5 minutes 36 seconds versus 8 minutes 15 seconds, respectively). A sequence was reconstructed in-line immediately after the accelerated 3D FLAIR acquisition from the same raw data with iterative denoising (accelerated-FLAIR iterative denoising). The signal intensity ratio image quality score and endolymphatic hydrops diagnosis were evaluated. RESULTS The mean signal intensity ratio for symptomatic and asymptomatic ears of accelerated-FLAIR iterative denoising was significantly higher than the mean SNR of conventional FLAIR (29.5 versus 19 and 25.9 versus 16.3, P < .001). Compared with the conventional FLAIR sequence, the image-quality score was higher with accelerated-FLAIR iterative denoising (mean image-quality score, 3.8 [SD, 0.4] versus 3.3 [SD, 0.6] for accelerated-FLAIR iterative denoising and conventional FLAIR, respectively, P = .003). There was no significant difference in the diagnosis of endolymphatic hydrops between the 2 sequences. Interreader agreement was good-to-excellent. CONCLUSIONS The iterative denoising algorithm applied to an accelerated 3D FLAIR sequence for exploration of endolymphatic hydrops enabled significantly reducing the scan time without compromising image quality and diagnostic performance.
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Affiliation(s)
- R Quint
- From the Department of Neuroradiology (R.Q., E.H., M.E.), Lariboisière University Hospital, Paris, France
| | - A Vaussy
- Siemens Healthineers France (A.V.), Saint-Denis, France
| | - A Stemmer
- Siemens Healthineers (A.S.), Erlangen, Germany
| | - C Hautefort
- Department of Head and Neck Surgery (C.H.), Lariboisière University Hospital, Paris, France
| | - E Houdart
- From the Department of Neuroradiology (R.Q., E.H., M.E.), Lariboisière University Hospital, Paris, France
- Faculté de Médecine (E.H.), Université de Paris, Paris, France
| | - M Eliezer
- From the Department of Neuroradiology (R.Q., E.H., M.E.), Lariboisière University Hospital, Paris, France
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Li J, Wang L, Hu N, Kong X, Ge X, Liu M, Li C, Sun L, Gong R. Improving diagnostic accuracy for probable and definite Ménière's disease using magnetic resonance imaging. Neuroradiology 2023; 65:1371-1379. [PMID: 37328652 DOI: 10.1007/s00234-023-03176-z] [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: 03/05/2023] [Accepted: 06/04/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To determine whether magnetic resonance imaging (MRI) can improve diagnostic accuracy for definite and probable Ménière's disease (MD) based on perilymphatic enhancement (PE) and endolymphatic hydrops (EH). METHODS 363 patients with unilateral MD (probable MD, n = 75 and definite MD, n = 288) were recruited. A three-dimensional zoomed imaging technique with parallel transmission SPACE real inversion recovery was performed 6 h after intravenous gadolinium injection to investigate the presence of PE and to evaluate the grading and location of EH. PE and EH characteristics were analyzed and compared between the probable and definite MD groups. RESULTS The cochlear and vestibular EH grading on the affected side was more severe in the definite MD group than that in the probable MD group (P < 0.001). The EH locations within the inner ear on the affected side also differed between the two groups (χ2 = 81.15, P < 0.001). The signal intensity ratio (SIR) on the affected side was significantly higher in the definite MD group than in the probable MD group (t = 2.18, P < 0.05). The assessment of the combination of PE and EH parameters within the inner ear revealed a higher area under the curve (AUC) in the definite MD group (0.82) compared with the AUCs of the parameters assessed alone. CONCLUSION The assessment of a combination of PE and EH parameters improved the diagnostic accuracy for probable and definite MD, suggesting that MRI findings may be clinically useful in the diagnosis of MD.
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Affiliation(s)
- Jinye Li
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Linsheng Wang
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Na Hu
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Xiao Kong
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Xiaoqian Ge
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Mengxiao Liu
- MR Scientific Marketing, Diagnostic Imaging, Siemens Healthineers Ltd, Shanghai, China
| | - Chuanting Li
- Department of Radiology, Shandong Provincial Hospital, Shandong University, 324 Jing Wu Wei-Qi Road, Jinan, China
| | - Lixin Sun
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China.
| | - Ruozhen Gong
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
- Gong Ruozhen Innovation Studio, Shandong Provincial Hospital, Shandong University, 324 Jing Wu Wei-Qi Road, Jinan, China
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de Pont LMH, Houben MTPM, Verhagen TO, Verbist BM, van Buchem MA, Bommeljé CC, Blom HM, Hammer S. Visualization and clinical relevance of the endolymphatic duct and sac in Ménière's disease. Front Neurol 2023; 14:1239422. [PMID: 37719762 PMCID: PMC10501721 DOI: 10.3389/fneur.2023.1239422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
Background Ménière's disease (MD) is a chronic inner ear disorder with a multifactorial etiology. Decreased visualization of the endolymphatic duct (ED) and sac (ES) is thought to be associated with MD, although controversy exists about whether this finding is specific to MD. Recent literature has revealed that two distinct ES pathologies, developmental hypoplasia and epithelial degeneration, can be distinguished in MD using the angular trajectory of the vestibular aqueduct (ATVA) or ED-ES system as a radiographic surrogate marker. It has been suggested that these two subtypes are associated with distinct phenotypical features. However, the clinical differences between the ATVA subtypes require further validation. Research objective The objective of this study is to investigate whether (1) non-visualization of the ED-ES system is a discriminative radiological feature for MD in a cohort of vertigo-associated pathologies (VAPs) and whether (2) different angular trajectories of the ED-ES system in MD are associated with distinguishable clinical features. Setting The study was conducted in the Vertigo Referral Center (Haga Teaching Hospital, The Hague, the Netherlands). Methods We retrospectively assessed 301 patients (187 definite MD and 114 other VAPs) that underwent 4h-delayed 3D FLAIR MRI. We evaluated (1) the visibility of the ED-ES system between MD and other VAP patients and (2) measured the angular trajectory of the ED-ES system. MD patients were stratified based on the angular measurements into αexit ≤ 120° (MD-120), αexit 120°-140° (MD-intermediate), or αexit ≥ 140° (MD-140). Correlations between ATVA subgroups and clinical parameters were evaluated. Results Non-visualization of the ED-ES system was more common in definite MD patients compared with other VAPs (P < 0.001). Among definite MD patients, the MD-140 subtype demonstrated a longer history of vertigo (P = 0.006), a higher prevalence of bilateral clinical disease (P = 0.005), and a trend toward a male preponderance (p = 0.053). No significant differences were found between ATVA subgroups regarding the presence or severity of auditory symptoms, or the frequency of vertigo attacks. Conclusion Non-visualization of the ED-ES system is significantly associated with MD. Among MD patients with a visible ED-ES system, we demonstrated that the MD-140 subtype is associated with a longer disease duration, a higher prevalence of bilateral MD, and a trend toward a male preponderance.
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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
| | - Maartje T. P. M. Houben
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Thijs O. Verhagen
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, 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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Leng Y, Fan W, Liu Y, Xia K, Zhou R, Liu J, Wang H, Ma H, Liu B. Comparison between audio-vestibular findings and contrast-enhanced MRI of inner ear in patients with unilateral Ménière’s disease. Front Neurosci 2023; 17:1128942. [PMID: 36992853 PMCID: PMC10040662 DOI: 10.3389/fnins.2023.1128942] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
ObjectiveThe diagnosis of Ménière’s disease (MD), characterized by idiopathic endolymphatic hydrops (ELH), remains a clinical priority. Many ancillary methods, including the auditory and vestibular assessments, have been developed to identify ELH. The newly emerging delayed magnetic resonance imaging (MRI) of the inner ear after intratympanic gadolinium (Gd) has been used for identifying ELH in vivo. We aimed to investigate the concordance of audio-vestibular and radiological findings in patients with unilateral MD.MethodsIn this retrospective study, 70 patients with unilateral definite MD underwent three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences following intratympanic application of Gd. Audio-vestibular evaluations were performed, including pure tone audiometry, electrocochleogram (ECochG), glycerol test, caloric test, cervical and ocular vestibular evoked myogenic potentials (VEMPs), and video head impulse test (vHIT). The relationship between imaging signs of ELH and audio-vestibular results was investigated.ResultsThe incidence of radiological ELH was higher than that of neurotological results, including the glycerol test, caloric test, VEMPs, and vHIT. Poor or slight agreement was observed between audio-vestibular findings and radiological ELH in cochlear and/or vestibular (kappa values <0.4). However, the pure tone average (PTA) in the affected side significantly correlated with the extent of both cochlear (r = 0.26795, p = 0.0249) and vestibular (r = 0.2728, p = 0.0223) hydrops. Furthermore, the degree of vestibular hydrops was also positively correlated with course duration (r = 0.2592, p = 0.0303) and glycerol test results (r = 0.3944, p = 0.0061) in the affected side.ConclusionIn the diagnosis of MD, contrast-enhanced MRI of the inner ear is advantageous in detecting ELH over the conventional audio-vestibular evaluations, which estimates more than hydropic dilation of endolymphatic space.
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Affiliation(s)
- Yangming Leng
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yingzhao Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaijun Xia
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renhong Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongchang Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Ma
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Hui Ma,
| | - Bo Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Bo Liu,
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10
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A systematic review on delayed acquisition of post-gadolinium magnetic resonance imaging in Ménière's disease: imaging of the endolymphatic spaces. J Laryngol Otol 2023; 137:239-245. [PMID: 35674257 DOI: 10.1017/s0022215122001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This study aimed to assess the clinical implications of delayed-acquisition post-gadolinium magnetic resonance imaging in identifying endolymphatic hydrops in Ménière's disease. METHOD This study was a systematic review using Medline and Embase and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with predetermined criteria, namely Ménière's disease, post-gadolinium magnetic resonance imaging and endolymphatic hydrops. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess bias. RESULTS Eleven studies were included; they all used 3T magnetic resonance imaging, with three-dimensional fluid-attenuated inversion recovery being the most common sequence. Intravenous gadolinium administration was more widely used compared with the intratympanic route. As for the timing of acquisition, 4 hours post-administration was universally used for the IV gadolinium and 24 hours was used for the intratympanic gadolinium. Despite patient-selection associated bias, all studies reported adequate visualisation of the endolymphatic spaces. CONCLUSION The use of delayed-acquisition magnetic resonance imaging is increasingly supported in visualising the endolymphatic spaces in Ménière's disease. Although the accessibility of 3T magnetic resonance imaging questions its wider applicability, it is a promising tool for the near future.
