Intratympanic Gadolinium Administration Research Articles

Endolymphatic hydrops imaging and correlation with clinical characteristics, audiovestibular function and mental impairment in patients with Meniere’s disease

PurposeMR imaging was used to visualize the vestibular and cochlear endolymphatic hydrops in patients with Meniere’s disease (MD). The relationship between the degree of hydrops and clinical characteristics, audiovestibular function, anxiety and depression state in MD patients.Methods70 patients with definitely or probably unilateral Meniere’s disease received bilateral intratympanic gadolinium administration and MR scanning. The degree of bilateral vestibular and cochlea hydrops were analyzed and evaluated by three-dimensional real inversion recovery (3D-real IR) sequence, and the correlation between the grades of endolymphatic hydrops (EH) and disease course, vertigo grading assessment, the duration of vertigo, hearing loss level, caloric test, vestibular myogenic evoked potential (VEMP), electrocochleogram (EcoG), vertigo disability scale (physical, emotional, functional), anxiety and depression scale were studied.ResultsIt was found that the vestibule and cochlea EH of the affected and the contralateral ear had different degrees of hydrops and there was no statistical difference between the left and right vestibules. The degree of vestibule EH (V-EH) was significantly positively correlated with the degree of cochlear EH (C-EH). C-EH and hearing loss level were positively correlated with EcoG. There was positive correlation between vestibular EH and hearing loss level, VEMP, caloric test, disease course or vertigo duration. There was a negative relationship between Dizziness Handicap Inventory (Emotion) (DHI(E)) and VEMP. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were positive correlated with DHI(E) and DHI total scores in MD patients.ConclusionEndolymph-enhancing MRI was used as an important imaging method for the diagnosis of labyrinthine hydrops in Meniere’s disease. There were certain correlation between EH and the degree of vertigo attack, hearing loss level, vestibular function, and further changes in anxiety and depression emotion.

Dexamethasone does not affect endolymphatic hydrops (EH) in patients with Meniere's disease within 24 h, and intratympanic administration of gadolinium plus dexamethasone simplifies high-quality imaging of EH using a novel protocol of 7 min

BackgroundIntratympanic administration of gadolinium chelate allows for a better visualization of endolymphatic hydrops (EH) using MRI than intravenous injection and was recently further improved to facilitate high-quality imaging of EH in 7 min. The aim of the present study was to simplify the intratympanic administration protocol by mixing gadolinium chelate with therapeutic dexamethasone and to evaluate the effects of this mixture on the visualization of EH in MRI. Materials and methodsIn an in vitro study, the potential impact of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) on the stability of dexamethasone was evaluated by analyzing dynamic changes in dexamethasone with high-performance liquid chromatography (HPLC) after mixing with Gd-DTPA. Ten patients with definite Meniere's disease (MD) were recruited to study the potential interference of dexamethasone on MRI visualization of EH, and 49 patients with MD were recruited to evaluate the effect of intratympanic injection of Gd-DTPA mixed with dexamethasone on MRI of EH using a 3T MR machine and a novel heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed using a magnitude plus zero-filled interpolation (hT2FLAIR-MZFI) sequence. ResultsThe retention times and peak area of dexamethasone in HPLC were not modified by the addition of Gd-DTPA. EH grading in the cochlea and vestibule was not influenced in any ear by intratympanic injection of dexamethasone. Excellent inner ear images were obtained from all patients, and EHs with various grades were displayed. There were significant correlations between diagnosis and cochlear EH (p < 0.01, Spearman's Rho), between diagnosis and vestibular EH (p < 0.01, Spearman's Rho), and between cochlear and vestibular EH (p < 0.01, Spearman's Rho). The distribution of Gd-DTPA plus dexamethasone negatively correlated with the grade of vestibular EH. Injury of the endolymph-perilymph barrier was detected in one cochlea and three vestibules of 59 inner ears with MD. ConclusionsIntratympanic administration of Gd-DTPA plus dexamethasone yielded high-quality MRI images of EH in patients with MD using a novel 7-min protocol and simplified the clinical application. Intratympanic administration of Gd-DTPA plus dexamethasone might be used to test its therapeutic effect in future work. Level of evidence3.

Observation of the mouse vestibule by 7.05 Tesla MRI after the intratympanic administration of gadolinium

Observation of the mouse vestibule by 7.05 Tesla MRI after the intratympanic administration of gadolinium

Diagnostic Value of the Magnetic Resonance Imaging With Intratympanic Gadolinium Administration (IT-Gd MRI) Versus Audio-Vestibular Tests in Menière's Disease: IT-Gd MRI Makes the Difference.

