Comparison between high-resolution 3D-IR with real reconstruction and 3D-flair sequences in the assessment of endolymphatic hydrops in 3 tesla.

BACKGROUND: The main sequences used to assess degree of endolymphatic hydrops (EH) are the 3D- inversion-recovery (IR) with real reconstruction and the 3D- fluid-attenuated inversion recovery (FLAIR). OBJECTIVES: The purpose of this study is to describe and compare both sequences. MATERIAL AND METHODS: Forty-two consecutive patients diagnosed with probable or definite Ménièr´s disease were referred for hydrops MR examination. Vestibular and cochlear EH in both sequences were read by two independent radiologists, unaware of the patient's clinical status. The primary study endpoint was the concordance in the hydrops detection and severity with both imaging sequences. This was assessed using the Cohen's kappa Κ statistic for disease grading and Pearson Χ2 test to test the difference in detection rates of hydrops. Statistical significance was defined as two-sided p < .05. RESULTS: We obtained an excellent overall concordance, with a kappa of 0.821, (p < .001) when comparing hydrops detection. The degree of concordance is higher in vestibular hydrops than in cochlear hydrops. The 3D-IR sequence detected more hydrops than the 3D FLAIR, (62 vs. 39.5%, p < .03). CONCLUSION: The 3D-IR sequence seems to be superior to the 3D-FLAIR for the assessment of EH. Significance: The 3D-IR sequence should be considered as a standalone parameter for a shorter and optimized EH magnetic resonance imaging protocol.

In vivo Assessment of an Endolymphatic Hydrops Gradient Along the Cochlea in Patients With Menière's Disease by Magnetic Resonance Imaging-A Pilot Study.

OBJECTIVE: To assess three strategies for evaluation and description of potential endolymphatic hydrops (EH) gradients along the cochlea in patients with Menière's disease. STUDY DESIGN: Prospective observational study. METHODS: Ten patients with definite Menière's disease revealed by magnetic resonance imaging were included in this prospectively conducted pilot study. The presence of cochlear endolymphatic hydrops as well as a potential hydrops gradient along the cochlea were subjectively evaluated by two readers. Furthermore, both readers performed planimetric measurements of the relative extent of endolymphatic hydrops in the cochlear turns for calculation of an apico-basal-index (ABI) and an average gradient slope of the endolymphatic hydrops. These models were correlated with the available pure tone audiometry (PTA). RESULTS: Qualitatively, 13 of 16 inner ears presented an apical EH distribution. The median ABI was 1.69 for patients with low-tone hearing loss and 1.17 for patients with a flat PTA curve (p = 0.03). The median EH slope was 7.44 and correlated with the steepness of the PTA (ρ = 0.583; p = 0.018). The subjective analysis and the slope model were best fit for prediction of a low-tone hearing loss type with sensitivities of 100% (specificity, 42.86%) and 88.9% (specificity, 71.4%), respectively. The inter-reader agreement in all three approaches was considered substantial to perfect. CONCLUSION: The presented qualitative approach and the slope model represent reliable methods for the description of a potential EH gradient along the cochlea. Furthermore, the average EH steepness along the cochlea correlates with the type of hearing loss.

Assessment of Meniere's disease from a radiological aspect - saccular otoconia as a cause of Meniere's disease?

CONCLUSION: Significant reduced visualization of the reuniting duct (ductus reuniens; RD), saccular duct (SD) and endolymphatic sinus (ES) in Meniere's disease (MD) compared with normal control ears on three-dimensional (3D) CT imaging suggests the blockage of endolymphatic flow there with radiodense substances, which may be explained by dislodged otoconia from the saccule. These structures could be involved in the pathogenesis of MD. OBJECTIVE: This study was designed to visualize and assess the RD, SD and ES in patients with MD using 3D CT. METHODS: Sixty-two patients with a definite diagnose of unilateral MD, based on criteria proposed by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), were compared with contralateral ears and normal controls (26 ears) using 3D CT. The RD, SD and ES were scrutinized for patency on 3D CT images. RESULTS: MD ears showed loss of continuity of the RD, SD and ES based on evaluation of 3D CT images, and differed significantly from normal healthy control ears (p < 0.01).