Magnetic resonance imaging of intratympanic gadolinium helps differentiate vestibular migraine from Ménière disease

Sun, Wenfang; Guo, Ping; Ren, Tongli; Wang, Wuqing

doi:10.1002/lary.26518

Cited by 48 publications

(33 citation statements)

References 35 publications

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“… 33 30 MD IT ECoG ECoG Sun et al . 34 30 VM, MD IT PTA, VEMP PTA, VEMP (partial) Seo et al . 35 26 MD IT PTA, ECoG, VEMP PTA, ECoG: Yamamoto et al .…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Intravenous Gadolinium Inner Ear MR Imaging in Diagnosis of Ménière’s Disease

Cho

Ahn

Choi

et al. 2018

Sci Rep

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This study aimed to investigate the usefulness of the intravenous gadolinium enhanced inner ear magnetic resonance imaging (IV-Gd inner ear MRI) in diagnosing Ménière’s disease(MD) and find a correlation between the degree of endolymphatic hydrops(EH) and the audiovestibular tests. Total 29 patients diagnosed with unilateral definite MD were enrolled. All patients underwent IV-Gd inner ear MRI and auditory and vestibular function tests such as pure tone audiometry (PTA), electrocochleography (ECoG), cervical vestibular evoked myogenic potential (cVEMP) and caloric test. The hydrops ratio in the cochlea and vestibule were significantly higher in the affected side than the unaffected side (p < 0.001). Average pure-tone thresholds for 0.5, 1 k, 2 k, and 4 k Hz correlated significantly with cochlear and vestibular hydrops (p < 0.01) in the affected side. When comparing the SP/AP ratio of ECoG with hydrops ratio in the vestibule, the affected and unaffected ears showed a significant difference (p < 0.05). Similarly, the results of the caloric test also showed a significant correlation (p < 0.05) with relative vestibular hydrops. However, the cVEMP response was not related to the hydrops ratio in the cochlea or vestibule. This study presents pertinent data with appropriate correlations with auditory vestibular functional testing which demonstrates the usefulness of IV-Gd inner ear MRI as a diagnostic method for visualizing the endolymphatic hydrops in MD.

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“… 33 30 MD IT ECoG ECoG Sun et al . 34 30 VM, MD IT PTA, VEMP PTA, VEMP (partial) Seo et al . 35 26 MD IT PTA, ECoG, VEMP PTA, ECoG: Yamamoto et al .…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Intravenous Gadolinium Inner Ear MR Imaging in Diagnosis of Ménière’s Disease

Cho

Ahn

Choi

et al. 2018

Sci Rep

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“…Currently, there are 5 large (53-74 patients) 113-117 and another 25 smaller case series that evaluated MD patients with delayed postcontrast MRI. 118-142 These data revealed that distention of the endolymphatic space in the cochlea and vestibule (ELH) is commonly identified in patients with definite MD and more frequently than other causes of SNHL or vertigo. However, this finding is not present in all patients with MD, and there remains variability within imaging protocols and proposed grading/assessment systems.…”

Section: Guideline Key Action Statementsmentioning

confidence: 97%

Clinical Practice Guideline: Ménière’s Disease

Basura

Adams

Monfared

et al. 2020

Otolaryngol.--head neck surg.

219

207

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Objective Ménière’s disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. Purpose The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

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“…Although several EH assessment techniques exist [11,12], this review combined the results of the most commonly reported grading method for hydrops MR evaluation in literature [13,14]. This method categorizes hydrops in either "mild" or "significant."…”

Section: Estimation Of Eh and Symptom Prevalencesmentioning

confidence: 99%

“…In total, 69 publications were selected after database searching and citation and reference retrieval for estimating the prevalence of EH and neuro-otologic symptoms in different types of study populations [3,9,12,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Based on the available data, three vestibular disorders were selected for prevalence estimation: (1) The clinical diagnosis of Menière's disease based on diagnostic criteria (Table 1) [16], (2) The diagnosis of vestibular schwannoma confirmed by MRI, (Table 2), and (3) The clinical diagnosis of vestibular migraine based on diagnostic criteria (Table 3) [17].…”

Section: Study Selectionmentioning

confidence: 99%

The “hype” of hydrops in classifying vestibular disorders: a narrative review

et al. 2020

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Background Classifying and diagnosing peripheral vestibular disorders based on their symptoms is challenging due to possible symptom overlap or atypical clinical presentation. To improve the diagnostic trajectory, gadolinium-based contrast-enhanced magnetic resonance imaging of the inner ear is nowadays frequently used for the in vivo confirmation of endolymphatic hydrops in humans. However, hydrops is visualized in both healthy subjects and patients with vestibular disorders, which might make the clinical value of hydrops detection on MRI questionable. Objective To investigate the diagnostic value of clinical and radiological features, including the in vivo visualization of endolymphatic hydrops, for the classification and diagnosis of vestibular disorders. Methods A literature search was performed in February and March 2019 to estimate the prevalence of various features in healthy subjects and in common vestibular disorders to make a graphical comparison between healthy and abnormal. Results Of the features studied, hydrops was found to be a highly prevalent feature in Menière’s disease (99.4%). Though, hydrops has also a relatively high prevalence in patients with vestibular schwannoma (48.2%) and in healthy temporal bones (12.5%) as well. In patients diagnosed with (definite or probable) Menière’s disease, hydrops is less frequently diagnosed by magnetic resonance imaging compared to the histological confirmation (82.3% versus 99.4%). The mean prevalence of radiologically diagnosed hydrops was 31% in healthy subjects, 28.1% in patients with vestibular migraine, and 25.9% in patients with vestibular schwannoma. An interesting finding was an absolute difference in hydrops prevalence between the two diagnostic techniques (histology and radiology) of 25.2% in patients with Menière’s disease and 29% in patients with vestibular schwannoma. Conclusions Although the visualization of hydrops has a high diagnostic value in patients with definite Menière’s disease, it is important to appreciate the relatively high prevalence of hydrops in healthy populations and other vestibular disorders. Endolymphatic hydrops is not a pathognomic phenomenon, and detecting hydrops should not directly indicate a diagnosis of Menière’s disease. Both symptom-driven and hydrops-based classification systems have disadvantages. Therefore, it might be worth to explore features “beyond” hydrops. New analysis techniques, such as Radiomics, might play an essential role in (re)classifying vestibular disorders in the future.

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Magnetic resonance imaging of intratympanic gadolinium helps differentiate vestibular migraine from Ménière disease

Abstract: 4 Laryngoscope, 127:2382-2388, 2017.

Cited by 48 publications

References 35 publications

Usefulness of Intravenous Gadolinium Inner Ear MR Imaging in Diagnosis of Ménière’s Disease

Usefulness of Intravenous Gadolinium Inner Ear MR Imaging in Diagnosis of Ménière’s Disease

Clinical Practice Guideline: Ménière’s Disease

The “hype” of hydrops in classifying vestibular disorders: a narrative review

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