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Li J, Wang L, Hu N, Li L, Song G, Xu H, Xu T, Dou W, Li C, Yan W, Sun L, Gong R. Longitudinal variation of endolymphatic hydrops in patients with Ménière's disease. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:44. [PMID: 36819498 PMCID: PMC9929744 DOI: 10.21037/atm-22-6313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Background The relationships of endolymphatic hydrops (EH) and perilymphatic enhancement (PE) with Ménière's disease (MD) remains unclear. This study aimed to describe the dynamic variation of EH and PE for MD patients over 2 hospitalizations by applying magnetic resonance imaging (MRI) to further clarify the relationships of EH and PE with MD. Methods A total of 77 MD patients who underwent inner ear MRI after intravenous administration of gadolinium and pure-tone average (PTA) testing during a first and second hospitalization were included. The degree of EH and PE were evaluated via MRI, and the duration and frequency of vertigo attacks and PTA were collected and recorded. The PTA, EH, and PE for the 2 hospitalizations were compared, and the relationships of EH and cochlear PE with the MD stage were investigated. Results There was no difference between the 2 hospitalizations for duration of vertigo attacks or frequency of vertigo attacks. However, there were significant differences in PTA (Z=-3.02, P=0.003). Additionally, the cochlear and vestibular EH in the asymptomatic ear at the second hospitalization was significantly worse than that of the first hospitalization (Z=-2.33 and -2.49, P=0.020 and 0.013, respectively), while there were no differences in EH and PE in the affected ear (all P>0.05). Moreover, the degree of cochlear and vestibular EH was correlated with MD stage (both P<0.01). Conclusions Although EH and PE in the affected ear were unchanged over 2 hospitalizations, an underlying EH in the asymptomatic ear and hearing loss in the affected ear for MD patients developed longitudinally with the duration of disease, and EH varied with the natural course of MD whereas PE did not. Therefore, EH instead of PE is necessary but insufficient to cause the clinical symptoms of MD.
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Affiliation(s)
- Jinye Li
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Linsheng Wang
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Na Hu
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Long Li
- Department of Medical Service, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Gesheng Song
- Department of Radiology, Shandong Province Qianfoshan Hospital, Jinan, China
| | - Han Xu
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Ting Xu
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, China
| | - Chuanting Li
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Wenqing Yan
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Lixin Sun
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Ruozhen Gong
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China;,Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China;,Gong Ruozhen Innovation Studio, Shandong Provincial Hospital, Shandong University, Jinan, China
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12
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Sone M, Kobayashi M, Yoshida T, Naganawa S. Pathophysiological analysis of idiopathic sudden sensorineural hearing loss by magnetic resonance imaging: A mini scoping review. Front Neurol 2023; 14:1193104. [PMID: 37153681 PMCID: PMC10159174 DOI: 10.3389/fneur.2023.1193104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Objective To summarize the pathophysiological analysis of idiopathic sudden sensorineural hearing loss (ISSNHL) by magnetic resonance imaging (MRI), focusing on the findings of high signal or endolymphatic hydrops (EH) in the inner ear. Methods We summarize the published studies of our research group regarding the pathophysiological analysis of ISSNHL on MRI and review related clinical articles that have reported significantly high signal or the existence of EH in ears with ISSNHL. Results Pre-contrast high signal on MRI may indicate minor hemorrhage or increased permeability of surrounding vessels to the perilymph, whereas post-contrast high signal indicates breakdown of the blood-labyrinth barrier, in which irreversible changes would lead to poor prognosis. In some cases of ISSNHL, primary EH could be pre-existing and may be a risk factor for the onset of ISSNHL. Conclusion Analysis of ISSNHL by cutting-edge MRI evaluation could provide useful information for elucidating its pathophysiology and for predicting prognosis in this disease.
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Affiliation(s)
- Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- *Correspondence: Michihiko Sone,
| | - Masumi Kobayashi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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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: 0] [Impact Index Per Article: 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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14
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Niu Y, Chen W, Lin M, Sha Y. Progression of endolymphatic hydrops and vertigo during treatment in Meniere's disease. Acta Otolaryngol 2022; 142:653-657. [PMID: 36369788 DOI: 10.1080/00016489.2022.2138968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with Meniere's disease (MD) receive treatment to reduce vertigo. PURPOSE To explore the fluctuation of vertigo symptoms and the changes in endolymphatic hydrops (EHs) in MD patients during long-term regular medication. MATERIALS AND METHODS We enrolled MD patients who had received two magnetic resonance imaging with intravenous contrast agents. RESULTS Of the 42 patients in the study, 18(42.9%) had progressive EHs and 3(7.1%) had remission. The change value of the signal intensity ratio (SIR; cochlear perilymph/cerebellum) on the affected side (1.2) was larger than that on the healthy side (0.9), but there was no statistical difference. Among the 30 patients followed up, two patients had complete control of vertigo, two patients had substantial control, and three patients had worse control. The other 23 patients had insignificant control of vertigo symptoms before and after treatment. The correlation between the progression of cochlear and vestibular hydrops and the improvement of vertigo symptoms in MD patients was not significant. CONCLUSIONS AND SIGNIFICANCE In treated patients with MD, EHs may progress or relieve over the long course of the disease. But there was no correlation between the development of EHs and changes in vertigo symptoms.
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Affiliation(s)
- Yue Niu
- Eye, Ear, Nose and Throat (EENT) Hospital, Fudan University, Shanghai, PR China
| | - Wei Chen
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, PR China
| | - Mengyan Lin
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, PR China
| | - Yan Sha
- Eye, Ear, Nose and Throat (EENT) Hospital, Fudan University, Shanghai, PR China
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15
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Detailed insight into magnetic resonance assessment of Ménière's disease - description of methodology and imaging findings in a case series. Pol J Radiol 2022; 87:e354-e362. [PMID: 35892073 PMCID: PMC9288196 DOI: 10.5114/pjr.2022.117971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The study aimed to describe the methodology and detailed interpretation of magnetic resonance imaging (MRI) in patients with Ménière’s disease (MD). Material and methods MRIs were performed on a 3T scanner. The three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence 4 hours after a double dose of intravenous contrast was added to the standard MRI protocol in patients with clinically diagnosed MD. MRI findings of 7 patients with unilateral MD were analysed using 2 qualitative grading systems by Barath and Bernaerts. Results In MRI, the following changes in the group of patients with MD were observed: lack of endolymphatic hydrops (cases #1 and #7), various grades of cochlear hydrops (cases #2 and #3), various grades of vestibular hydrops (cases #4, #5, and #6), endolymphatic hydrops herniation into the semi-circular canal (case #6), and more robust perilymphatic enhancement (case #7). Conclusions In patients with MD, endolymphatic hydrops can be studied on MRI using 3D-FLAIR delayed post-contrast images. The qualitative grading system may be easily used in endolymphatic hydrops assessment. Recently described new radiological signs of MD such as increased perilymphatic enhancement of the cochlea and an extra low-grade VH may increase MD diagnosis sensitivity. MRI not only supports the clinical diagnosis of MD but also may help to understand its pathophysiology.
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Optimized 3D-FLAIR sequences to shorten the delay between intravenous administration of gadolinium and MRI acquisition in patients with Menière's disease. Eur Radiol 2022; 32:6900-6909. [PMID: 35759015 DOI: 10.1007/s00330-022-08889-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to shorten the 4-h delay between the intravenous administration of gadolinium and MRI acquisition for hydrops evaluation using an optimized 3D-FLAIR sequence in patients with Menière's disease. METHODS This was a single-center prospective study including 29 patients (58 ears), recruited between November 2020 and February 2021. All patients underwent a 3-T MRI with an optimized 3D-FLAIR sequence without contrast then at 1 h, 2 h, and 4 h after intravenous administration of gadobutrol. The signal intensity ratio was quantitatively assessed with the region of interest method. We also evaluated the volume of endolymphatic structures (saccule, utricle) then the presence of endolymphatic hydrops and blood-labyrinthine barrier impairment at each acquisition time. RESULTS For all ears, the signal intensity ratio was significantly non-inferior at 2 h compared to 4 h, with a mean geometric signal intensity ratio at 0.83 (95% CI: 0.76 to 0.90, one-sided p < .001 for non-inferiority at -30% margin). Mean volume equivalence of saccule and utricle between 2 and 4 h was proven at a ± 0.20 standardized deviation equivalence margin. Intra-rater agreements (Cohen's kappa) were all greater than 0.90 for all endolymphatic hydrops location and blood-labyrinthine-barrier impairment between the 2- and 4-h assessments. CONCLUSIONS We demonstrated that using an optimized 3D-FLAIR sequence we could shorten the acquisition from 4 to 2 h with a high reliability for the diagnosis of endolymphatic hydrops and blood-labyrinthine-barrier impairment. CLINICAL TRIAL REGISTRATION Clinical trial no: 38RC15.173 KEY POINTS: • Magnetic resonance imaging with delayed 3D-FLAIR sequences allows the diagnosis of endolymphatic hydrops in patients with definite Menière's disease. • An optimized 3D-FLAIR sequence with a long TR of 16000 ms and a constant flip angle allows for reducing the delay between intravenous injection of gadobutrol and MRI acquisition from 4 to 2 h to diagnose endolymphatic hydrops. • Reducing this delay between intravenous injection and MRI acquisition could have implications for clinical practice for both patients and imaging departments.
