Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle–Delayed 3D-FLAIR Sequences in Menière Disease

Nahmani, Sarah; Vaussy, Alexis; Hautefort, Charlotte; Guichard, J.-P.; Guillonet, A.; Houdart, Emmanuel; Attyé, Arnaud; Eliezer, Michaël

doi:10.3174/ajnr.a6483

Cited by 18 publications

(14 citation statements)

References 30 publications

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“…After assessing the abstract and title, full-text evaluation, and quality assessment (results in appendix C), 30 eligible articles were included in the review (Fig. 1) (19–48).…”

Section: Resultsmentioning

confidence: 99%

“…The remaining two studies were animal studies in which IV administration was used (19–30). There were 15 studies on PL of the inner ear and three phantom studies (31–48).…”

Section: Resultsmentioning

confidence: 99%

“…One study found no significant difference in CM-SIR between single and double GBCA doses in affected ears, but the single dose resulted in higher CM-SIR than double dose when using 3D-FLAIR with a low TE ( P = 0.009) (31). One study specifically studied rFA and reported significant benefit in using a constant rFA of 140° compared to a variable rFA in both affected and unaffected ears ( P < 0.001) (36). Additionally, three articles that used variable rFA reported lower CM-SIRs than did the article with constant rFA of 120° (31,37,44,45).…”

Section: Resultsmentioning

confidence: 99%

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Optimal sequences and sequence parameters for GBCA-enhanced MRI of the glymphatic system: a systematic literature review

et al. 2020

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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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“…After assessing the abstract and title, full-text evaluation, and quality assessment (results in appendix C), 30 eligible articles were included in the review (Fig. 1) (19–48).…”

Section: Resultsmentioning

confidence: 99%

“…The remaining two studies were animal studies in which IV administration was used (19–30). There were 15 studies on PL of the inner ear and three phantom studies (31–48).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Optimal sequences and sequence parameters for GBCA-enhanced MRI of the glymphatic system: a systematic literature review

et al. 2020

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“…A number of technical innovations have been recently added to the MR armamentarium to improve the identification of EH, such as the Variable and Constant Flip Angle-Delayed 3D-FLAIR Sequences ( 44 ) or the i.t.-Gd “ medium inversion time inversion recovery imaging with magnitude reconstruction ” (MIIRMR) ( 65 ).…”

Section: Discussionmentioning

confidence: 99%

Advanced Imaging of the Vestibular Endolymphatic Space in Ménière's Disease

et al. 2021

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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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“…The high-resolution, strongly T2weighted, 3D constructive interference steady state (CISS) sequence of the temporal bones was performed to evaluate the anatomy of the whole-fluid-filled labyrinthine spaces and had the following parameters: TR 1,000 ms, TE 133 ms, FA 100 • , FOV 192 × 192 mm 2 , 56 slices, base resolution 384, averages 4, acceleration factor of 2 using GRAPPA algorithm, slice thickness of 0.5 mm and acquisition time 8:36 min. The presence of ELH was observed on the 3D-FLAIR images as enlarged negativesignal spaces inside the labyrinth, according to a previously reported method (18,46).…”

Section: Data Acquisitionmentioning

confidence: 99%

Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study

et al. 2021

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In-vivo non-invasive verification of endolymphatic hydrops (ELH) by means of intravenous delayed gadolinium (Gd) enhanced magnetic resonance imaging of the inner ear (iMRI) is rapidly developing into a standard clinical tool to investigate peripheral vestibulo-cochlear syndromes. In this context, methodological comparative studies providing standardization and comparability between labs seem even more important, but so far very few are available. One hundred eight participants [75 patients with Meniere's disease (MD; 55.2 ± 14.9 years) and 33 vestibular healthy controls (HC; 46.4 ± 15.6 years)] were examined. The aim was to understand (i) how variations in acquisition protocols influence endolymphatic space (ELS) MR-signals; (ii) how ELS quantification methods correlate to each other or clinical data; and finally, (iii) how ELS extent influences MR-signals. Diagnostics included neuro-otological assessment, video-oculography during caloric stimulation, head-impulse test, audiometry, and iMRI. Data analysis provided semi-quantitative (SQ) visual grading and automatic algorithmic quantitative segmentation of ELS area [2D, mm2] and volume [3D, mm3] using deep learning-based segmentation and volumetric local thresholding. Within the range of 0.1–0.2 mmol/kg Gd dosage and a 4 h ± 30 min time delay, SQ grading and 2D- or 3D-quantifications were independent of signal intensity (SI) and signal-to-noise ratio (SNR; FWE corrected, p < 0.05). The ELS quantification methods used were highly reproducible across raters or thresholds and correlated strongly (0.3–0.8). However, 3D-quantifications showed the least variability. Asymmetry indices and normalized ELH proved the most useful for predicting quantitative clinical data. ELH size influenced SI (cochlear basal turn p < 0.001), but not SNR. SI could not predict the presence of ELH. In conclusion, (1) Gd dosage of 0.1–0.2 mmol/kg after 4 h ± 30 min time delay suffices for ELS quantification. (2) A consensus is needed on a clinical SQ grading classification including a standardized level of evaluation reconstructed to anatomical fixpoints. (3) 3D-quantification methods of the ELS are best suited for correlations with clinical variables and should include both ears and ELS values reported relative or normalized to size. (4) The presence of ELH increases signal intensity in the basal cochlear turn weakly, but cannot predict the presence of ELH.

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Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle–Delayed 3D-FLAIR Sequences in Menière Disease

Cited by 18 publications

References 30 publications

Optimal sequences and sequence parameters for GBCA-enhanced MRI of the glymphatic system: a systematic literature review

Optimal sequences and sequence parameters for GBCA-enhanced MRI of the glymphatic system: a systematic literature review

Advanced Imaging of the Vestibular Endolymphatic Space in Ménière's Disease

Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study

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