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Magnetic resonance imaging of endolymphatic hydrops: a comparison of methods with and without gadolinium-based contrast agent administration

Ohashi, Toshio Naganawa, Shinji Nasu, Yusuke Kuno, Kayao Kato, Katsuhiko 名古屋大学

2023.05

概要

Meniere’s disease is a neurological disorder of the inner ear with symptoms that include
attacks of vertigo, hearing loss, tinnitus, and aural fullness.1 Endolymphatic hydrops (EH) in the
inner ear has been considered as a pathological finding of Meniere’s disease.1 The presence of
EH has been clinically evaluated using magnetic resonance (MR) imaging after the intravenous
administration of a gadolinium-based contrast agent (IV-GBCA).1-3 Intravenously administered
GBCAs cross the blood-perilymph barrier, but do not cross the blood-endolymph and perilymphendolymph barriers.4 The amount of intravenously administered GBCA that penetrates into the
perilymph is too small to detect using conventional T1-weighted imaging. 2,5 A heavily T2weighted three-dimensional fluid-attenuated inversion recovery (hT2w-3D-FLAIR) sequence can
detect subtle T1 shortening such as in fluid with very small concentrations of GBCA, and hence
has been applied for the evaluation of EH with MR imaging.3,5 A HYbriD of Reversed image
Of Positive endolymph signal and native image of positive perilymph Signal (HYDROPS) and a
HYDROPS-Mi2 (HYDROPS-Multiplied with hT2w MRC) sequence enables separate visualization
of the endolymph, perilymph, and surrounding bony structures.6,7 This separate visualization of
the endo- and perilymph reduces the difficulty of the EH evaluation.2,6,7 A Nakashima grade has
been proposed as the criterion for the diagnosis of EH on MR imaging.8 A quantitative evaluation
of the endolymphatic space by volumetric measurement has also been reported.9 MR imaging
with GBCA administration has thus been applied clinically for the qualitative and quantitative
evaluation of EH.1,2,8,9
Recently, several studies for the evaluation of EH using MR imaging without GBCA administration have been reported.10-12 They have proposed that MR cisternography (MRC) permits
the direct evaluation of the vestibular endolymphatic space through anatomical identification.10-12
One of the studies suggested that the utricular endolymph has a lower signal intensity than the
vestibular perilymph on MRC without IV-GBCA.10 The other studies assessed vestibular EH by
measuring the height and width of the saccule on MRC without IV-GBCA.11,12 The saccule was
defined as the region bounded by the utricular macula and the lateral membranous walls of the
saccule for the measurement of the saccular size.11,12
The evaluation of EH using MRC without GBCA administration has clinical implications. In
our hospital, we routinely perform the evaluation of EH at 4 h post-IV-GBCA administration, and
Nagoya J. Med. Sci. 85. ...

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参考文献

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2 Naganawa S, Nakashima T. Visualization of endolymphatic hydrops with MR imaging in patients with

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accurate, fast, and without contrast material intravenous injection. Eur Radiol Exp. 2017;1(1):14. doi:10.1186/

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References End

Nagoya J. Med. Sci. 85. 299–309, 2023

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doi:10.18999/nagjms.85.2.299

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