title: Blood-Labyrinth Barrier Permeability in Menière Disease and Idiopathic Sudden Sensorineural Hearing Loss: Findings on Delayed Postcontrast 3D-FLAIR MRI.
abstract: OBJECTIVE
  Menière disease and idiopathic sudden sensorineural hearing loss can have overlapping clinical presentation and may have similar pathophysiology. Prior studies using postcontrast 3D-FLAIR MR imaging suggest abnormal blood-labyrinth barrier permeability in both conditions, but the 2 diseases have not been directly compared by using the same imaging techniques. We hypothesized that delayed postcontrast 3D-FLAIR MR imaging would show differences in blood-labyrinth barrier permeability between Menière disease and idiopathic sudden sensorineural hearing loss.
  
  
  METHODS
  Patients with unilateral Menière disease (n= 32) and unilateral idiopathic sudden sensorineural hearing loss (n= 11) imaged with delayed postcontrast 3D-FLAIR MR imaging were retrospectively studied. Signal intensities of the medulla and perilymph of the cochlear basal turns of both ears in each patient were measured in a blinded fashion. Cochlea/medulla ratios were calculated for each ear as a surrogate for blood-labyrinth barrier permeability. The ears were segregated by clinical diagnosis.
  
  
  RESULTS
  Cochlea/medulla ratio was higher in symptomatic ears of patients with Menière disease (12.6 ± 7.4) than in patients with idiopathic sudden sensorineural hearing loss (5.7 ± 2.0) and asymptomatic ears of patients with Menière disease (8.0 ± 3.1), indicating increased blood-labyrinth barrier permeability in Menière disease ears. The differences in cochlea/medulla ratio between symptomatic and asymptomatic ears were significantly higher in Menière disease than in idiopathic sudden sensorineural hearing loss. Asymptomatic ears in patients with Menière disease showed higher cochlea/medulla ratio than symptomatic and asymptomatic ears in patients with idiopathic sudden sensorineural hearing loss.
  
  
  CONCLUSIONS
  Increased cochlea/medulla ratio indicates increased blood-labyrinth barrier permeability in Menière disease compared with idiopathic sudden sensorineural hearing loss. Increased cochlea/medulla ratio in asymptomatic ears of patients with Menière disease also suggests an underlying systemic cause of Menière disease and may provide a pathophysiologic biomarker.
authors.affiliation: From the Departments of Radiological Sciences (M.N.P., H.J.K., W.B.P., A.R.S.).
authors.forename: M N
authors.identifier: http://orcid.org/0000-0003-1049-9880
authors.initials: MN
authors.lastname: Pakdaman
authors.affiliation: Neurology (G.I.).
authors.forename: G
authors.identifier: http://orcid.org/0000-0003-4382-8089
authors.initials: G
authors.lastname: Ishiyama
authors.affiliation: Head and Neck Surgery (A.I., K.A.P.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-1913-0812
authors.initials: A
authors.lastname: Ishiyama
authors.affiliation: Head and Neck Surgery (A.I., K.A.P.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: K A
authors.identifier: http://orcid.org/0000-0002-9166-0869
authors.initials: KA
authors.lastname: Peng
authors.affiliation: From the Departments of Radiological Sciences (M.N.P., H.J.K., W.B.P., A.R.S.).
authors.forename: H J
authors.identifier: http://orcid.org/0000-0003-1225-3489
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: From the Departments of Radiological Sciences (M.N.P., H.J.K., W.B.P., A.R.S.).
authors.forename: W B
authors.identifier: http://orcid.org/0000-0003-4803-1992
authors.initials: WB
authors.lastname: Pope
authors.affiliation: From the Departments of Radiological Sciences (M.N.P., H.J.K., W.B.P., A.R.S.) alisepahdari@gmail.com.
authors.forename: A R
authors.identifier: http://orcid.org/0000-0002-3806-1728
authors.initials: AR
authors.lastname: Sepahdari