The value of four stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Meni\xe8re\u2019s disease on MRI

Anja Bernaerts,Stephanie Vanden Bossche,Bert De Foer,Jan W Casselman,Floris L Wuyts,Robby Vanspauwen,Joost Van Dinther,Cathérine Blaivie,Erwin Offeciers,Andrzej Zarowski

doi:10.1007/s00234-019-02155-7

Anja Bernaerts, Stephanie Vanden Bossche + Show 8 more

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https://doi.org/10.1007/s00234-019-02155-7

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Abstract

PurposeThere is still a clinical-radiologic discrepancy in patients with Menière’s disease (MD). Therefore, the purpose of this study was to investigate the reliability of current MRI endolymphatic hydrops (EH) criteria according to Baráth in a larger study population and the clinical utility of new imaging signs such as a supplementary fourth low-grade vestibular EH and the degree of perilymphatic enhancement (PE) in patients with Menière’s disease (MD).MethodsThis retrospective study included 148 patients with probable or definite MD according to the 2015 American Academy of Otolaryngology, Head and Neck Surgery criteria who underwent a 4-h delayed intravenous Gd-enhanced 3D-FLAIR MRI between January 2015 and December 2016. Vestibular EH, vestibular PE, cochlear EH, and cochlear PE were reviewed twice by three experienced readers. Cohen’s Kappa and multivariate logistic regression were used for analysis.ResultsThe intra- and inter-reader reliability for the grading of vestibular-cochlear EH and PE was excellent (0.7 < kappa < 0.9). The two most distinctive characteristics to identify MD are cochlear PE and vestibular EH which combined gave a sensitivity and specificity of 79.5 and 93.6%. By addition of a lower grade vestibular EH, the sensitivity improved to 84.6% without losing specificity (92.3%). Cochlear EH nor vestibular PE showed added-value.ConclusionsMRI using vestibular-cochlear EH and PE grading system is a reliable technique. A four-stage vestibular EH grading system in combination with cochlear PE assessment gives the best diagnostic accuracy to detect MD.

Highlights

More than 150 years ago, Prosper Menière described for the first time that vertigo can be elicited from the inner ear
The purpose of this study is to investigate the reliability and validity of the current magnetic resonance imaging (MRI) diagnostic criteria and grading system for endolymphatic hydrops (EH) [8] on delayed intravenous contrast-enhanced 3D FLAIR MRI in a larger study population and the clinical utility of possible new imaging signs such as a supplementary fourth low-grade vestibular EH and the degree of perilymphatic enhancement (PE)
Patients were clinically evaluated by our ORL-HNS department and were diagnosed with probable or definite Menière’s disease (MD) according to the 2015 revised diagnostic criteria of the Academy of Otolaryngology Head and Neck Surgery (AAO HNS)

Summary

Introduction

More than 150 years ago, Prosper Menière described for the first time that vertigo can be elicited from the inner ear. Until it was believed vertigo was a disorder of the brain. In 1995, the American Academy of Otolaryngology Head and Neck Surgery (AAO HNS) established a specific set of criteria for the diagnosis of Menière’s disease (MD). In this classification, the disease is divided into certain (with postmortem histologic confirmation), definite, probable, and possible categories [1]. The clinical diagnosis of MD can be complemented with a battery of audiological, vestibular, and electrophysiological tests; the lack of a definitive gold standard diagnostic test still complicates the process of diagnosis [3]

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