Our aim was to evaluate the validity and reliability of clinically relevant tests in the diagnosis of Menière's disease (MD) according to the criteria formulated during 2015 as well as their efficacy in detecting endolymphatic hydrops (EH). The focus was on: three-dimensional fluid-attenuated inversion recovery-SPectral Attenuated Inversion Recovery (3D-FLAIR-SPAIR) sequences using 3 Tesla magnetic resonance imaging (3T MRI) performed 24 hours after intratympanic Gadolinium injection (IT-Gd) in comparison with the functional tests pure tone audiometry (PTA), caloric test, video head impulse test (vHIT), and cervical-vestibular-evoked-myogenic-potentials (cVEMP). Retrospective study. Tertiary care center. Primary eligibility criteria were given clinical suspicion of MD and the performance of an IT-Gd MRI leading to a group of 31 patients and 52 ears to be analyzed separately. Reanalysis of the raw diagnostic data leading to comparability of IT-Gd MRI, PTA, caloric test, vHIT, and cVEMP concerning their valency for clinically diagnosed MD and quantifiability of EH. Considering sensitivity, specificity, and the likelihood-ratio only the IT-Gd MRI displayed results qualifying it as a viable device for MD-diagnostics in regards to the criteria of 2015 (p = 0.01), it even provides direct imaging evidence for the underlying pathology of the disease. Furthermore, the comparison between MRI images and test results of caloric test, vHIT and cVEMP revealed that neither of these diagnostic functional tests serves as a reliable indicator for EH. It appears that the diagnosing process of MD would benefit from turning IT-Gd MRI into a standard diagnostic procedure in cases of suspected MD, displaying better results than caloric test, vHIT, and cVEMP.

Imaging of Ménière Disease.

Visualization of the morphologic substrate of Ménière disease, the endolymphatic hydrops, can be performed using noncontrast or contrast-enhanced MR imaging techniques. Noncontrast MR imaging uses a heavily T2-weighted sequence; however, its reproducibility remains to be confirmed. Contrast-enhanced MR imaging techniques mainly use a 3-dimensional fluid-attenuated inversion recovery sequence after intratympanic gadolinium administration or after a 4-hour delayed intravenous gadolinium administration. The latter technique is most frequently used and is able to detect and grade Ménière disease. It is a reliable technique with a high diagnostic accuracy, enabling visualization of endolymphatic hydrops.

MRI in Menière’s Disease

The visualization of the morphologic substrate of Meniere’s disease -the endolymphatic hydrops – can be performed using non-contrast as well as contrast-enhanced magnetic resonance imaging techniques. The non-contrast magnetic resonance imaging technique uses a heavily T2-weighted sequence; however, the reproducibility of this technique remains to be confirmed. The contrast-enhanced techniques most frequently use a 3-dimensional fluid-attenuated inversion recovery sequence or a real 3-dimensional inversion recovery sequence either after intratympanic gadolinium administration either 4 hours after intravenous gadolinium administration. The latter is the most frequently used technique and is able to detect definite Meniere’s disease with a high sensitivity and specificity. It has been proven to be a reliable technique with a high diagnostic accuracy, enabling the visualization of endolymphatic hydrops.

Diagnosis of endolymphatic hydrops by means of 3 T magnetic resonance imaging after intratympanic administration of gadolinium

ObjectiveTo detect and graduate endolymphatic hydrops or endolymphatic space dilations in patients with suspected Meniere's disease or immune-mediated inner ear disease by magnetic resonance imaging. Material and methodsA prospective study was performed including all the patients with clinical suspicion of Meniere's disease or immune-mediated inner ear disease treated at the Otolaryngology department during a one year period. In all cases, magnetic resonance imaging (MRI) was performed in a 3T scanner. IR sequence was performed after 24–28h prior intratimpanic injection of gadolinium on both ears. Two neurorradiologist graduated endolymphatic space volume as agreed on normal, moderate and significant in the obtained images. ResultsThe presence of hydrops was documented by MRI in six patients with definite or probable Meniere's disease. In two of the four cases without vertigo hydrops was not demonstrated. In the other two cases with a high clinical suspicion of immune-mediated disease but with negative autoimmune tests hydrops was proved. There was only disagreement on cochlear hydrops presence on two patients. ConclusionThe detection of endolymphatic hydrops in patients with definite or probable Meniere's disease served to confirm the final diagnosis. Moreover, hydrops was detected in patients with suspected immune-mediated inner ear disease, which could have an impact on the diagnosis and treatment of these patients. Therefore, we suggest that this test could be included for the diagnosis of these inner ear diseases.

