Semi-quantitative evaluation of endolymphatic hydrops by bilateral intratympanic gadolinium-based contrast agent (GBCA) administration with MRI for Meniere's disease.
CONCLUSIONS
Bilateral intratympanic administration of a gadolinium-based contrast agent (GBCA) in MRI was successfully performed and proved to be beneficial in the semi-quantitative evaluation of endolymphatic hydrops. Such image-based diagnosis will lead to re-revaluation and reclassification of the diagnostic criteria for Meniere's disease (MD).


OBJECTIVE
To visualize endolymphatic hydrops semi-quantitatively in patients with MD, by using bilateral intratympanic GBCA administration with MRI.


METHODS
A total of 13 patients were evaluated, including 12 with MD and one with acute low-tone sensorineural hearing loss. Diluted gadodiamide (a kind of GBCA) was administered to the bilateral tympanic cavity by injection through the tympanic membrane. After 24 h, the endolymphatic hydrops was evaluated with a 3.0 T MR scanner. The areas enhanced by gadodiamide were measured semi-quantitatively.


RESULTS
Three-dimensional, fluid-attenuated inversion recovery (3D-FLAIR) MRI showed that the gadodiamide successfully penetrated the round window membrane, entering the perilymphatic space and delineating the gadodiamide-enhanced perilymphatic and gadodiamide-negative endolymphatic spaces of the inner ear. All the patients with MD showed a reduced gadodiamide-enhanced area representing the perilymphatic space, and the quantitative ratio was 0.15 to 0.85. Furthermore, endolymphatic hydrops was also demonstrated in the patient with atypical MD who had fluctuating low frequency sensorineural hearing loss without vertigo.
Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan.
Hisakuni
H
Fukuoka
Keita
K
Tsukada
Maiko
M
Miyagawa
Tomohiro
T
Oguchi
Yutaka
Y
Takumi
Makoto
M
Sugiura
Hitoshi
H
Ueda
Masumi
M
Kadoya
Shin-ichi
S
Usami
D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D003287:Contrast Media / Q000008:administration & dosage*; D004432:Ear, Middle; D004710:Endolymph; D018159:Endolymphatic Hydrops / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D019786:Gadolinium DTPA; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis* / Q000503:physiopathology; D008875:Middle Aged; D010498:Perilymph; D014724:Vestibular Function Tests
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA