The diagnostic performance of Cochlear Endolymphatic Hydrops and Perilymphatic Enhancement in Stratifying Ménière's Disease probabilities: A Meta-Analysis of semi-quantitative MRI-based grading systems

Abstract

Background The diagnosis of Meniere’s Disease (MD) presents significant challenges due to its complex symptomatology and the absence of definitive biomarkers. Advancements in MRI technology have spotlighted endolymphatic hydrops (EH) as a key pathological marker, necessitating a reevaluation of its diagnostic utility amidst the need for standardized and validated MRI-based grading scales. Methods Our meta-analysis scrutinized the diagnostic efficacy of semi-quantitative MRI-based cochlear EH and perilymphatic enhancement (PLE) grading systems in delineating clinically relevant discriminations: “Spotting” the shift from normal or asymptomatic ears to pMD, “Confirming” the progression to dMD, and “Establishing” the presence of dMD. A thorough literature search up to October 2023 resulted in 35 pertinent studies, forming the basis of our analysis through a bivariate mixed-effects regression model. Results Using criteria from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and Barany Society, across varying thresholds and disease probabilities; the Establishment model at an EH grade 1 threshold revealed a sensitivity of 85.4% and a specificity of 82.7%. Adjusting the threshold to EH grade 2 results in a sensitivity increase to 92.1% (CI: 85.9–95.7) and a specificity decrease to 70.6% (CI: 64.5–76.1), with a DOR of 28.056 (CI: 14.917–52.770). The Confirmation model yields a DOR of 5.216, indicating a lower diagnostic accuracy. The Spotting model demonstrates a sensitivity of 48.3% (CI: 34.8–62.1) and a specificity of 88.0% (CI: 77.8–93.9), with a DOR of 6.882. The normal ears subgroup demonstrated a notably high specificity of 89.7%, while employing Nakashima's criteria resulted in a reduced sensitivity of 74.9%, significantly diverging from other systems (p-value < 0.001). The PLE grading system showcased exceptional sensitivity of 98.4% (CI: 93.7–99.6, p-value < 0.001). Conclusion Our findings advocate for a deliberate, informed choice of grading system, encapsulating the essence of a customized diagnostic approach in MD management.