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Ishii M, Ishiyama G, Ishiyama A, Kato Y, Mochizuki F, Ito Y. Relationship Between the Onset of Ménière's Disease and Sympathetic Hyperactivity. Front Neurol 2022; 13:804777. [PMID: 35370896 PMCID: PMC8970286 DOI: 10.3389/fneur.2022.804777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The pathogenesis of Ménière's disease is still largely unknown; however, it is known to be strongly associated with stress. Excessive stress can cause hyperactivity of the sympathetic autonomic nervous system. With the aim of understanding changes in sympathetic hyperactivity before and after Ménière's disease, we compared autonomic nervous function in patients in a stable phase of Ménière's disease and that in healthy adults. We also gathered data over about 10 years on autonomic nervous function immediately before a Ménière's attack. Study Design Prospective study. Patients Autonomic nervous function was analyzed in 129 patients in a stable phase of Ménière's disease 31 healthy adult volunteers. In nine patients, autonomic nervous function was also measured immediately before and after treatment of a vertigo attack. Main Outcome Measure Power spectrum analysis of heart rate variability (HRV) of EEG/ECG and an infrared electronic pupillometer were used. Sympathetic and parasympathetic nervous function was measured. Results There were no statistically significant differences in autonomic nervous function determined by HRV and electronic pupillometry between patients in a stable phase of Ménière's disease and healthy adults. Sympathetic function as measured by electronic pupillometry parameters VD and T5 showed no difference between the affected and unaffected sides in the baseline data measured in the stable phase (VD: affected side is 31.02 ± 6.16 mm/sec, unaffected side is 29.25 ± 5.73 mm/sec; T5: affected side is 3.37 ± 0.43 msec, unaffected side is 3.25 ± 0.39 msec). In contrast, all nine patients whose HRV data had been obtained just before an attack showed marked suppression of the parasympathetic nervous system and activation of the sympathetic nervous system. Electronic pupillometry also revealed an overactivation of the sympathetic nervous system on the affected side, just before the attacks. Analysis of sequential changes after the onset of an attack revealed that overactivation on the affected side was reduced after treatment, and no difference between affected and unaffected sides was observed 3 days after treatment. Conclusion Detailed analysis of autonomic nervous function showed that immediately before an attack of Ménière's disease, the sympathetic nervous system on the affected side was strongly overactivated.
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Affiliation(s)
- Masanori Ishii
- Department of Otorhinolaryngology, Japan Community Health Care Organization (JCHO) Tokyo Shinjuku Medical Center, Tokyo, Japan
- Department of Otorhinolaryngology and Head & Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
- *Correspondence: Masanori Ishii
| | - Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Akira Ishiyama
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Yujin Kato
- Department of Otorhinolaryngology and Head & Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiro Mochizuki
- Department of Otorhinolaryngology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yusuke Ito
- Department of Otorhinolaryngology, St. Marianna University School of Medicine, Kanagawa, Japan
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Ahn SJ, Taoka T, Moon WJ, Naganawa S. Contrast-Enhanced Fluid-Attenuated Inversion Recovery in Neuroimaging: A Narrative Review on Clinical Applications and Technical Advances. J Magn Reson Imaging 2022; 56:341-353. [PMID: 35170148 DOI: 10.1002/jmri.28117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/15/2022] Open
Abstract
While contrast-enhanced fluid-attenuated inversion recovery (FLAIR) has long been regarded as an adjunct sequence to evaluate leptomeningeal disease in addition to contrast-enhanced T1-weighted imaging, it is gradually being used for more diverse pathologies beyond leptomeningeal disease. Contrast-enhanced FLAIR is known to be highly sensitive to low concentrations of gadolinium within the fluid. Accordingly, recent research has suggested the potential utility of contrast-enhanced FLAIR in various kinds of disease, such as Meniere's disease, seizure, stroke, traumatic brain injury, and brain metastasis, in addition to being used for visualizing glymphatic dysfunction. However, its potential applications have been reported sporadically in an unorganized manner. Furthermore, the exact mechanism for its superior sensitivity to low concentrations of gadolinium has not been fully understood. Rapidly developing magnetic resonance technology and unoptimized parameters for FLAIR may challenge its accurate application in clinical practice. This review provides the fundamental mechanism of contrast-enhanced FLAIR, systematically describes its current and potential clinical application, and elaborates on technical considerations for its optimization. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 5.
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Affiliation(s)
- Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Toshiaki Taoka
- Department of Innovative Biomedical Visualization (iBMV), Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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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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Osman S, Hautefort C, Attyé A, Vaussy A, Houdart E, Eliezer M. Increased signal intensity with delayed post contrast 3D-FLAIR MRI sequence using constant flip angle and long repetition time for inner ear evaluation. Diagn Interv Imaging 2021; 103:225-229. [PMID: 34690107 DOI: 10.1016/j.diii.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to compare the degree of perilymphatic enhancement between 4 hour post-contrast constant flip angle three-dimensional fluid attenuated inversion recovery (3D-FLAIR) images obtained with short repetition time (TR) and those obtained with long TR. MATERIALS AND METHODS This single-center, prospective study included patients who underwent MRI of the inner ear with heavily T2-weighted sequence, 3D-FLAIR sequence with a "short" TR of 10,000 ms (s3D-FLAIR) and with a "long" TR of 16,000 ms (l3D-FLAIR). Signal intensity ratio (SIR) and contrast-to-noise ratio (CNR) obtained with s3D-FLAIR and l3D-FLAIR were quantitatively assessed using region of interest (ROI) method and compared. The morphology of the endolymphatic space on both sequences was also evaluated. RESULTS From March 2020 to July 2020, 20 consecutive patients were enrolled (9 women and 11 men; mean age, 52.1 ± 14.5 [SD] years; age range: 29-75 years). On l3D-FLAIR images, mean SIR (21.1 ± 8.8 [SD]; range: 7.6-46.1) was significantly greater than that on s3D-FLAIR images (15.7 ± 6.7 [SD]; range: 5.9-33.4) (P < 0.01). On l3D-FLAIR images, mean CNR (17 ± 8.5 [SD]; range: 2-40) was significantly greater than that on s3D-FLAIR images (12 ± 6.3 [SD]; range: 3.2-29.8) (P < 0.01). Kappa value for inter-rater agreement for endolymphatic hydrops, vestibular atelectasis and perilymphatic fistula were 0.93 (95% CI: 0.74-1), 1 (95% CI: 0.85-1) and 1 (95% CI: 0.85-1) respectively. CONCLUSION This study demonstrates that the sensitivity of 3D-FLAIR sequences to low concentration gadolinium in the perilymphatic space is improved by elongation of the TR, with SIR and CNR increased by +34.4% and +41.3% respectively.
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Affiliation(s)
- Samir Osman
- Department of Neuroradiology, Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, 75010 Paris, France
| | - Charlotte Hautefort
- Université de Paris, Faculté de Médecine, 75010 Paris, France; Department of Head and Neck Surgery, Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, 75010 Paris, France
| | - Arnaud Attyé
- Department of Neuroradiology and MRI, Grenoble Alpes University Hospital, SFR RMN Neurosciences, 38000 Grenoble, France
| | | | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, 75010 Paris, France; Université de Paris, Faculté de Médecine, 75010 Paris, France
| | - Michael Eliezer
- Department of Neuroradiology, Lariboisière University Hospital, Assistance Publique Hôpitaux de Paris, 75010 Paris, France; Université de Paris, Faculté de Médecine, 75010 Paris, France.
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Mijnders LSP, Steup FWR, Lindhout M, van der Kleij PA, Brink WM, van der Molen AJ. Optimal sequences and sequence parameters for GBCA-enhanced MRI of the glymphatic system: a systematic literature review. Acta Radiol 2021; 62:1324-1332. [PMID: 33153270 DOI: 10.1177/0284185120969950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The glymphatic system (GS) is a recently discovered waste clearance system in the brain. PURPOSE To evaluate the most promising magnetic resonance imaging (MRI) sequence(s) and the most optimal sequence parameters for glymphatic MRI (gMRI) 4-24 h after administration of gadolinium-based contrast agent (GBCA). MATERIAL AND METHODS Multiple literature databases were systematically searched for articles regarding gMRI or MRI of the perilymph in the inner ear until 11 May 2020. All relevant MRI sequence parameters were tabulated for qualitative analysis. Their potential was assessed based on detection of low dose GBCA, primarily measured as signal intensity (SI) ratio. RESULTS Thirty articles were included in the analysis. Three-dimensional fluid attenuated inversion recovery (3D-FLAIR), 3D Real Inversion Recovery (3D-Real IR), and multiple 3D T1-weighted gradient echo sequences were used. In perilymph, 3D-FLAIR with a TE of at least 400 ms yielded the highest SIRs. In the qualitative analysis of inner ear studies using 3D-FLAIR, TR was in the range of 4400-10,000 ms, TI 1500-2600 ms, refocusing flip angle (rFA) (range 120°-180°), and echo train length (ETL) 23-173. In the gMRI studies, quantitative analysis was not possible. In the qualitative analysis, 3D-FLAIR was used in the majority (8/12) of the studies, usually with TR 4800-9000 ms, TI 1650-2500 ms, TE 311-561 ms, rFA 90°-120°, and ETL 167-278. CONCLUSION Long TE 3D-FLAIR is the most promising sequence for detection of low-dose GBCA in the GS. Clinical and/or phantom studies on other MRI parameters are needed for further optimization of gMRI.
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Affiliation(s)
- Liesje SP Mijnders
- Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Feline WR Steup
- Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Mette Lindhout
- Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Paul A van der Kleij
- Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Wyger M Brink
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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22
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Min X, Gu H, Zhang Y, Li K, Pan Z, Jiang T. Clinical value of abnormal MRI findings in patients with unilateral sudden sensorineural hearing loss. ACTA ACUST UNITED AC 2021; 26:429-436. [PMID: 32755877 DOI: 10.5152/dir.2020.19229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE We aimed to determine the relationship of abnormal labyrinthine signals on heavily T2-weighted three-dimensional fluid-attenuated inversion recovery imaging (HF sequence) with hearing impairment and prognosis in patients with sudden sensorineural hearing loss (SSNHL). METHODS Patients with unilateral SSNHL underwent magnetic resonance imaging, including pre-contrast HF sequences and post-contrast HF sequences with a 4-hour scan delay after intravenous gadolinium injection. We measured the signal intensity ratio (SIR) of the vestibule and cochlea relative to the cerebellar medulla on post-contrast HF sequences, and analyzed the relationship of SIR with hearing impairment and prognosis. RESULTS Of 61 patients, 23 (37.7%) showed signal abnormalities on post-contrast HF sequences. Initial hearing loss and hearing recovery were worse in the HF+ group than in the HF- group (P < 0.05). Profound hearing loss was more common in the HF+ group (52.2% vs. 23.7%), while moderate hearing loss was more common in the HF- group (18.4% vs. 0.0%; P < 0.05 for both). The rate of partial recovery was higher in the HF- group (42.1%) than in the HF+ group (13.0%; P < 0.05). The SIRs of the vestibule and cochlea were positively correlated with the severity of hearing loss and hearing recovery, with higher SIRs indicating more severe hearing loss and poor recovery. CONCLUSION Labyrinthine signal abnormalities were found on post-contrast HF sequences in 37.7% of patients with SSNHL. These abnormalities were found only in patients with severe-to-profound hearing loss. Increased SIR indicated more severe hearing loss and poor prognosis.