大阪大学における General Electric 製 3テスラ MRI 装置を用いた内耳造影撮影

Visualization of endolymphatic hydrops (EH) by magnetic resonance imaging (MRI) is becoming increasingly important and popular for the diagnosis of various inner ear diseases, such as Meniere's disease. However, most studies have been performed using Siemens scanners. At Osaka University, we have been using General Electric (GE) scanners at 3 Tesla for imaging EH since 2007. Both the scanning protocols of 24h after intratympanic administration of gadolinium (Gd) and 4h after intravenous injection of Gd are used. In contrast to the Siemens system, in which MRI sequences specific for EH imaging are available, we use the conventional two-dimensional fluid-attenuated inversion-recovery (2D-FLAIR) and three-dimensional fast imaging sequences employing steady state acquisition (FIESTA, also known as “cisternography”) to acquire axial images of the inner ear of 2-mm and 0.5-mm thickness, respectively. Written informed consent is obtained from the patients before the imagings. The examinations are performed in compliance with the Declaration of Helsinki and are approved by the institutional ethics committee. In total, 76 patients have undergone MRI under various clinical situations, such as before and after sac surgery, and before intratympanic administration of gentamycin to treat Meniere's disease. The presence of hydrops is clearly detected by T2-FLAIR images in most patients with clinical EH. Unlike the MRI sequences obtained using the Siemens system, it is currently difficult to distinguish the area of the inner ear with no enhancement (either perilymph with no contrast or endolymph) from bony areas surrounding the inner ear in our T2-FLAIR images obtained using the GE system. Comparison between T2-FLAIR and FIESTA sections at the same level is recommended. Three-dimensional volumetric co-registration of FIESTA images to T2-FLAIR images is also helpful when the patient's head movements during the MRI scanning are not negligible.

Click Stimulus Electrocochleography Versus MRI With Intratympanic Contrast in Ménière's Disease: A Systematic Review.

To evaluate the diagnostic value of electrocochleography compared with magnetic resonance imaging (MRI) with intratympanic gadolinium administration to diagnose endolymphatic hydrops in patients with Ménière's disease. An electronic search was performed in the PubMed, EMBASE, and Cochrane databases on September 15, 2015. A systematic search was conducted. Articles were included if written in English, Dutch, German, or French language. Original studies reporting on the diagnostic value of electrocochleography compared with MRI with intratympanic gadolinium administration, were included. The methodological quality of the studies was independently assessed by two reviewers using an adjusted version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. The results of the diagnostic values of both tests were extracted. We performed analyses for the sensitivity, specificity, positive predictive value, and negative predictive value of compared electrocochleography with MRI with intratympanic gadolinium administration in patients with definite Ménière's disease. The results of this systematic review, based on a very low number of patients, show there is a relative low sensitivity and negative predictive value for click stimulus electrocochleography compared with MRI with intratympanic gadolinium administration for detecting endolymphatic hydrops in patients with definite Ménière's disease.

Magnetic Resonance Imaging Fails to Show Evidence of Endolymphatic Hydrops in a Case with Tumarkin’s Otolithic Crisis

Tumarkin’s otolithic crisis refers to drop attacks that are an unusual manifestation of Meniere’s disease. It has been proposed that these drop attacks result from mechanical deformation of the otolithic organs related to the endolymphatic hydrops that occurs in Meniere’s disease, as revealed by MRI with intratympanic gadolinium enhancement. Here we report a patient with Tumarkin’s otolithic crisis in whom inner-ear MRI with intratympanic gadolinium administration during the acute attack did not reveal the presence of endolymphatic hydrops. J Korean Neurol Assoc 33(4):306-309, 2015

The Reliability of 3T MRI in Detecting Endolymphatic Hydrops in the Meniere’s Disease and Sudden Sensorineural Hearing Loss

