A new magnetic resonance imaging scoring system for perilymphatic space appearance after intratympanic gadolinium injection, and its clinical application

Abstract

A convenient method is proposed which offers reliable radiological diagnostic criteria for Ménière's disease and delayed endolymphatic hydrops.

Semi-quantification of Endolymphatic Size on MR Imaging after Intravenous Injection of Single-dose Gadodiamide: Comparison between Two Types of Processing Strategies

“…Another study proposed a grading method in which the labyrinth was segmented into 7 parts, the presence of contrast enhancement of perilymph on 3D-FLAIR obtained after IT administration of GBCM was noted for each part, and the parts showing enhancement were counted. 20 The points correlated well with patient symptoms, and interobserver variability was small. However, endolymphatic size cannot be directly evaluated by counting the number of parts with perilymph enhancement after IT administration of GBCM.…”

Intratympanic Contrast in the Evaluation of Meniere Disease: Understanding the Limits

“…Nevertheless, series have not found a reliable correlation between the extent of en- dolymphatic distention and patient response to subsequent IT steroids, 16,18 and there has been variable correlation between imaging with summating potential/action potential ratios electrocochleography and vestibular-evoked myogenic potential. 17,25,31 These outcomes may be partially due to lack of standardization of criteria for severity based on imaging findings 8,12,13 but also may reflect the spectrum of findings through the range associated with the natural history of Menière disease. The delayed post-IT injection FLAIR sequence should be interpreted with multiplanar projections, to avoid interpretation errors due to partial volume averaging as illustrated in Fig 2. Additionally, any nonstandard sequences must be reviewed in the context of a full IAC protocol, including fluid-sensitive, DWI, FLAIR, and postcontrast T1 sequences of the entire auditory pathway, to exclude a schwannoma 32 or other source of…”

“…Studies of IT injections at other centers have demonstrated that the endolymphatic space is conspicuously distended in patients with Menière disease and less commonly in other causes of sensorineural hearing loss. 10,11 Most interesting, endolymphatic distention characterized by these methods has been demonstrated in 20%-65% of contralateral asymptomatic ears in patients with Menière disease via IT or IV-GBCA methods, [12][13][14] furthering the debate regarding imaging overestimation or clinical underestimation of Menière disease.…”

“…A variety of sequences has been used to evaluate the ear following IT injection of GBCA, including 3D real inversion recovery, 8,15 3D-inversion recovery TSE, 16 and 3D sampling perfection with application-optimized contrast using different flip angle evolutions FLAIR, 12 with versions of 3D FLAIR techniques most commonly used. 7,[17][18][19] While the availability of 32-channel head coils has improved resolution to 0.4 ϫ 0.4 ϫ 0.8 mm, these volumetric sequences come at the cost of time, requiring up to 15 minutes for an acquisition, with potential for motion degradation and decreased SNR due to parallel imaging techniques.…”

Concepts of Ménière's disease in the Archives of The Journal of Laryngology and Otology

“…Recent studies published in the Journal suggest we may yet be able to see the hydrops, as has long been proposed, in vivo and in real time. 16,17 'Magnetic resonance imaging for Ménière's disease: correlation with tone burst electrocochleography', J Hornibrook et al (2012) The newly developed use of magnetic resonance imaging of the human inner ear, on a 3 Tesla EDITORIAL scanner with intratympanically administered gadolinium, can now reliably distinguish perilymph from endolymph and visually confirm the presence or absence of endolymphatic hydrops. Transtympanic tone burst electrocochleography is an established, and under-utilised evoked response electrophysiological test for hydrops, but it relies on a symptom score to indicate the likelihood of hydrops being present.…”