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Affiliation(s)
- Xiaohong Min
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua Gu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Hyperbaric Oxygen, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kun Li
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Pan
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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23
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Zanetti D, Conte G, Scola E, Casale S, Lilli G, Di Berardino F. Advanced Imaging of the Vestibular Endolymphatic Space in Ménière's Disease. Front Surg 2021; 8:700271. [PMID: 34497826 PMCID: PMC8419327 DOI: 10.3389/fsurg.2021.700271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/19/2021] [Indexed: 02/04/2023] Open
Abstract
The diagnosis of "definite" Méniére's disease (MD) relies upon its clinical manifestations. MD has been related with Endolymphatic Hydrops (EH), an enlargement of the endolymphatic spaces (ES) (cochlear duct, posterior labyrinth, or both). Recent advances in Magnetic Resonance (MR) imaging justify its increasing role in the diagnostic workup: EH can be consistently recognized in living human subjects by means of 3-dimensional Fluid-Attenuated Inversion-Recovery sequences (3D-FLAIR) acquired 4 h post-injection of intra-venous (i.v.) Gadolinium-based contrast medium, or 24 h after an intratympanic (i.t.) injection. Different criteria to assess EH include: the comparison of the area of the vestibular ES with the whole vestibule on an axial section; the saccule-to-utricle ratio ("SURI"); and the bulging of the vestibular organs toward the inferior 1/3 of the vestibule, in contact with the stapedial platina ("VESCO"). An absolute link between MD and EH has been questioned, since not all patients with hydrops manifest MD symptoms. In this literature review, we report the technical refinements of the imaging methods proposed with either i.t. or i.v. delivery routes, and we browse the outcomes of MR imaging of the ES in both MD and non-MD patients. Finally, we summarize the following imaging findings observed by different researchers: blood-labyrinthine-barrier (BLB) breakdown, the extent and grading of EH, its correlation with clinical symptoms, otoneurological tests, and stage and progression of the disease.
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Affiliation(s)
- Diego Zanetti
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Audiology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giorgio Conte
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Scola
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Casale
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Lilli
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Audiology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Federica Di Berardino
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Audiology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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24
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Eliezer M, Attyé A, Toupet M, Hautefort C. Imaging of endolymphatic hydrops: A comprehensive update in primary and secondary hydropic ear disease. J Vestib Res 2021; 31:261-268. [PMID: 33646188 DOI: 10.3233/ves-200786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Since the first description by Hallpike and Cairns, the excess of endolymphatic fluid, also known as endolymphatic hydrops (EH), has been established as being the main biomarker in patients with Menière's disease. Recently, the concept of primary (PHED) and secondary hydropic ear disease (SHED) has been introduced. PHED corresponded to Menière's disease while SHED was defined as the presence of EH in patients with pre-existing inner ear disease. OBJECTIVE In this article, we would like to summarize the methodology of hydrops exploration using MRI and the previously published radiological findings in patients with PHED and SHED. RESULTS Before the emergence of delayed inner ear MRI, the presence of EH was assumed based on clinical symptoms. However, because of the recent technical developments, inner ear MRI became an important tool in clinical settings for identifying EH in vivo, in patients with PHED and SHED. The presence of EH on MRI is related with the degree of sensorineural hearing loss whether in patients with PHED or SHED. By contrast, in PHED or SHED patients without sensorineural hearing loss, MRI showed no sign of EH. CONCLUSIONS Thanks to the recent technical developments, inner ear MRI became an important tool in clinical settings for identifying EH in vivo, in patients with PHED and SHED.
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Affiliation(s)
- Michael Eliezer
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France
| | - Arnaud Attyé
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France.,Grenoble Alps University Hospital, IRMaGe, Grenoble, France
| | - Michel Toupet
- Centre d'Explorations Fonctionnelles Otoneurologiques, Paris, France
| | - Charlotte Hautefort
- Department of Head and Neck Surgery, Lariboisière University Hospital, Paris, France
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25
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Isolated Saccular Hydrops on High-resolution MRI Is Associated With Full Spectrum Menière's Disease. Otol Neurotol 2021; 42:876-882. [PMID: 33481544 DOI: 10.1097/mao.0000000000003051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To describe the clinical presentation of patients with isolated saccular endolymphathic hydrops (EH) detected. STUDY DESIGN Clinical case series. SETTING University-based tertiary referral center. PATIENTS All subjects presenting with vertigo or hearing loss who had isolated saccular EH detected. INTERVENTION High-resolution delayed-contrast magnetic resonance imaging (MRI) conducted between November 2015 and November 2016. MAIN OUTCOME MEASURES Audiovestibular testing results and analysis of clinical histories. RESULTS Isolated saccular EH was detected in 18 subjects. Sixteen met criteria for definite Menière's disease (MD, n = 12) or delayed endolymphatic hydrops (DEH, n = 4). One had a history of sudden sensorineural hearing loss (SSNHL) and 3 years after MRI developed recurrent vertigo characteristic of DEH. One patient had a history of atypical DEH (Tumarkin falls without vertigo following SSNHL). Four patients had Tumarkin falls. Most (83%) demonstrated mild-to-severe low-frequency fluctuating loss, and six (33.3%) had a history of ipsilateral sudden profound SNHL. Nine of the 17 (53%) patients tested had an ipsilateral caloric paresis ranging from 26 to 67%. Ipsilateral vestibular-evoked myogenic potentials showed reduced or absent responses in 5 of the 17 tested (29%). CONCLUSIONS The full spectrum of MD may be associated with saccular hydrops. We propose that MD and DEH often begin in the saccule, and MRI may provide clues to the pathophysiology of MD. Saccular hydrops was present in one patient with SSNHL who did not develop vertigo spells until 3 years after MRI, indicating that saccular hydrops may be the first manifestation of MD or DEH.
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26
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Alonso JE, Ishiyama GP, Fujiwara RJT, Pham N, Ledbetter L, Ishiyama A. Cochlear Meniere's: A Distinct Clinical Entity With Isolated Cochlear Hydrops on High-Resolution MRI? Front Surg 2021; 8:680260. [PMID: 34222320 PMCID: PMC8242163 DOI: 10.3389/fsurg.2021.680260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Describe the clinical characteristics of patients with isolated cochlear endolymphatic hydrops (EH). Study design: Clinical case series. Setting: Tertiary Neurotology referral clinic. Patients: All subjects presenting to a University Neurotology clinic during a 1-year period from July 2015 until August 2016 who had isolated cochlear EH on MRI. Patients with a history of temporal bone surgery prior to the MRI were excluded. Intervention: High-resolution delayed-intravenous contrast MRI. Main outcome measures: Audiometric and vestibular testing, clinical history analysis. Results: 10 subjects demonstrated isolated, unilateral cochlear hydrops on MRI. None of these patients met the criteria for Meniere's disease. Mean age of the group was 66.4 years and most were males (70%). Unilateral aural fullness (70%), tinnitus (80%), and hearing loss (90%) were frequently observed. Only one patient presented with unsteadiness (10%) and one patient had a single isolated spell of positional vertigo 1 month prior to the MRI (10%) but no further vertigo spells in the 4 years following the MRI. The mean PTA was 37.8 dB which was significantly decreased from the non-affected ear with PTA of 17.9 (p < 0.001). One patient developed vertiginous spells and unsteadiness 4 years after initial presentation and a repeat MRI revealed progression to utricular, saccular and cochlear hydrops. Vestibular testing was obtained in five patients with one patient presenting with 50% caloric paresis and all others normal. The most common treatment tried was acetazolamide in seven patients with 86% reporting subjective clinical improvement. Two out of the 10 patients had a history of migraine (20%). Conclusions: Patients with MRI exhibiting isolated cochlear EH present with predominantly auditory symptoms: mild to moderate low-frequency hearing loss, aural fullness, tinnitus without significant vertigo. Isolated cochlear hydrops is more common in males, average age in mid-60's and there is a low comorbidity of migraine headaches. This contrasts significantly with patients with isolated saccular hydrops on MRI from our prior studies. We believe that isolated cochlear EH with hearing loss but no vertigo is distinct from Meniere's disease or its variant delayed endolymphatic hydrops. We propose that cochlear Meniere's disease represents a distinct clinical entity that could be a variant of Meniere's disease.
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Affiliation(s)
- Jose E. Alonso
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gail P. Ishiyama
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rance J. T. Fujiwara
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nancy Pham
- Department of Neuroradiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Luke Ledbetter
- Department of Neuroradiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Akira Ishiyama
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States
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27
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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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28
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Song CI, Pogson JM, Andresen NS, Ward BK. MRI With Gadolinium as a Measure of Blood-Labyrinth Barrier Integrity in Patients With Inner Ear Symptoms: A Scoping Review. Front Neurol 2021; 12:662264. [PMID: 34093410 PMCID: PMC8173087 DOI: 10.3389/fneur.2021.662264] [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: 01/31/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Capillaries within the inner ear form a semi-permeable barrier called the blood-labyrinth barrier that is less permeable than capillary barriers elsewhere within the human body. Dysfunction of the blood-labyrinth barrier has been proposed as a mechanism for several audio-vestibular disorders. There has been interest in using magnetic resonance imaging (MRI) with intravenous gadolinium-based contrast agents (GBCA) as a marker for the integrity of the blood labyrinth barrier in research and clinical settings. This scoping review evaluates the evidence for using intravenous gadolinium-enhanced MRI to assess the permeability of the blood-labyrinth barrier in healthy and diseased ears. Methods: A systematic search was conducted of three databases: PubMed, EMBASE, CINAHL PLUS. Studies were included that used GBCA to study the inner ear and permeability of the blood-labyrinth barrier. Data was collected on MRI protocols used and inner ear enhancement patterns of healthy and diseased ears in both human and animal studies. Results: The search yielded 14 studies in animals and 53 studies in humans. In healthy animal and human inner ears, contrast-enhanced MRI demonstrated gradual increase in inner ear signal intensity over time that was limited to the perilymph. Signal intensity peaked at 100 min in rodents and 4 h in humans. Compared to controls, patients with idiopathic sudden sensorineural hearing loss and otosclerosis had increased signal intensity both before and shortly after GBCA injection. In patients with Ménière's disease and vestibular schwannoma, studies reported increased signal at 4 h, compared to controls. Quality assessment of included studies determined that all the studies lacked sample size justification and many lacked adequate control groups or blinded assessors of MRI. Conclusions: The included studies provided convincing evidence that gadolinium crosses the blood-labyrinth barrier in healthy ears and more rapidly in some diseased ears. The timing of increased signal differs by disease. There was a lack of evidence that these findings indicate general permeability of the blood-labyrinth barrier. Future studies with consistent and rigorous methods are needed to investigate the relationship between gadolinium uptake and assessments of inner ear function and to better determine whether signal enhancement indicates permeability for molecules other than gadolinium.
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Affiliation(s)
- Christopher I Song
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jacob M Pogson
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Nicholas S Andresen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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29
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Tang S, Yonezawa T, Maeda Y, Ono M, Maeba T, Miyoshi T, Momota R, Tomono Y, Oohashi T. Lack of collagen α6(IV) chain in mice does not cause severe-to-profound hearing loss or cochlear malformation, a distinct phenotype from nonsyndromic hearing loss with COL4A6 missense mutation. PLoS One 2021; 16:e0249909. [PMID: 33848312 PMCID: PMC8043391 DOI: 10.1371/journal.pone.0249909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Congenital hearing loss affects 1 in every 1000 births, with genetic mutations contributing to more than 50% of all cases. X-linked nonsyndromic hereditary hearing loss is associated with six loci (DFNX1-6) and five genes. Recently, the missense mutation (c.1771G>A, p.Gly591Ser) in COL4A6, encoding the basement membrane (BM) collagen α6(IV) chain, was shown to be associated with X-linked congenital nonsyndromic hearing loss with cochlear malformation. However, the mechanism by which the COL4A6 mutation impacts hereditary hearing loss has not yet been elucidated. Herein, we investigated Col4a6 knockout (KO) effects on hearing function and cochlear formation in mice. Immunohistochemistry showed that the collagen α6(IV) chain was distributed throughout the mouse cochlea within subepithelial BMs underlying the interdental cells, inner sulcus cells, basilar membrane, outer sulcus cells, root cells, Reissner's membrane, and perivascular BMs in the spiral limbus, spiral ligament, and stria vascularis. However, the click-evoked auditory brainstem response analysis did not show significant changes in the hearing threshold of Col4a6 KO mice compared with wild-type (WT) mice with the same genetic background. In addition, the cochlear structures of Col4a6 KO mice did not exhibit morphological alterations, according to the results of high-resolution micro-computed tomography and histology. Hence, loss of Col4a6 gene expression in mice showed normal click ABR thresholds and normal cochlear formation, which differs from humans with the COL4A6 missense mutation c.1771G>A, p.Gly591Ser. Therefore, the deleterious effects in the auditory system caused by the missense mutation in COL4A6 are likely due to the dominant-negative effects of the α6(IV) chain and/or α5α6α5(IV) heterotrimer with an aberrant structure that would not occur in cases with loss of gene expression.
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Affiliation(s)
- Shaoying Tang
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Yonezawa
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- * E-mail:
| | - Yukihide Maeda
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mitsuaki Ono
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahiro Maeba
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryusuke Momota
- Department of Human Morphology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuko Tomono
- Division of Molecular and Cell Biology, Shigei Medical Research Institute, Okayama, Japan
| | - Toshitaka Oohashi
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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30
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Ishiyama G. Selected Otologic Disorders Causing Dizziness. ACTA ACUST UNITED AC 2021; 27:468-490. [PMID: 34351115 DOI: 10.1212/con.0000000000000977] [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: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article details updated clinical presentations and current treatment paradigms of the common otologic disorders that may present to the neurologist for vertigo, including Ménière disease, superior semicircular canal dehiscence syndrome, perilymphatic fistula, barotrauma, cholesteatoma, Ramsay Hunt syndrome, enlarged vestibular aqueduct syndrome, and autoimmune inner ear disease including Cogan syndrome. RECENT FINDINGS The recent data on modern imaging techniques with three-dimensional delayed IV contrast in Ménière disease, findings on the clinical and testing parameters to diagnose semicircular canal dehiscence and barotrauma, and clinical findings in Ramsay Hunt syndrome, cholesteatoma, and enlarged vestibular aqueduct syndrome are discussed in the article. The most recent findings on the treatment and evaluation of autoimmune inner ear disease and Cogan syndrome are also covered. SUMMARY This article discusses the common clinical otologic entities in patients who may present to the neurologist for vertigo, and it can be used as a guide in the diagnosis of these conditions with the use of auditory, vestibular, and imaging results.
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31
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Suh YH, Kang Y, Baek MJ, Kim SH, Lee HJ, Lee J, Baik J. T2 relaxation time shortening in the cochlea of patients with sudden sensory neuronal hearing loss: a retrospective study using quantitative synthetic magnetic resonance imaging. Eur Radiol 2021; 31:6438-6445. [PMID: 33609144 DOI: 10.1007/s00330-021-07749-5] [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: 09/09/2020] [Revised: 01/04/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES High cochlear signal intensity on three-dimensional (3D) T2 fluid-attenuated inversion recovery (FLAIR) sequences in patients with sudden sensorineural hearing loss (SSNHL) has been reported. Here, we evaluated the cochlear T2 relaxation time differences in patients with idiopathic SSNHL using quantitative synthetic MRI (SyMRI). METHODS Twenty-four patients with unilateral SSNHL who underwent precontrast conventional 3D FLAIR and SyMRI were retrospectively included. T1 and T2 relaxation times and the proton density (PD) of the bilateral ears were measured by manually drawn regions of interest. Wilcoxon signed-rank tests and intra- and interobserver correlation analyses were performed. Qualitative analysis was also performed to determine the presence and laterality of the asymmetric high signal intensity on synthetic FLAIR (SyFLAIR) images. RESULTS The T2 relaxation time was significantly lower in the affected (basal and apico-middle turns) than in the unaffected cochlea (basal turn: 519 ± 181.3 vs. 608.8 ± 203.6, p = 0.042; apico-middle turn: 410.8 ± 163.8 vs. 514.5 ± 186.3, p = 0.037). There were no significant differences in the T1 relaxation time and PD between the affected and unaffected ears (p > 0.05). Additionally, three patients without asymmetric signal intensity on conventional MRI showed asymmetric increased signal intensity in the affected ear on SyFLAIR. CONCLUSIONS The T2 relaxation time was significantly shorter in the affected than in the unaffected cochlea of patients with idiopathic SSNHL. The SyMRI-derived T2 relaxation time may be a promising imaging marker, suggesting that the changes in inner ear fluid composition are implicated in the idiopathic SSNHL development. KEY POINTS • T2 relaxation time was significantly lower in the affected than in the unaffected cochlea. • SyFLAIR showed increased lesion conspicuity compared to conventional 3D-FLAIR in detecting asymmetric high signal intensity of the affected side. • SyMRI-derived T2 relaxation time may be a promising imaging marker of the affected ear in patients with idiopathic SSNHL.
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Affiliation(s)
- Young Hwa Suh
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yeonah Kang
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Moo Jin Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Shin Hye Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | | | - Jiyeon Baik
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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State of the Art Imaging in Menière’s Disease. Tips and Tricks for Protocol and Interpretation. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of Review
Menière’s disease (MD) is a burdensome and not well understood inner ear disorder that has received increasing attention of scientists over the past decade. Until 2007, a certain diagnosis of endolymphatic hydrops (EH) required post-mortem histology. Today, dedicated high-resolution magnetic resonance imaging (MRI) protocols enable detection of disease-related changes in the membranous labyrinth in vivo. In this review, we summarize the current status of MR imaging for MD.
Recent Findings
The mainstays of hydrops imaging are inversion recovery sequences using delayed acquisition after intravenous or intratympanic contrast administration. Based on these techniques, several methods have been developed to detect and classify EH. In addition, novel imaging features of MD, such as blood-labyrinth barrier impairment, have recently been observed.
Summary
Delayed contrast enhanced MRI has emerged as a reliable technique to demonstrate EH in vivo, with promising application in the diagnosis and follow-up of MD patients. Therefore, familiarity with current techniques and diagnostic imaging criteria is increasingly important.
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Touska P, Connor S. Imaging of the temporal bone. Clin Radiol 2020; 75:658-674. [DOI: 10.1016/j.crad.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
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Labyrinthine enhancement on 3D black blood MR images of the brain as an imaging biomarker for cisplatin ototoxicity in (lung) cancer patients. Neuroradiology 2020; 63:81-90. [PMID: 32761280 DOI: 10.1007/s00234-020-02504-x] [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: 05/26/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Cancer patients treated with platinum-based chemotherapy can present with ototoxicity symptoms. The purpose of this work is to report the imaging features related to cisplatin ototoxicity. METHODS Between December 2015 and March 2019, a cohort of 96 consecutive patients with lung cancer was selected. Only patients who received cisplatin chemotherapy and underwent an imaging protocol consisting of a Gd-enhanced 3D-BB and 3D-T1W sequence, as well as T2W sequence to exclude metastases, were included. Labyrinthine enhancement was assessed, and all findings regarding the auditory and vestibular function were retrieved from the clinical files. RESULTS Twenty-one patients met the inclusion criteria. The Gd-enhanced 3D-BB images were used to divide them into the labyrinth enhancement group (LEG) and the labyrinth non-enhancement group (LNEG). None of these patients demonstrated enhancing regions on the 3D-T1W images. The labyrinthine fluid remained high on the T2 images in all patients, excluding metastases. The LEG consisted of 6 patients. The cochlea and semicircular canals were the most frequently affected regions. All the LEG patients that presented with hearing loss (4/6) had cochlear enhancement. Patients with normal hearing had no cochlear enhancement. Five patients (5/6) showed vestibular enhancement. Four of these patients had vestibular symptoms. CONCLUSION Labyrinthine enhancement as an imaging feature related to cisplatin ototoxicity is unreported. This study demonstrates a correlation between hearing loss and cochlear enhancement and also between vestibular impairment and vestibular/semicircular enhancement on 3D-BB images, which remained invisible on the 3D-T1W images. The labyrinthine enhancement on 3D-BB images in the presence of normal signal intensity of the intralabyrinthine fluid can be used as an imaging biomarker for cisplatin toxicity in daily clinical practice and should not be mistaken for intralabyrinthine metastases.