Aim: The aim of this study was to assess the reliability of 3T MRI in detecting endolymphatic hydrops (EH) in the Meniere’s disease (MD) and sudden sensorineural hearing loss (SSHL). Methods: Fifty patients with the unilateral clinical diagnosis of definite MD and twenty with unilateral sudden sensorineural hearing loss were evaluated with inner ear MRI. The MRI detection and imaging measurement was completed 24 hrs after intratympanic administration of gadolinium chelate. The sequence of MRI was three-dimensional fast spin-echo T1-weighted imaging (3D-FSET1WI). Results: For the vestibule, the EH was visualized in 45 of 50 (90%) patients with MD and 4 of 20 (20%) patients with SSHL. For the cochlea, the EH was visualized in 46 of 50 (92%) patients with MD and 4 of 20 (20%) patients with SSHL. Conclusion: For detecting EH in MD and SSHL, the inner ear MRI assessment after intratympanic injection of gadolinium is a useful and confident method for the diagnosis of EH in MD and SSHL. The present work also approved existence of EH in SSHL for the first time in the literature.

Visualization of endolymphatic hydrops in 3D-FLAIR MRI after intratympanic Gd-DTPA administration in Meniere's disease patients

To study the feasibility of endolymphatic visualization and the diagnosis of Meniere's disease by applying intratympanic gadolinium administration through the tympanic membrance and three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI). To study the relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests, such as pure tone audiometry (PTA), electrocochleography (EcoG), caloric test and vestibular evoked myogenic potential (VEMP). With a three Tesla magnetic resonance imaging (MRI) unit, 3D-FLAIR imaging was performed 24 hours after intratympanic gadolinium through the tympanic membrance in 32 patients with clinically diagnosed unilateral Meniere's Disease. We visualized the enhanced imaging of perilymphatic space in bilateral cochlea, vestibular and (or) canal, scoring scala tympani and scala vestibule of bilateral cochlear basal turn respectively and measuring the developing area of bilateral vestibule and the signal intensity ratio (SIR) between the vestibule and the brain stem subjectively. PTA, EcoG, caloric test and VEMP were performed. The relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests were studied. The gadolinium appeared in almost all parts of the perilymph in cochlea, vestibular and (or) canals in all 32 patients' inner ears, so the endolymphatic space was clearly shown on 3D-FLAIR imaging. The scala vestibuli score value between the affected side and the healthy side were statistically significant (Z = 4.309, P < 0.05) . The developing vestibular area between the affected side and the healthy side [(6.04 ± 2.89) mm(2), (8.28 ± 3.04)mm(2)] were statistically significant (t = 3.322, P < 0.05) . Abnormal vestibular evoked myogenic potentials were significantly correlated with the developing vestibular area of the affected side (F = 11.96, P < 0.05) . Abnormal electrocochleography were significantly correlated with scala vestibuli score value of cochlear basal turn in the affected side (Z = 3.17, P < 0.05) . No significant correlation was found between the scala vestibuli score value or the developing vestibular area and caloric test or PTA findings. 3D-FLAIR MRI with intratympanic gadolinium injection through the tympanic membrance can discriminate the border between the perilymph and the endolymph and show endolymphatic hydrops. This method may provide radiographic reference for the diagnosis of Meniere's disease. The results of VEMP and electrocochleography might have appropriate correlation with degree of vestibular and cochlear hydrops.

Diagnostic value of three-dimensional fluid-attenuated inversion recovery MR imaging after intratympanic administration of contrast media in Meniere's disease

Objective After intratympanic gadolinium administration through the tympanic membrane,three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) was performed to evaluate endolymphatic visualization and its diagnostic value in Meniere's disease.Methods Twenty-four hours after intratympanic gadolinium administration through the tympanic membrane,19 patients with unilateral Meniere's disease diagnosed clinically underwent 3D-FLAIR and 3D-Balance-FFE imaging at 3.0 T MR scanner.The enhanced imaging of perilymphatic space in bilateral cochlea,vestibular and (or) canal were observed.Scala tympani and scala vestibule of bilateral cochlear basal turn were scored respectively.The enhanced range of bilateral vestibule and the signal intensity ratio (SIR) between the vestibule and the brain stem were measured. Wilcoxon tests and paired t tests were used.Results The gadolinium appeared in almost all parts of the perilymph in cochlea,vestibular and (or) canal,so the endolymphatic space was clearly visualized on 3D-FLAIR imaging.The score of scala vestibuli between the affected side (3 cases scored 2,9 cases scored 1,7 cascs scored 0) and the healthy side ( 15 cases scored 2,2 cases scored 1,2 cases scored 0 ) were significantly different ( U =3.090,P ＜ 0.05 ).The area of enhanced vestibular were (5.77 ± 2.33) mm2 and (8.11 ± 3.32) mm2 for the affected side and the healthy side,which were significantly different ( U =3.090,P ＜ 0.05 and t =2.638,P ＜ 0.05 ).Conclusions According to 3D-Balance-FFE MRI and the enhancement of perilymphatic space,3D-FLAIR MRI with intratympanic gadolinium injection through the tympanic membrance can be used to show the border between the perilymph and the endolymph and confirm endolymphatic hydrops,thus providing radiographic evidence for the diagnosis of Meniere's disease. Key words: Meniere's disease; Endolymphatic hydrops; Magnetic resonance imaging

