MR Imaging of Ménière’s Disease after Combined Intratympanic and Intravenous Injection of Gadolinium using HYDROPS2

Abstract

Endolymphatic hydrops (EH) in Ménière's disease is currently evaluated by 3-dimensional (3D)-real inversion recovery (IR) sequence after intratympanic (IT) administration of gadolinium (Gd) or by heavily T 2 -weighted (hT 2 W)-3D-fluid-attenuated IR (FLAIR) sequence after intravenous (IV) injection of Gd. Unilateral IT injection is usually performed. We employed a method in which we simultaneously administered contrast into one ear intravenously (IV side) and into the other ear both intravenously and intratympanically (IT + IV side) to evaluate EH in 10 patients with Ménière's disease. We then compared a HYDROPS2 image obtained by subtracting magnetic resonance cisternography from hT 2 W-3D-FLAIR with an image obtained by 3D-real IR and found that we could evaluate EH in all ears on the HYDROPS2 image but only in the IT + IV side on the 3D-real IR image.

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

“…Only HYDROPS images were able to demonstrate EH in all ears VEH and cEH were demonstrated in 89% and 67% of ears, respectively. A significant rate of vEH (55%) and cEH (44%) was also found in the contralateral asymptomatic ears 27 .…”

“…The presence of EH in the contralateral asymptomatic ears was demonstrated by Lida et al by using both IT and IV administration: 67% of asymptomatic ears were shown to have both vEH and cEH 26 . A comparison between the results obtained after simultaneous IV-IT administration was made by Naganawa et al, by using 3D-real IR images for IT-IV side and HYDROPS2 for IV 27 . Only HYDROPS images were able to demonstrate EH in all ears VEH and cEH were demonstrated in 89% and 67% of ears, respectively.…”

Visualization of endolymphatic hydrops with MR imaging in patients with Ménière’s disease and related pathologies: current status of its methods and clinical significance

“…HYDROPS2 imaging can evaluate both the IV-only side and the IT ? IV side simultaneously [66] (Fig. 2).…”

Heavily T₂-Weighted 3D-FLAIR Improves the Detection of Cochlear Lymph Fluid Signal Abnormalities in Patients with Sudden Sensorineural Hearing Loss

“… 13 In contrast, HF enables the detection of endolymphatic hydrops after a single dose of intravenous gadolinium-based contrast agent in patients with Ménière’s disease. 14 – 23 …”