Imaging of the saccule for the diagnosis of endolymphatic hydrops in Meniere disease, using a three-dimensional T2-weighted steady state free precession sequence: accurate, fast, and without contrast material intravenous injection

Aïna Venkatasamy,Sophie Riehm,Maher Abu Eid,Hella Vuong,Aude Fleury,Anne Charpiot,Francis Veillon,Dominique Rohmer,Henri Sick,Benoit Romain,Michael Eliezer

doi:10.1186/s41747-017-0020-7

Abstract

BackgroundEndolymphatic hydrops can be studied on magnetic resonance imaging (MRI) using images acquired 4 h after intravenous injection of Gd-chelate. Our aim was to compare high-resolution T2-weighted images of the saccule in normal subjects with histological sections from cadavers and to identify its changes in Meniere disease, compared to healthy volunteers.MethodsSixty-four healthy volunteers without any otologic disease and 64 patients who fulfilled all the criteria for unilateral Meniere disease underwent 3 T MRI using a T2-weighted steady state free precession (SSFP) sequence, without contrast material injection. Images of healthy volunteers were compared with histological sections of normal inner ears from premature foetuses and compared with volunteers.ResultsThe normal saccule was easily visible on T2-weighted images in volunteers, with a normal maximal height of 1.6 mm (1.4 ± 0.1 mm, mean ± standard deviation) and a good correlation with reference histological sections, while in Meniere disease the saccule was dilated in 52/62 patients (84%), with a saccular height greater than 1.6 mm (1.69 ± 0.24 mm, p = 0.001), found in 45/52 patients (86%). An associated increased width (greater than 1.4 mm) was found in 23/52 patients (44%). A round shape or the non-visualisation of the saccule were also found in 2/52 (4%) and in 5/62 patients (8%), respectively.ConclusionsA T2-weighted sequence is an easy method to diagnose Meniere disease. Saccular abnormalities were found in 84% of the cases: elongation (height > 1.6 mm) in 86%, increased saccular width in 44%, or a missing saccule in 8%.

Highlights

Endolymphatic hydrops can be studied on magnetic resonance imaging (MRI) using images acquired 4 h after intravenous injection of Gd-chelate
Meniere disease symptoms are known to be correlated to the degree of endolymphatic hydrops, which is the distension of endolymph-filled structures (Fig. 1a) [2, 3]
Study population Patients who presented at our institution with all criteria for unilateral definite Meniere disease according to the 2015 classification provided by the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) [1] were prospectively enrolled from 01/01/2014 to 01/01/2016

Summary

Introduction

Endolymphatic hydrops can be studied on magnetic resonance imaging (MRI) using images acquired 4 h after intravenous injection of Gd-chelate. Our aim was to compare high-resolution T2-weighted images of the saccule in normal subjects with histological sections from cadavers and to identify its changes in Meniere disease, compared to healthy volunteers. Meniere disease symptoms are known to be correlated to the degree of endolymphatic hydrops, which is the distension of endolymph-filled structures (Fig. 1a) [2, 3]. The endolymphatic hydrops can be studied with 3 T magnetic resonance imaging (MRI). All published studies used delayed images acquired 4 h after intravenous injection of a Gd-chelate or 24 h after intratympanic injection of a Gdchelate [4,5,6,7,8,9,10]

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