Saccular measurements in routine MRI can predict hydrops in Menière’s disease

Abstract

Most patients with suspicion of hydrops do not have access to MRI with 3D reconstruction of the endolymphatic space. Our main objective was to show that measurements of the saccule on a non-enhanced 3D-T2 MRI could show hydrops and help diagnose Menière disease. We conducted a prospective study from 2015 to 2016 to compare consecutive patients consulting for Menière's disease to a control group (patients with unilateral non-hydrops disorders and contralateral healthy ears). They all received full auditory and vestibular testing. They also underwent a 3-Tesla 3D-T2 MRI using CISS sequence (0.4 mm thick slices), which were blindly evaluated by two independent neuroradiologists. The saccular height and width were measured in a coronal plane and Menière's disease patients' symptomatic ears were compared to asymptomatic and control ears. 36 patients with definite Menière's disease and 36 control patients were studied, including 42 symptomatic Menière, 30 asymptomatic Menière and 72 control ears. Saccular measurements were significantly different between symptomatic Menière ears compared to healthy ears (1.59 vs 1.32 mm, p < 0.001 for height; 1.13 vs 0.90 mm, p < 0.001 for width). Symptomatic and asymptomatic Menière ears' measurements were not significantly different (p = 0.307 and p = 0.109). Using ROC curve, we found cut-off values for saccular height 1.51 mm, Se = 63%, Sp = 95% and width 1.05 mm, Se = 41%, Sp = 95%. Routine 3D-T2 MRI, which patients must undergo for differential diagnosis, could help diagnose hydrops with high specificity using saccular measurements.

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

“…This is in line with prior studies in which for the evaluation of patients with MD, only the evaluation of the saccule and utricle are incorporated. Moreover, the papers in literature on the use of heavily T2-weighted sequences in the evaluation of patients with definite MD also only evaluate the vestibule in demonstrating MD, showing a high percentage of dilated saccules in definite MD patients [13, 14]. …”

Magnetic resonance imaging of Ménière's disease: early clinical experience in a UK centre

“…These currently employ high-resolution 3D T2-weighted gradient echo sequences, such as constructive interference in steady state (‘CISS’) and fast imaging employing steady-state acquisition (‘FIESTA’), and have focused on the assessment of saccule size. Although the reliability and reproducibility of these techniques requires confirmation, 36,37 the potential for non-gadolinium-enhanced MRI sequences to demonstrate some endolymphatic structures would help justify not only the inclusion of a control group of healthy subjects but also the use of serial imaging studies in order to evaluate any fluctuation or progression of imaging changes with duration of disease, and to allow an assessment of imaging response to interventions.…”

MRI in Menière’s Disease

“…The data on the use of non-contrast MR techniques in the evaluation of patients with MD in literature are limited. So far, only two papers have documented the saccule measurement on coronal reformations of a heavily T2-weighted sequence [6,7]. On these images, the saccule can be detected as a small oval hypo-intense lesion in the vestibule on a coronal reconstruction.…”