title: Visualization of a high protein concentration in the cochlea of a patient with a large endolymphatic duct and sac, using three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging.
abstract: OBJECTIVE
  To evaluate the inner ear of a patient with an enlarged vestibular aqueduct and acute hearing deterioration, using three-dimensional fluid-attenuated inversion recovery (3D FLAIR) magnetic resonance imaging (MRI).
  
  
  BACKGROUND
  Three-dimensional fluid-attenuated inversion recovery MRI has been recently developed to detect haemorrhage and high concentrations of protein. Application of this method to inner-ear diseases has not been fully described.
  
  
  METHODS
  We used 3D FLAIR MRI to evaluate a patient with an enlarged vestibular aqueduct and acute hearing deterioration.
  
  
  RESULTS
  On 3D FLAIR MRI, this patient had high signals in the endolymphatic duct and sac, the vestibule and the cochlea and was diagnosed as having a high protein concentration in the inner ear. These high signal areas were not detected by T1- and T2-weighted MRI.
  
  
  CONCLUSIONS
  This is the first published case in which a high protein concentration in the cochlea of a patient with an enlarged vestibular aqueduct was detected by 3D FLAIR MRI. These findings strongly supported the theory of the pathophysiology of hearing deterioration in patients with an enlarged vestibular aqueduct, which states that hyperosmolar fluid in the enlarged endolymphatic sac refluxes into the cochlea, resulting in damage to the hair cells. Thus, these finding may help clarify the cause of hearing deterioration in the presence of a large endolymphatic duct and sac.
authors.affiliation: Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan. makotos@med.nagoya-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Sugiura
authors.forename: S
authors.initials: S
authors.lastname: Naganawa
authors.forename: E
authors.initials: E
authors.lastname: Sato
authors.forename: T
authors.initials: T
authors.lastname: Nakashima
mesh_terms: D000328:Adult; D003051:Cochlea / Q000002:abnormalities*; D004711:Endolymphatic Duct; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011506:Proteins / Q000032:analysis; D016896:Treatment Outcome; D014723:Vestibular Aqueduct / Q000002:abnormalities*
chemical_list: D011506:Proteins