Intratympanic Contrast in the Evaluation of Meniere Disease: Understanding the Limits

Bykowski, Julie; Harris, Jeffrey P.; Miller, Matthew W.; Du, Jiulin; Mafee, Mahmood F.

doi:10.3174/ajnr.a4277

Cited by 18 publications

(8 citation statements)

References 35 publications

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“…The presence of EH in other audiological disorders can be shown by IT administration: Hornibrook et al assessed the presence of EH not only in patients with definite MD (14/30 ears), but also in patients with other audiological disorders (3/45 ears), even if at a very low rate (6%) 29 . To address potential pitfalls in the acquisition or in the interpretation of the images, Bykowski et al used an 8 channel surface coils and acquired MR images 26 hours after monolateral IT administration in 6 definite MD patients 30 . Variable FLAIR inversion time images were used to determine the impact on fluid-suppression interpretation.…”

Section: Resultsmentioning

confidence: 99%

MR imaging of endolymphatic hydrops in Ménière’s disease: not all that glitters is gold

Conte

Russo

Calloni

et al. 2018

Acta Otorhinolaryngol Ital

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Section: Resultsmentioning

confidence: 99%

MR imaging of endolymphatic hydrops in Ménière’s disease: not all that glitters is gold

Conte

Russo

Calloni

et al. 2018

Acta Otorhinolaryngol Ital

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“…Although MRI is useful for EH diagnosis and exclusion of other diagnoses, the 2015 MD criteria emphasize clinical signs and symptoms in establishing a diagnosis. [76][77][78][79] EH has been documented using three-dimensional fluid-attenuated inversion recovery sequences in patients with MD, vestibular migraine, and isolated SNHL, and even in healthy subjects, so EH cannot be considered a specific finding in MD. 76 The use of intravenous gadolinium chelated-enhanced MRI allows visualization of EH.…”

Section: Vestibular Function Testsmentioning

confidence: 99%

Current Understanding and Clinical Management of Meniere's Disease: A Systematic Review

Pérez-Carpena

Lopez-Escamez

2019

Semin Neurol

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Meniere's disease (MD) is a set of uncommon disorders with core phenotype of tinnitus, episodic vertigo, and sensorineural hearing loss. MD shows a genetic predisposition and a family history is found in 10% cases, with an autosomal dominant inheritance pattern. It is a multifactorial condition whose onset and development are triggered by the combined effect of genetic and environmental factors. Histopathological studies have associated MD with the accumulation of endolymph in the cochlea and the vestibular organs. However, endolymphatic hydrops does not fully explain the persistence of tinnitus, hearing loss progression, or the frequency of vertigo attacks.There are several comorbidities associated with MD, such as migraine, anxiety, autoimmune, and autoinflammatory disorders, adding more complexity to the phenotype. This “extended phenotype” can make the diagnosis and clinical management more complex, but it could also lead to a better characterization, understanding, and treatment of MD patients.We have conducted a systematic review on MD to update current knowledge, focusing on its mechanisms, diagnosis, comorbidities, and practical management.

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“…Various MRI sequences and protocols have been used to study the inner ear following intratympanic injection(2). Nakashima et al devised a grading system using three-dimensional (3D) real inversion recovery imaging utilizing a ratio of the area of endolymphatic space to the vestibular fluid space (peri- plus endolymphatic spaces)(4,5).…”

Section: Discussionmentioning

confidence: 99%

“…We were able to achieve 0.5mm slice thickness resolution in 0.75s total scanning time. Bykowski et al utilizing 3-inch surface coil for 3T FLAIR MRI imaging showed 0.375×0.375mm in-plane FLAIR resolution at approximately five minutes imaging time, but highlighted a pitfall regarding overestimation of vestibular endolymphatic distention due to partial volume averaging(2). Finally, one study comparing IT to IV GBCA injection found IT to provide superior perilymphatic enhancement(10).…”

Section: Discussionmentioning

confidence: 99%

“…IT injection has shown gadolinium's ability to diffuse through the round window membrane (RWM), enhancing the perilymphatic space without causing enhancement of the endolymph. IV injection has demonstrated decreased contrast to noise ratios, resulting in lower image quality compared to IT injection(2). However, limitations to MRI inner ear imaging include tradeoffs between data acquisition time and resolution, with resolution decreasing as data acquisition time is reduced, partial volume averaging, and possible motion artifact.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intratympanic Iodine Contrast Injection Diffuses Across the Round Window Membrane Allowing for Perilymphatic CT Volume Acquisition Imaging

Abt

Lehar

Guajardo

et al. 2016

Otology &Amp; Neurotology

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Hypothesis Whether the RWM is permeable to iodine-based contrast agents (IBCA) is unknown; therefore, our goal was to determine if IBCAs could diffuse through the RWM using CT volume acquisition imaging. Introduction Imaging of hydrops in the living human ear has attracted recent interest. Intratympanic (IT) injection has shown gadolinium's ability to diffuse through the round window membrane (RWM), enhancing the perilymphatic space. Methods Four unfixed human cadaver temporal bones underwent intratympanic IBCA injection using three sequentially studied methods. The first method was direct IT injection. The second method used direct RWM visualization via tympanomeatal flap for IBCA-soaked absorbable gelatin pledget placement. In the third method, the middle ear was filled with contrast after flap elevation. Volume acquisition CT images were obtained immediately post-exposure, and at 1, 6, and 24 hour intervals. Post-processing was accomplished using color ramping and subtraction imaging. Results Following the third method, positive RWM and perilymphatic enhancement were seen with endolymph sparing. Gray scale and color ramp multiplanar reconstructions displayed increased signal within the cochlea compared to pre-contrast imaging. The cochlea was measured for attenuation differences compared to pure water, revealing a pre-injection average of −1,103 HU and a post-injection average of 338 HU. Subtraction imaging shows enhancement remaining within the cochlear space, Eustachian tube, middle ear epithelial lining, and mastoid. Conclusions Iohexol iodine contrast is able to diffuse across the RWM. Volume acquisition CT imaging was able to detect perilymphatic enhancement at 0.5mm slice thickness. The clinical application of IBCA IT injection appears promising but requires further safety studies.

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Intratympanic Contrast in the Evaluation of Meniere Disease: Understanding the Limits

Cited by 18 publications

References 35 publications

MR imaging of endolymphatic hydrops in Ménière’s disease: not all that glitters is gold

MR imaging of endolymphatic hydrops in Ménière’s disease: not all that glitters is gold

Current Understanding and Clinical Management of Meniere's Disease: A Systematic Review

Intratympanic Iodine Contrast Injection Diffuses Across the Round Window Membrane Allowing for Perilymphatic CT Volume Acquisition Imaging

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