Magnetic resonance imaging: Role on diagnosing all types of endolymphatic hydrops

Lin, Kai‐Wei; Lu, Chi‐Ju; Young, Yi‐Ho

doi:10.1016/j.jfma.2021.08.027

Cited by 14 publications

(11 citation statements)

References 23 publications

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“…Although EH is the hallmark of MD, other histopathological features i.e., rupture, fistula or collapse of the labyrinthine membrane could also be demonstrated on temporal bones of MD donors, but not on MR images of MD patients. 8 Lin et al 12 reported that MD patients with recovery of hearing (resolution of EH), immediately after vertiginous episode (rupture of EH), or chronic hearing loss (collapse of cochlear duct), may result in negative cochlear EH on MR images. Hence, indication for engaging on MR imaging in MD patients warrants an issue to investigate.…”

Section: Discussionmentioning

confidence: 99%

“…However, those with atypical MD or MD patients with asymptomatic hydrops on the opposite ear are seldom correctly diagnosed, unless they develop cardinal MD features in long‐term follow up. The rationale for performing MR imaging in an atypical MD patient is because MD and sudden sensorineural hearing loss (SSHL) have significant overlap in symptoms, especially in MD patients with monosymptomatic onset of hearing loss at initial stage, or SSHL patients with vertigo 12 . Additionally, as asymptomatic hydrops on the opposite ear acts a transient state from unilateral MD to bilateral MD, 13,14 MR imaging thus helps mapping the affected territory of EH 15 …”

Section: Introductionmentioning

confidence: 99%

“…Recently, correlation between hearing level and the grade of cochlear EH offers a promising way to study the progression of MD 16 . However, not all differentials for EH can be visualized on MR images, leading to various sensitivities and specificities of MR imaging for confirming EH 12 . To lessen clinical‐radiological discrepancy, appropriate patient counseling and engagement on MR imaging workup are essential.…”

Section: Introductionmentioning

confidence: 99%

“… 16 However, not all differentials for EH can be visualized on MR images, leading to various sensitivities and specificities of MR imaging for confirming EH. 12 To lessen clinical‐radiological discrepancy, appropriate patient counseling and engagement on MR imaging workup are essential. Hence, this study correlated audiological results with MR images to predict positive cochlear EH on MR images in MD patients.…”

Section: Introductionmentioning

confidence: 99%

“…The rationale for performing MR imaging in an atypical MD patient is because MD and sudden sensorineural hearing loss (SSHL) have significant overlap in symptoms, especially in MD patients with monosymptomatic onset of hearing loss at initial stage, or SSHL patients with vertigo. 12 Additionally, as asymptomatic hydrops on the opposite ear acts a transient state from unilateral MD to bilateral MD, 13,14 MR imaging thus helps mapping the affected territory of EH. 15 Recently, correlation between hearing level and the grade of cochlear EH offers a promising way to study the progression of MD.…”

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confidence: 99%

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Predicting positive cochlear endolymphatic hydrops on magnetic resonance images

Lin

Young

2022

Laryngoscope Investig Oto

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Objective/hypothesis This study correlated audiological results with magnetic resonance (MR) images to predict positive cochlear endolymphatic hydrops (EH) on MR images in patients with Meniere's disease (MD). Study design Retrospective study. Methods Twenty definite MD patients with positive cochlear EH on MR images were assigned to Group A. Another 20 definite MD patients with negative cochlear EH on MR images were assigned to Group B. All patients underwent an inner ear test battery followed by MR imaging using HRDROPS‐Mi2 technique. Results The mean hearing levels (MHLs) at frequencies of 125, 250, 500 and 1000 Hz revealed significantly worse in Group A than Group B. Significantly deteriorated MHLs were noted from Grades 0 to II at low frequency (125, 250, and 500 Hz), but not at mid‐frequency and high frequency. The respective cutoff hearing thresholds at frequencies of 125, 250, and 500 Hz were 27.5, 32.5, and 40 dBHL, which help predict positive cochlear EH on MR images. By using the sum (27.5 + 32.5 + 40 = 100 dBHL) of cutoff thresholds from three low frequencies as a cutoff value, Group A (80%) showed significantly more ears with sum of low‐frequency hearing threshold >100 dBHL than Group B (30%). Conclusion When sum of three low‐frequency (125, 250, and 500 Hz) hearing levels is >100 dBHL, positive cochlear EH may be shown on MR images in definite MD patients. In contrast, those MD patients with sum of three low‐frequency hearing levels <100 dBHL, MR imaging should be postponed because resolution of EH may cause negative MR images. Level of evidence: 4

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Predicting positive cochlear endolymphatic hydrops on magnetic resonance images

Lin

Young

2022

Laryngoscope Investig Oto

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Role of conventional MD staging in modern era of hydrops MR imaging

Yan,

Young

2024

Laryngoscope Investig Oto

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Objective/HypothesisThis study correlated stage of Meniere's disease (MD) with MR imaging of endolymphatic hydrops (EH) to assess the role of MD staging in modern era.Study DesignRetrospective study.MethodsFifty‐four MD patients (60 ears) underwent an inner ear test battery and were further confirmed by MR imaging. Sixty MD ears were divided into stages I–IV, and hydrops MR images at each stage were compared.ResultsHydrops MRI demonstrated that EH at the cochlea with respective Grades 0/I/II were 3/7/1 ears for stage I, 0/5/3 ears for stage II, 1/6/26 ears for stage III and 0/2/6 ears for stage IV. Significant relationship was not identified between MD stage and grades of cochlear hydrops. Similarly, no significant relationship was shown between MD stage and grades of vestibular (saccular/utricular) hydrops. The optimal cutoff value of four‐tone average for predicting severe type (Grade II–III) cochlear/vestibular EH was 48 dB, which was within the stage III. Hence, prevalence of severe type (Grade II) cochlear EH in stages III (79%) and IV (75%) was significantly higher than stages I (9%) and II (38%). Similarly, severe type saccular/utricular EH in stages III (64%) and IV (75%) also showed significantly higher than stages I (18%) and II (25%).ConclusionAlthough conventional MD staging fails to correlate with the grades of EH on hydrops MRI, late‐stage MD may indicate heightened EH severity in the cochlea and vestibule.Level of Evidence4.

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Delayed post gadolinium MRI descriptors for Meniere’s disease: a systematic review and meta-analysis

et al. 2023

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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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Magnetic resonance imaging: Role on diagnosing all types of endolymphatic hydrops

Cited by 14 publications

References 23 publications

Predicting positive cochlear endolymphatic hydrops on magnetic resonance images

Predicting positive cochlear endolymphatic hydrops on magnetic resonance images

Role of conventional MD staging in modern era of hydrops MR imaging

Delayed post gadolinium MRI descriptors for Meniere’s disease: a systematic review and meta-analysis

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