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Magnetic resonance imaging of Ménière's disease: early clinical experience in a UK centre. The Journal of Laryngology & Otology 2020; 134:302-310. [PMID: 32241307 DOI: 10.1017/s0022215120000626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent developments in magnetic resonance imaging have enabled demonstration of endolymphatic hydrops, and the clinical application of these imaging studies in Ménière's disease is being explored. OBJECTIVE To evaluate our centre's experience to date of hydrops magnetic resonance imaging in patients with episodic vertigo. METHODS Magnetic resonance imaging was performed using a high-resolution three-dimensional fluid-attenuated inversion recovery sequence on a 3 Tesla scanner at 4 hours following double-dose gadolinium administration. RESULTS The study included 31 patients, 28 of whom had a clinical diagnosis of Ménière's disease. In unilateral Ménière's disease, magnetic resonance imaging was able to lateralise endolymphatic hydrops to the clinically symptomatic ear in all cases. Mild hydrops was often seen in clinically asymptomatic ears. CONCLUSION There is a good correlation between the clinical symptoms and lateralisation of hydropic changes on magnetic resonance imaging. Further refinements of imaging techniques and grading system will likely improve the diagnostic accuracy and clinical utilisation of hydrops magnetic resonance imaging.
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Nahmani S, Vaussy A, Hautefort C, Guichard JP, Guillonet A, Houdart E, Attyé A, Eliezer M. Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle-Delayed 3D-FLAIR Sequences in Menière Disease. AJNR Am J Neuroradiol 2020; 41:706-711. [PMID: 32193190 DOI: 10.3174/ajnr.a6483] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Endolymphatic hydrops in patients with Menière disease relies on delayed postcontrast 3D-FLAIR sequences. The purpose of this study was to compare the degree of perilymphatic enhancement and the detection rate of endolymphatic hydrops using constant and variable flip angles sequences. MATERIALS AND METHODS This was a retrospective study performed in 16 patients with Menière disease who underwent 3T MR imaging 4 hours after gadolinium injection using two 3D-FLAIR sequences with a constant flip angle at 140° for the first and a heavily-T2 variable flip angle for the second. The signal intensity ratio was measured using the ROI method. We graded endolymphatic hydrops and evaluated the cochlear blood-labyrinth barrier impairment. RESULTS Both for symptomatic and asymptomatic ears, the median signal intensity ratio was significantly higher with the constant flip angle than with the heavily-T2 variable flip angle (7.16 versus 1.54 and 7.00 versus 1.45, P < .001). Cochlear blood-labyrinth barrier impairment was observed in 4/18 symptomatic ears with the heavily-T2 variable flip angle versus 8/19 with constant flip angle sequences. With heavily-T2 variable flip angle sequences, endolymphatic hydrops was observed in 7-10/19 symptomatic ears versus 12/19 ears with constant flip angle sequences. We found a significant association between the clinical symptomatology and the presence of endolymphatic hydrops with constant flip angle but not with heavily-T2 variable flip angle sequences. Interreader agreement was always perfect with constant flip angle sequences while it was fair-to-moderate with heavily-T2 variable flip angle sequences. CONCLUSIONS 3D-FLAIR constant flip angle sequences provide a higher signal intensity ratio and are superior to heavily-T2 variable flip angle sequences in reliably evaluating the cochlear blood-labyrinth barrier impairment and the endolymphatic space.
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Affiliation(s)
- S Nahmani
- From the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
| | - A Vaussy
- Siemens Healthineers (A.V.), Saint-Denis, France
| | - C Hautefort
- Head and Neck Surgery (C.H.), Lariboisiere University Hospital, Paris, France
| | - J-P Guichard
- From the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
| | - A Guillonet
- From the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
| | - E Houdart
- From the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
| | - A Attyé
- Department of Neuroradiology and MRI (A.A.), Grenoble Alpes University Hospital, SFR RMN Neurosciences, Grenoble, France
| | - M Eliezer
- From the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
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Endolymphatic hydrops evaluation on MRI: Practical considerations. Am J Otolaryngol 2020; 41:102361. [PMID: 31784143 DOI: 10.1016/j.amjoto.2019.102361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 11/21/2022]
Abstract
Four-hour delayed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence after intravenous gadolinium-based contrast agent administration is an optimal magnetic resonance imaging technique to evaluate endolymphatic hydrops in patients with known or suspected Ménière's disease. Nonenhanced endolymphatic space surrounded by enhanced perilymphatic space is evaluated in the cochlea and vestibule separately. In cochlear hydrops, the scala media is enlarged, potentially obliterating the scala vestibuli. In vestibular hydrops, the size of the saccule becomes equal to or larger than that of the utricle; as hydrops progresses, the saccule and utricle become larger and confluent until complete obliteration of the vestibule's perilymphatic space. In patients with a unilateral clinical presentation of Ménière's disease, it is possible to depict the asymmetries of perilymph enhancement, which may be increased on the affected side and reflect a permeability alteration of the blood-perilymph barrier. In addition, endolymphatic hydrops can be observed in the asymptomatic ear of these patients with a unilateral clinical presentation, showing that Ménière's disease tends to undergo bilateral evolution over time.
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Eliezer M, Hautefort C, Van Nechel C, Duquesne U, Guichard JP, Herman P, Kania R, Houdart E, Attyé A, Toupet M. Electrophysiological and inner ear MRI findings in patients with bilateral vestibulopathy. Eur Arch Otorhinolaryngol 2020; 277:1305-1314. [PMID: 32036409 DOI: 10.1007/s00405-020-05829-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/24/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Bilateral vestibulopathy (BV) is an uncommon disorder and the etiology remained idiopathic in most cases. Delayed 3D-FLAIR sequences have provided new insights into various inner ear diseases, allowing the evaluation of the endolymphatic space and the permeability of the blood-labyrinthine barrier (BLB). The aim of this study was to assess both the morphology of the endolymphatic space and the permeability of the BLB in patients with BV as evaluated by delayed 3D-FLAIR sequences. METHODS In this retrospective study, we performed 3D-FLAIR sequences 4 h after administering contrast media to 42 patients with BV. Two radiologists independently evaluated the morphology of the endolymphatic space (either vestibular atelectasis or endolymphatic hydrops) and the permeability of the BLB. RESULTS Morphologic anomalies of the endolymphatic space and vestibular blood-labyrinthine barrier impairment were observed in 59.6% of patients with BV. Bilateral vestibular atelectasis (VA) was found in 21 patients (50%), involving only the utricle and all three ampullas while the saccule was always observed with no sign of collapse: idiopathic BV (n = 19), aminoglycoside administration (n = 1) and few days following abdominal surgery (n = 1). One patient had bilateral vestibular malformation. BLB impairment was observed in five patients (11.9%): paraneoplastic (n = 1), lymphoma (n = 1), autoimmune (n = 1), and vestibular "neuritis" (n = 2). Seventeen patients (40.4%) had normal MRI with no endolymphatic space anomaly or BLB impairment. CONCLUSION Patients with BV presented with morphologic anomalies of the endolymphatic space or BLB impairment in 59.6% of patients.
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Affiliation(s)
- Michael Eliezer
- Department of Neuroradiology and MR Unit, Lariboisière University Hospital, 75010, Paris, France.
| | - Charlotte Hautefort
- Department of Head and Neck Surgery, Lariboisiere University Hospital, Paris, France
| | | | | | - Jean-Pierre Guichard
- Department of Neuroradiology and MR Unit, Lariboisière University Hospital, 75010, Paris, France
| | - Philippe Herman
- Department of Head and Neck Surgery, Lariboisiere University Hospital, Paris, France
| | - Romain Kania
- Department of Head and Neck Surgery, Lariboisiere University Hospital, Paris, France
| | - Emmanuel Houdart
- Department of Neuroradiology and MR Unit, Lariboisière University Hospital, 75010, Paris, France
| | - Arnaud Attyé
- Department of Neuroradiology and MRI, SFR RMN Neurosciences, Grenoble Alpes University Hospital, Grenoble, France
| | - Michel Toupet
- Centre d'Explorations Fonctionnelles Otoneurologiques, Paris, France
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van Steekelenburg JM, van Weijnen A, de Pont LMH, Vijlbrief OD, Bommeljé CC, Koopman JP, Verbist BM, Blom HM, Hammer S. Value of Endolymphatic Hydrops and Perilymph Signal Intensity in Suspected Ménière Disease. AJNR Am J Neuroradiol 2020; 41:529-534. [PMID: 32029469 DOI: 10.3174/ajnr.a6410] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Ménière disease is characterized by endolymphatic hydrops, whereas perilymphatic enhancement on MR imaging has been suggested to be of additional value in diagnosing Ménière disease. This study evaluates the presence of endolymphatic hydrops and perilymphatic enhancement in patients with Ménière disease and with other vertigo-associated inner ear pathology. MATERIALS AND METHODS A 3D-FLAIR sequence 4 hours after intravenous gadolinium injection was performed to visualize the endolymph and perilymph in 220 patients suspected of having Ménière disease. Patients' ears were retrospectively categorized as having Ménière disease (probable or definite) or other vertigo-associated inner ear pathology not attributable to Ménière disease. Endolymphatic hydrops was evaluated using a visual classification system, and perilymphatic enhancement was scored both visually and quantitatively. RESULTS Endolymphatic hydrops was present in 137 (91.9%) of the definite Ménière disease ears and in 9 (7.0%) of the ears with other vertigo-associated inner ear pathology (P < .001). The combination of endolymphatic hydrops and visually increased perilymphatic enhancement was present in 122 (81.9%) definite Ménière disease ears compared with 4 (3.1%) ears with other vertigo-associated inner ear pathology (P < .001). This combination increases the positive predictive value from 0.94 for endolymphatic hydrops and 0.91 for perilymphatic enhancement to 0.97. The addition of measured perilymphatic enhancement leads to a moderate decrease in sensitivity from 0.92 for endolymphatic hydrops to 0.86. CONCLUSIONS The combination of perilymphatic enhancement and endolymphatic hydrops in patients suspected of having Ménière disease increases the positive predictive value in the diagnosis of definite Ménière disease.