Progression of Endolymphatic Hydrops in Ménière's Disease as Evaluated by Magnetic Resonance Imaging

To evaluate the presence and the degree of endolymphatic hydrops (EHs) in patients with unilateral Ménière's disease (MD), as a function of duration of the disease, estimated using a 3-dimensional fluid-attenuated inversion recovery sequence in a 3-Tesla magnetic resonance imaging unit, after intratympanic gadolinium administration. A total of 32 patients (21 male and 11 female subjects, aged 25-78 yr; median, 56 yr) participated in the investigation. The duration of the disease ranged from 2 months to 10 years (median, 3 yr), with a prevalence of vertigo spells in the last 6 months ranging from 0.5 to 8 per month (median, 2.5). A 0.6-ml solution of gadobutrol (1 mmol/ml) diluted 1:7 in saline was injected in the affected ear through the inferior-posterior quadrant of the tympanic membrane, using a 22-gauge spinal needle. The patient was kept with the head rotated 45 degrees contralaterally for 30 minutes after each injection. Twenty-four hours later, a 3-dimensional fluid-attenuated inversion recovery magnetic resonance imaging was performed. Perilymphatic enhancement was evaluated in different portions of the labyrinth as a function of MD duration. Reduced or absence of enhancement of the vestibule occurred precociously and occurred in all subjects at long term. The prevalence of enhancement abnormalities in the cochlea and the semicircular canals was directly proportional to MD duration. At long term, the vestibule and the cochlea showed a more severe hydropic involvement compared with semicircular canals. A statistical significant correlation between enhancement abnormalities and MD duration was observed for most inner ear sites. The increased prevalence and severity of EH with the duration of MD indicates that hydrops is a progressive degenerative phenomenon. The frequent abnormality in the vestibule and, secondarily, in the cochlea is in line with some histopathologic investigations. It remains to be clarified whether hydropic changes are related to specific signs and symptoms of MD.

Does intratympanic gadolinium injection predict efficacy of gentamicin partial chemolabyrinthectomy in Menière’s disease patients?

Using actual diagnostic criteria, the diagnosis of certain Menière's disease remains impossible during life without histopathologic confirmation. Assessing the value of a diagnostic test is difficult due to the lack of a gold standard. Recent studies reported on the use of MRI after intratympanic gadolinium injection to demonstrate endolymphatic hydrops in vivo. We evaluate whether MRI after intratympanic gadolinium administration is useful for predicting the effect and outcome of intratympanic gentamicin therapy. The correlation between transtympanic electrocochleographic (TT-ECoG) results and hydrops grade on MRI images is also investigated. Twelve definite Menière's disease patients with incapacitating vertigo attacks, not responding to drug and behavioral treatment, were selected for partial chemolabyrinthectomy with intratympanic gentamicin. All patients underwent transtympanic electrocochleography followed by surgical middle ear inspection, partial chemolabyrinthectomy (gentamicin solution 40 mg/ml applied during 60 min) and intratympanic gadolinium injection with clear exposure of the round window membrane. The MR images were reviewed and a hydrops grade was assigned. Correlation between the hydrops grade and the electrocochleographic data was assessed. Only 5 of 12 patients showed gadolinium enhancement in the inner ear. However, 6 of the 7 patients that did not show postoperative intracochlear or intralabyrinthine gadolinium distribution did report the clinical improvement after intratympanic gentamicin therapy. Hydrops grade correlated with the result of transtympanic electrocochleography in four of five cases that showed gadolinium enhancement. We conclude that the use of intratympanic gadolinium has no added value in predicting the clinical outcome of intratympanic gentamicin application. However, based on these data, a correlation between the result of TT-ECoG and hydrops grading on MRI images can be suggested.

