Communication between cochlear perilymph and cerebrospinal fluid through the cochlear modiolus visualized after intratympanic administration of Gd-DTPA.
OBJECTIVE
Intratympanic injection of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) has been reported as a procedure to visualize endolymphatic hydrops of Meniere's disease. We frequently noted that cerebrospinal fluid (CSF) in the internal auditory canal (IAC) was also enhanced after this procedure. The purpose of this study was to evaluate how frequently this occurs and to investigate the specific features of patients who lack this communication.


METHODS
A total of 25 patients with clinically suspected endolymphatic hydrops underwent the procedure. After 24 h, three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and 3D constructive interference in steady state (3D-CISS) were performed. The presence of contrast enhancement in the CSF space of the fundus of the IAC was evaluated.


RESULTS
The contrast ratio between CSF of the IAC fundus and cerebellar white matter on the injected side was 1.49 +/- 0.65, and that of the noninjected side was 0.32 +/- 0.16 (P < 0.01). Enhancement of the CSF space in the IAC fundus was seen in all but two subjects: one had enlarged endolymphatic duct and sac syndrome (EEDS), and the other had cochlear nerve agenesis. In these two patients, the cochlear modiolus seemed to be normal.


CONCLUSIONS
Intratympanic Gd-DTPA administration can reveal permeability of the modiolus and might facilitate evaluation of functional abnormalities of the modiolus not detected by conventional imaging tests.
Naganawa
Shinji
S
Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, Japan. naganawa@med.nagoya-u.ac.jp
Satake
Hiroko
H
Iwano
Shingo
S
Sone
Michihiko
M
Nakashima
Tsutomu
T
D000328:Adult; D000368:Aged; D003051:Cochlea / Q000473:pathology*; D003287:Contrast Media; D018159:Endolymphatic Hydrops / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010498:Perilymph; D014432:Tympanic Membrane / Q000473:pathology*; D055815:Young Adult
D003287:Contrast Media; D019786:Gadolinium DTPA