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Affiliation(s)
| | - A van Weijnen
- Otorhinolaryngology (A.v.W., C.C.B., J.P.K., H.M.B.), Haga Teaching Hospital, The Hague, the Netherlands
| | - L M H de Pont
- From the Departments of Radiology (J.M.v.S., L.M.H.d.P., S.H.)
| | - O D Vijlbrief
- Department of Radiology (O.D.V.), Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - C C Bommeljé
- Otorhinolaryngology (A.v.W., C.C.B., J.P.K., H.M.B.), Haga Teaching Hospital, The Hague, the Netherlands
| | - J P Koopman
- Otorhinolaryngology (A.v.W., C.C.B., J.P.K., H.M.B.), Haga Teaching Hospital, The Hague, the Netherlands
| | - B M Verbist
- Department of Radiology (B.M.V.), Leiden University Medical Centre, Leiden, the Netherlands
| | - H M Blom
- Otorhinolaryngology (A.v.W., C.C.B., J.P.K., H.M.B.), Haga Teaching Hospital, The Hague, the Netherlands
| | - S Hammer
- From the Departments of Radiology (J.M.v.S., L.M.H.d.P., S.H.)
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Zheng YX, Liu AG, Wang XL, Hu Y, Zhang YF, Peng LY. The Role of Endolymphatic Hydrops in Patients with Pantonal Idiopathic Sudden Sensorineural Hearing Loss: A Cause or Secondary Reaction. Curr Med Sci 2019; 39:972-977. [PMID: 31845229 DOI: 10.1007/s11596-019-2130-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/23/2019] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to investigate the presence of endolymphatic hydrops (EH) in both affected and unaffected ears of patients with pantonal unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) using three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) and further evaluate the significance of EH in this disorder. Twenty-seven ISSHL patients were enrolled in this study. 3D-FLAIR MRI was performed 24 h after intratympanic injection of gadolinium-diethylenetriaminepentaacetic acid (Gd-DPTA). The incidences of EH in the affected ears and contralateral unaffected ears were compared and the correlations of EH with vertigo or prognosis were analyzed using the Chi-square test. The results showed that the incidence of EH was 68.0% (17/25) in the affected ears and 34.8% (8/23) in the unaffected ears. There was a statistically significant difference between affected ears and unaffected ears in regard to the incidence of EH (P<0.05). There were no significant correlations of EH with vertigo (P=1.000) or with prognosis (P=0.359) in the affected ears. In conclusion, there is EH in the inner ear of patients with pantonal ISSNHL; EH is not related to vertigo, a concomitant symptom of ISSNHL, and the prognosis of this condition. The presence of EH may be a secondary reaction following the impairment of the inner ears with pantonal ISSNHL.
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Affiliation(s)
- Ye-Xian Zheng
- Department of Otorhinolaryngology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and technology, Wuhan, 430014, China
| | - Ai-Guo Liu
- Department of Otorhinolaryngology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and technology, Wuhan, 430030, China
| | - Xing-Long Wang
- Department of Otorhinolaryngology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and technology, Wuhan, 430030, China
| | - Ying Hu
- Department of Otorhinolaryngology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and technology, Wuhan, 430030, China
| | - Yan-Fei Zhang
- Department of Otorhinolaryngology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and technology, Wuhan, 430030, China
| | - Li-Yan Peng
- Department of Otorhinolaryngology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and technology, Wuhan, 430030, China.
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Kahn L, Hautefort C, Guichard JP, Toupet M, Jourdaine C, Vitaux H, Herman P, Kania R, Houdart E, Attyé A, Eliezer M. Relationship between video head impulse test, ocular and cervical vestibular evoked myogenic potentials, and compartmental magnetic resonance imaging classification in menière's disease. Laryngoscope 2019; 130:E444-E452. [PMID: 31742710 DOI: 10.1002/lary.28362] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS Currently, it is possible to assess in vivo the morphology of each compartment of the endolymphatic spaces 4 hours after an intravenous administration of gadolinium on magnetic resonance imaging (MRI). The aim of this study was to assess the correlation between otolithic and ampullar functions (cervical vestibular evoked myogenic potential [cVEMP], ocular vestibular evoked myogenic potential [oVEMP], video head impulse test [VHIT]) and delayed inner ear MRI based on a compartmental, anatomically based classification that included the cochlea, the saccule, the utricle, and the ampullas. STUDY DESIGN Retrospective case-control study. METHODS In this retrospective study, we performed three-dimensional fluid-attenuated inversion recovery sequences with delayed acquisition in 26 healthy subjects and 31 definite Menière's disease (MD) patients. Each subject was then graded on MRI on the basis on cochlear, saccular, utricular, and ampullar hydrops in MD patients. All patients underwent pure-tone audiometry, VHIT, cVEMP, and oVEMP testing. RESULTS Cochlear, saccular, utricular, and ampullar hydrops were found on MRI in 88%, 91%, 50%, and 8.5% respectively. We found no significant correlation between the presence of saccular hydrops versus cVEMP, utricular hydrops versus oVEMP, and ampullar hydrops versus VHIT. However, the severity of endolymphatic hydrops on MRI was correlated to the degree of hearing loss. CONCLUSIONS We proposed a compartmental, anatomically based classification for endolymphatic hydrops on MRI, which included the whole vestibular compartment. Using this classification, we observed increasing morphological changes as the disease evolved, affecting first the saccule, then the utricle, and finally the ampullas. The severity of vestibular endolymphatic hydrops is only correlated to hearing loss severity. LEVEL OF EVIDENCE 3 Laryngoscope, 130:E444-E452, 2020.
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Affiliation(s)
- Laureline Kahn
- Department of Head and Neck Surgery, Lariboisière University Hospital, Paris, France
| | - Charlotte Hautefort
- Department of Head and Neck Surgery, Lariboisière University Hospital, Paris, France
| | | | - Michel Toupet
- Otoneurological Functional Exploration Center, Paris, France
| | - Clément Jourdaine
- Department of Head and Neck Surgery, Lariboisière University Hospital, Paris, France
| | - Hélène Vitaux
- Department of Head and Neck Surgery, Lariboisière University Hospital, Paris, France
| | - Philippe Herman
- Department of Head and Neck Surgery, Lariboisière University Hospital, Paris, France
| | - Romain Kania
- Department of Head and Neck Surgery, Lariboisière University Hospital, Paris, France
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France
| | - Arnaud Attyé
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France.,Department of Neuroradiology and Magnetic Resonance Imaging, Grenoble Alpes University Hospital, French Society of Radiology, Nuclear Magnetic Resonance Neurosciences, Grenoble, France
| | - Michael Eliezer
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France
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Ishiyama G, Lopez IA, Acuna D, Ishiyama A. Investigations of the Microvasculature of the Human Macula Utricle in Meniere's Disease. Front Cell Neurosci 2019; 13:445. [PMID: 31636542 PMCID: PMC6787152 DOI: 10.3389/fncel.2019.00445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
The integrity and permeability of the blood labyrinthine barrier (BLB) in the inner ear is important to maintain adequate blood supply, and to control the passage of fluids, molecules and ions. Identifying the cellular and structural components of the BLB, the vascular endothelial cells (VECs), pericytes, and the perivascular basement membrane, is critical to understand the pathophysiology of the inner ear microvasculature and to design efficient delivery of therapeutics across the BLB. A recent study of the normal and pathological ultrastructural changes in the human macula utricle microvasculature demonstrated that the VECs are damaged in Meniere’s disease (MD), and further studies identified oxidative stress markers (iNOS and nitrotyrosine) in the VECs. Using fluorescence microscopy, the microvasculature was studied in the macula utricle of patients diagnosed with MD that required transmastoid labyrinthectomy for intractable vertigo (n = 5), and patients who required a translabyrinthine approach for vestibular schwannoma (VS) resection (n = 3). Normal utricles (controls) were also included (n = 3). VECs were identified using rabbit polyclonal antibodies against the glucose transporter-1 (GLUT-1) and pericytes were identified using mouse monoclonal antibodies against alpha-smooth muscle actin (α-SMA). Immunofluorescence (IF) staining was made in half of the utricle and flat mounted. The other half was used to study the integrity of the BLB using transmission electron microscopy (TEM). GLUT-1-IF, allowed delineation of the macula utricle microvasculature (located in the stroma underneath the sensory epithelia) in both MD and VS specimens. Three sizes of vessels were present in the utricle vasculature: Small size (<15 μm), medium size (15–25 μm) and large size >25 μm. α-SMA-IF was present in pericytes that surround the VECS in medium and thick size vessels. Thin size vessels showed almost no α-SMA-IF. AngioTool software was used for quantitative analysis. A significant decreased number of junctions, total vessel length, and average vessel length was detected in the microvasculature in MD specimens compared with VS and control specimens. The deeper understanding of the anatomy of the BLB in the human vestibular periphery and its pathological changes in disease will enable the development of non-invasive delivery strategy for the treatment of hearing and balance disorders.
