MRI of endolymphatic hydrops in patients with Meniere’s disease: a case-controlled study with a simplified classification based on saccular morphology

PurposeThere 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).MethodsThis 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.ResultsThe 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.ConclusionsMRI 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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“…Accordingly, Attyé et al described inversion of the saccule-to-utricle area ratio (SURI) as a qualitative marker [10]. …”

Section: Discussionmentioning

confidence: 99%

The value of four stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Menière’s disease on MRI

et al. 2019

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“…The degree of SH was defined as none; grade I, when the saccule appeared larger or equal to the utricle, surrounded by perilymphatic space; or grade II, when the saccule touched the oval window, without surrounding perilymphatic space (Fig. ) …”

Section: Methodsmentioning

confidence: 99%

“…Many hydrops classifications have been developed since the first description by Nakashima et al The authors have evaluated separately the area of the endolymphatic space in the cochlea and the vestibule without differentiating the saccule from the utricle. Other research teams proposed anatomical classification based on the saccular dilatation and utricular protrusion in the nonampullated part of the lateral semicircular canal in association with saccular hydrops (SH) in MD patients …”

Section: Introductionmentioning

confidence: 99%

Relationship between video head impulse test, ocular and cervical vestibular evoked myogenic potentials, and compartmental magnetic resonance imaging classification in menière's disease

et al. 2019

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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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“…Subjective evaluation methods such as the saccule-toutricle ratio inversion (SURI) 13 and the presence of the vestibular endolymphatic space contacting the oval window (VESCO) 14 have been utilized in conjunction with 3D-FLAIR images. However, the presence of EH was only evaluated using 3D-FLAIR images after IV-GBCA in these studies.…”

Section: Resultsmentioning

confidence: 99%

“…However, the presence of EH was only evaluated using 3D-FLAIR images after IV-GBCA in these studies. 13,14 Using only 3D-FLAIR images, it is not possible to differentiate between bone, air, and the endolymphatic space. Even for these subjective evaluation methods, it might be easier to used 3D-real IR imaging than to use 3D-FLAIR imaging.…”

Section: Resultsmentioning

confidence: 99%

Quantification of Endolymphatic Space Volume after Intravenous Administration of a Single Dose of Gadolinium-based Contrast Agent: 3D-real Inversion Recovery versus HYDROPS-Mi2

Ohashi

Naganawa

Takeuchi

et al. 2020

MRMS

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Purpose: Recently, the use of 3D real inversion recovery (3D-real IR) imaging has been proposed for the evaluation of endolymphatic hydrops (EH). This method shows similar contrast between the endolymphatic and perilymphatic spaces and surrounding bone compared with the hybrid of reversed image of positive endolymph signal and native image of perilymph signal multiplied with heavily T 2 -weighted MR cisternography (HYDROPS-Mi2) image. We measured the volume of the endolymphatic space using 3D-real IR and HYDROPS-Mi2 images, and compared the measurements obtained with both techniques.Methods: HYDROPS-Mi2 and 3D-real IR images were obtained for 30 ears from 15 patients with clinical suspicion of EH; imaging was performed 4 h after intravenous administration of a single dose of gadoliniumbased contrast agent. We measured the volume of the endolymphatic space in the cochlea and vestibule by manually drawing the regions of interest. The correlation between endolymphatic volume determined from HYDROPS-Mi2 images and 3D-real IR images was calculated.Results: There was a strong positive linear correlation between the cochlear and vestibular endolymphatic volume determined from HYDROPS-Mi2 and 3D-real IR images. The Spearman's rank correlation coefficient (ρ) between the measurements obtained with both images was 0.805 (P < 0.001) for the cochlea and 0.826 (P < 0.001) for the vestibule. Conclusion:The endolymphatic volume measured using 3D-real IR images strongly correlated with that measured using HYDROPS-Mi2 images. Thus, 3D-real IR imaging might be a suitable method for the measurement of endolymphatic volume.

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MRI of endolymphatic hydrops in patients with Meniere’s disease: a case-controlled study with a simplified classification based on saccular morphology

Abstract: • Half of MD patients presented with inversion of the saccule to utricle ratio. • Saccular analysis is crucial when assessing patients with Meniere's disease. • In some patients, the saccule is not visible, suggestive of intra-labyrinthine fistulae.

Cited by 125 publications

References 29 publications

The value of four stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Menière’s disease on MRI

The value of four stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Menière’s disease on MRI

Relationship between video head impulse test, ocular and cervical vestibular evoked myogenic potentials, and compartmental magnetic resonance imaging classification in menière's disease

Quantification of Endolymphatic Space Volume after Intravenous Administration of a Single Dose of Gadolinium-based Contrast Agent: 3D-real Inversion Recovery versus HYDROPS-Mi2

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