Reliability of Magnetic Resonance Imaging Performed After Intratympanic Administration of Gadolinium in the Identification of Endolymphatic Hydrops in Patients With Ménière's Disease

To evaluate the reliability of magnetic resonance imaging performed after intratympanic gadolinium administration in evidencing endolymphatic hydrops in patients with Ménière's disease (MD). A total of 26 patients (18 male and 8 female subjects, aged 25-78 yr; median age, 56 yr) with definite MD and 12 subjects (8 male and 4 female subjects, aged 31-75 yr; median age, 51 yr) with various unilateral non-MD disorders of the inner ear were examined. A 0.6-ml solution of gadobutrol (1 mmol/ml), diluted 1:7 in saline, was injected in the affected ear through the inferior-posterior quadrant of the tympanic membrane, using a 22-gauge spinal needle. In 9 MD patients, the contralateral ear also was injected. The patient was kept with the head rotated 45 degrees contralaterally for 30 minutes after each injection. Twenty-four hours later, a 3-dimensional fluid-attenuated inversion recovery magnetic resonance imaging using a 3 Tesla unit was performed. Perilymphatic enhancement was evaluated in different portions of the labyrinth in MD ears and compared with the outcomes obtained in the non-MD ears. All MD ears showed impaired perilymphatic enhancement of variable degrees. No enhancement defects could be observed in all examined contralateral unaffected ear of the patients with MD, as well as in 11 of the 12 ears of the subjects with various unilateral non-MD disorders. Perilymphatic enhancement defect of variable degrees is observed in the pathologic ear of every patient with MD. The consistency of this phenomenon in MD ears and the complete enhancement in most of the ears without MD safely enable to attribute these findings to endolymphatic hydrops. It is likely in the near future that imaging may be used to achieve a certain diagnosis of MD in life.

Endolymphatic hydrops in Meniere's disease detected by MRI after intratympanic administration of gadolinium: Comparison with sudden deafness

Conclusion: The detection rate of endolymphatic hydrops was significantly higher in patients with Meniere's disease compared with those with sudden deafness, indicating that 3 T magnetic resonance imaging (MRI) with intratympanic gadolinium injection was effective in diagnosing endolymphatic hydrops. Objectives: To compare the detection rate of endolymphatic hydrops between patients with Meniere's disease and sudden deafness as controls by 3 T MRI after intratympanic gadolinium injection with conventional pulse sequence such as two-dimensional fluid-attenuated inversion recovery. Methods: Ten patients with unilateral Meniere's disease and eight with sudden deafness underwent inner ear MRI 24 h after intratympanic gadolinium injection. Results: The endolymphatic space was detected as a low signal intensity area, while the perilymphatic space showed high intensity by gadolinium enhancement. Due to faint enhancement, images could not be evaluated in 1 of 10 patients with Meniere's disease. However, the other nine patients together with two of the eight with sudden deafness were diagnosed as having hydrops. The difference in detection rates between the two diseases was statistically significant. Two hydrops-positive cases with sudden deafness were considered to be of the secondary type of hydrops, because images were taken after partial recovery from hearing loss several months after the onset of the disease.

MRI performed after intratympanic gadolinium administration in patients with Ménière’s disease: correlation with symptoms and signs

The objective of the study was to compare the outcomes of a series of diagnostic parameters in Ménière's disease (MD) patients with the extent of endolymphatic hydrops (EH) as shown by magnetic resonance imaging (MRI) performed after intra-tympanic gadolinium administration using 18 patients (13 males and 5 females, age 25-78 years, median age 54.3 years) with definite MD. A 0.6-ml solution of Gadobutrol (1 mmol/ml) diluted 1:7 in saline was injected through the inferior-posterior quadrant of the tympanic membrane, using a 22-gauge spinal needle. The patient was kept with the head rotated 45° contralaterally for 30 min after the injection. Twenty-four hours later, three-dimensional fluid-attenuated inversion recovery MRI, using a 3-Tesla unit, was performed. Prevalence and extension of EH in MD patients was evaluated and correlated with age, duration and stage of the disease, frequency of attacks, time interval from the last attack, functional level scale, tinnitus, aural fullness, caloric stimulation, electrocochleography, and vestibular evoked myogenic potentials. All patients showed impaired enhancement of the inner ear of variable degree with the vestibular portion of the labyrinth more frequently involved than the cochlea. Abnormal vestibular evoked myogenic potentials, duration, and stage of the disease were significantly correlated to the number of inner ear sites involved. Modern imaging makes possible the identification of the endolymphatic hydrops in MD patients, improving diagnostic accuracy. The role of hydrops in the clinical manifestations and its correlation with most of the diagnostic parameters remain, however, not completely clear.