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Affiliation(s)
- Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Ivan A Lopez
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Dora Acuna
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Shi S, Zhou F, Wang W. 3D-real IR MRI of Meniere's disease with partial endolymphatic hydrops. Am J Otolaryngol 2019; 40:589-593. [PMID: 31113683 DOI: 10.1016/j.amjoto.2019.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES A three-dimensional inversion-recovery sequence with real reconstruction (3D-real IR) sequence 4 h after intravenous gadolinium injection (IV) has been used to visualize the endolymphatic hydrops (ELH) in Meniere's disease (MD). This study was designed to explore the pathology of MD with partial ELH. METHODS We collected 338 patients with definite MD, all of whom underwent the IV method. Patients who were found to have partial ELH (vestibular or cochlear) were enrolled. The hearing thresholds of the enrolled patients were analyzed, the regions of interest of the cochlear perilymph and the cerebellum white matter were determined, and the signal intensity ratio in the former to the latter (CC ratio) for both sides in the patients was subsequently evaluated. RESULTS Of the 338 collected patients with definite MD, 19 patients (5.6%) had unilateral vestibular ELH (N = 18) or cochlear ELH (N = 1), and 4 patients (1.2%) with bilateral ELH had contralateral cochlear ELH. The CC ratio of the affected side (1.44 ± 0.46) was higher than that of the unaffected side (1.15 ± 0.33, P < 0.05) in the 19 patients with unilateral ELH. Conversely, there was no difference between the ratio of the contralateral side (1.18 ± 0.16) and the unaffected side (P > 0.05) in the 4 patients with bilateral ELH. CONCLUSIONS Partial vestibular ELH was more common than partial cochlear ELH in MD. Moreover, vestibular ELH, rather than cochlear ELH, may correlate with the elevated contrast effect in the affected side, which may better reflect the pathologic mechanism of MD.
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Affiliation(s)
- Suming Shi
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Fenyang Road No. 83, Shanghai 200031, China; Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Fenyang Road No. 83, Shanghai 200031, China
| | - Feng Zhou
- Department of Otolaryngology - Head and Neck Surgery, Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, 817 Middle Road No. 602, Fuzhou, Fujian Province 350004, China
| | - Wuqing Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Fenyang Road No. 83, Shanghai 200031, China; Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Fenyang Road No. 83, Shanghai 200031, China.
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Lee J, Kim ES, Lee Y, Lee K, Yoon DY, Ju YS, Lee HJ, Hong SK, Kwon MJ. Quantitative analysis of cochlear signal intensity on three-dimensional and contrast-enhanced fluid-attenuated inversion recovery images in patients with Meniere's disease: Correlation with the pure tone audiometry test. J Neuroradiol 2019; 46:307-311. [PMID: 30953681 DOI: 10.1016/j.neurad.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to correlate the quantitative analysis of cochlear signal intensity (SI) on 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and contrast-enhanced (CE) 3D-FLAIR images with results of the pure tone audiometry (PTA) test in patients with Meniere's disease (MD). MATERIALS AND METHODS Over a 3-year period, 123 patients with MD underwent 3-Tesla (3 T) temporal magnetic resonance imaging (MRI), including 3D-FLAIR and CE-FLAIR sequences. The SI of membranous labyrinth of the cochlea in both ears of each patient was measured by drawing a region of interest (ROI) with a seed growing technique. The correlation between measured cochlear SIs on 3D-FLAIR and CE-FLAIR images, contrast enhancement index (CEI), and contrast enhancement ratio (CER) and clinical findings and pre- and post-treatment PTA results were assessed. RESULTS Cochlear signal ratios of symptomatic ears on 3D-FLAIR and CE-FLAIR images were significantly higher than those of asymptomatic ears (P < 0.001). The area under the curve, from the receiver operating characteristic curve of cochlear SIs on 3D-FLAIR and CE-FLAIR images for discrimination between symptomatic and asymptomatic ears, was 0.729 and 0.728, respectively. Cochlear SIs on 3D-FLAIR and CE-FLAIR images were significantly correlated with patients' sex (P < 0.05 and P < 0.01, respectively), symptomatic ear (both P < 0.0001), and pre-treatment PTA (P < 0.0001 and P < 0.005, respectively), but were not significantly correlated with patients' age, post-treatment PTA or hearing threshold level at 0.5, 1.0, 2.0, or 4.0 kHz. CONCLUSION Quantitative analysis of cochlear SI on 3D-FLAIR and CE-FLAIR images may be a helpful diagnostic adjunct for MD, but may be of little value in predicting the prognosis of MD.
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Affiliation(s)
- Jaehyung Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam City, Kyeonggi-do, South Korea
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea.
| | - Yul Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young-Su Ju
- Department of Industrial Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Sung Kwang Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
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Eliezer M, Poillon G, Horion J, Lelion P, Gerardin E, Magne N, Gillibert A, Attyé A. MRI diagnosis of saccular hydrops: Comparison of heavily-T2 FIESTA-C and 3D-FLAIR sequences with delayed acquisition. J Neuroradiol 2019; 48:446-452. [DOI: 10.1016/j.neurad.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/19/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
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Abstract
Visualization of the morphologic substrate of Ménière disease, the endolymphatic hydrops, can be performed using noncontrast or contrast-enhanced MR imaging techniques. Noncontrast MR imaging uses a heavily T2-weighted sequence; however, its reproducibility remains to be confirmed. Contrast-enhanced MR imaging techniques mainly use a 3-dimensional fluid-attenuated inversion recovery sequence after intratympanic gadolinium administration or after a 4-hour delayed intravenous gadolinium administration. The latter technique is most frequently used and is able to detect and grade Ménière disease. It is a reliable technique with a high diagnostic accuracy, enabling visualization of endolymphatic hydrops.
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Affiliation(s)
- Anja Bernaerts
- Department of Radiology, GZA Hospitals Antwerp, Oosterveldlaan 24, Wilrijk 2610, Belgium.
| | - Bert De Foer
- Department of Radiology, GZA Hospitals Antwerp, Oosterveldlaan 24, Wilrijk 2610, Belgium
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The value of four stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Menière's disease on MRI. Neuroradiology 2019; 61:421-429. [PMID: 30719545 PMCID: PMC6431299 DOI: 10.1007/s00234-019-02155-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022]
Abstract
Purpose There is still a clinical-radiologic discrepancy in patients with Menière’s disease (MD). Therefore, the purpose of this study was to investigate the reliability of current MRI endolymphatic hydrops (EH) criteria according to Baráth in a larger study population and the clinical utility of new imaging signs such as a supplementary fourth low-grade vestibular EH and the degree of perilymphatic enhancement (PE) in patients with Menière’s disease (MD). Methods This retrospective study included 148 patients with probable or definite MD according to the 2015 American Academy of Otolaryngology, Head and Neck Surgery criteria who underwent a 4-h delayed intravenous Gd-enhanced 3D-FLAIR MRI between January 2015 and December 2016. Vestibular EH, vestibular PE, cochlear EH, and cochlear PE were reviewed twice by three experienced readers. Cohen’s Kappa and multivariate logistic regression were used for analysis. Results The intra- and inter-reader reliability for the grading of vestibular-cochlear EH and PE was excellent (0.7 < kappa < 0.9). The two most distinctive characteristics to identify MD are cochlear PE and vestibular EH which combined gave a sensitivity and specificity of 79.5 and 93.6%. By addition of a lower grade vestibular EH, the sensitivity improved to 84.6% without losing specificity (92.3%). Cochlear EH nor vestibular PE showed added-value. Conclusions MRI using vestibular-cochlear EH and PE grading system is a reliable technique. A four-stage vestibular EH grading system in combination with cochlear PE assessment gives the best diagnostic accuracy to detect MD.
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Eliezer M, Attyé A, Guichard JP, Vitaux H, Guillonnet A, Toupet M, Herman P, Kania R, Houdart E, Hautefort C. Vestibular atelectasis: Myth or reality? Laryngoscope 2019; 129:1689-1695. [DOI: 10.1002/lary.27793] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Michael Eliezer
- Department of Neuroradiology; Lariboisière University Hospital; Paris France
| | - Arnaud Attyé
- Department of Neuroradiology; Lariboisière University Hospital; Paris France
- Department of Neuroradiology and MRI; Grenoble Alpes University Hospital, SFR RMN Neurosciences; Grenoble France
| | | | - Hélène Vitaux
- Department of Head and Neck Surgery; Lariboisière University Hospital; Paris France
| | - Antoine Guillonnet
- Department of Neuroradiology; Lariboisière University Hospital; Paris France
| | - Michel Toupet
- Centre d'Explorations Fonctionnelles Otoneurologiques; Paris France
| | - Philippe Herman
- Department of Head and Neck Surgery; Lariboisière University Hospital; Paris France
| | - Romain Kania
- Department of Head and Neck Surgery; Lariboisière University Hospital; Paris France
| | - Emmanuel Houdart
- Department of Neuroradiology; Lariboisière University Hospital; Paris France
| | - Charlotte Hautefort
- Department of Head and Neck Surgery; Lariboisière University Hospital; Paris France
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Marques P, Duan M, Perez-Fernandez N, Spratley J. Gentamicin delivery to the inner ear: Does endolymphatic hydrops matter? PLoS One 2018; 13:e0207467. [PMID: 30440019 PMCID: PMC6237362 DOI: 10.1371/journal.pone.0207467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Middle ear application of gentamicin is a common medical treatment for uncontrolled Ménière’s disease. The objective of the study was to evaluate the impact of endolymphatic hydrops on inner ear delivery. Methods Perilymph gentamicin concentrations and correlation with endolymphatic hydrops in an animal model were assessed. A group of 24 guinea pigs was submitted to surgical obstruction of the endolymphatic sac and duct of the right ear. Gentamicin was applied either to the right ear’s round window niche or through a transtympanic injection. Perilymph specimens were collected at different times. Histologic morphometry was used to evaluate both turn-specific and overall hydrops degree. Results In animals with endolymphatic hydrops, lower concentrations of gentamicin were observed after 20 or 120 minutes of exposure and in both types of administration, when compared to controls. This difference reached statistical significance in the round window niche application group (Mann-Whitney, p = 0,007). A negative correlation between perilymphatic gentamicin concentration and hydrops degree could be observed in both groups, after 120 minutes of exposure (Spearman correlation, round window niche p<0,001; TT p = 0,005). Conclusions The study indicates that the endolymphatic hydrops degree has a negative interference on the delivery of gentamicin into the inner ear following middle ear application.
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Affiliation(s)
- Pedro Marques
- Department of Otorhinolaryngology, S.João Hospital Centre, Porto, Portugal
- Unit of Otorhinolaryngology, Department of Surgery and Physiology, University of Porto Medical School, Porto, Portugal
- * E-mail:
| | - Maoli Duan
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology, Head and Neck Surgery, Karolinska Universisty Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Jorge Spratley
- Department of Otorhinolaryngology, S.João Hospital Centre, Porto, Portugal
- Unit of Otorhinolaryngology, Department of Surgery and Physiology, University of Porto Medical School, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), University of Porto Medical School, Porto, Portugal
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