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

Cho, Young Sang; Ahn, Jung Min; Choi, Ji Eun; Park, Hyun Woo; Kim, Yi Kyung; Kim, Hyung Jin; Chung, Won Ho

doi:10.1038/s41598-018-35709-5

Cited by 26 publications

(40 citation statements)

References 39 publications

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“…ECochG was reported as a valuable tool in the diagnosis of MD due to its sensitivity to the ELH ( 18 , 19 ). Cho et al reported that the vestibular ELH was larger in patients with abnormal SP/AP than those with normal results ( 51 ). Yang et al showed a correlation between SP/AP with vestibular ELH, but not with cochlear ELH ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

The Correlation of a 2D Volume-Referencing Endolymphatic-Hydrops Grading System With Extra-Tympanic Electrocochleography in Patients With Definite Ménière's Disease

Zhang

Zheng

et al. 2021

Front. Neurol.

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Background: Although magnetic resonance imaging (MRI) of the membranous labyrinth and electrocochleography (ECochG) have been used to diagnose endolymphatic hydrops (ELH) in patients with Ménière's disease (MD), the relationship between imaging and ECochG is not well-documented.Objectives: This study evaluates the ELH using 3D-FLAIR MRI and extra-tympanic ECochG (ET-ECochG) and correlates the results from 3D-FLAIR MRI to those from ET-ECochG.Materials and Methods: 3D-FLAIR MRI images of 50 patients were assessed using a 2D volume-referencing grading system (VR scores, relative scores according to the known volumes of the cochlea, vestibule, and semicircular canals). Forty healthy subjects were included and compared to 51 definite MD ears of 50 patients while analyzing the ET-ECochG, which used a self-made bronze foil electrode. The amplitude ratio of the summating potential (SP) to the action potential (AP) (SP/AP) and the area ratio of SP to AP (Asp/Aap) were collected. Relative ELH grade scores were then correlated to ET-ECochG (SP/AP, Asp/Aap).Results: The VR scores showed a better correlation (r = 0.88) with the pure tone average (PTA), disease duration, and vertigo frequency of MD than the Bernaerts scores (grading the cochlea and vestibule separately) (r = 0.22). The SP/AP and Asp/Aap of the unilateral MD patients were statistically comparable to those measured in contralateral ears and the results between the definite MD ears with healthy ears were statistically comparable (p < 0.05). In a ROC analysis Asp/Aap (area under curve, AUC 0.98) significantly (p = 0.01) outperformed SP/AP (AUC 0.91). The total score of ELH, vestibular ELH, and cochlear ELH were also correlated with SP/AP and Asp/Aap. The strongest correlation was found between the Asp/Aap and cochlear ELH (r = 0.60).Conclusion: The 2D volume-referencing grading system was more meaningful than the Bernaerts scores. A correlation was found between ELH revealed by 3D-FLAIR MRI and the SP/AP of ET-ECochG in evaluating definite MD patients. The Asp/Aap appeared a more sensitive and reliable parameter than SP/AP for diagnosing the ELH of the membranous labyrinth.

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Section: Discussionmentioning

confidence: 99%

The Correlation of a 2D Volume-Referencing Endolymphatic-Hydrops Grading System With Extra-Tympanic Electrocochleography in Patients With Definite Ménière's Disease

Zhang

Zheng

et al. 2021

Front. Neurol.

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“…audiovestibular results 11 . IV-Gd inner-ear MRI is less invasive and are much more efficient because it requires less time after the injection of the contrast agent compared to the IT method (4 hr vs. 24 hr) and can evaluate both sides simultaneously 12 .…”

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confidence: 99%

Automated measurement of hydrops ratio from MRI in patients with Ménière’s disease using CNN-based segmentation

Cho

Park

et al. 2020

Sci Rep

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Ménière's Disease (MD) is difficult to diagnose and evaluate objectively over the course of treatment. Recently, several studies have reported MD diagnoses by MRI-based endolymphatic hydrops (EH) analysis. However, this method is time-consuming and complicated. Therefore, a fast, objective, and accurate evaluation tool is necessary. The purpose of this study was to develop an algorithm that can accurately analyze EH on intravenous (IV) gadolinium (Gd)-enhanced inner-ear MRI using artificial intelligence (AI) with deep learning. In this study, we developed a convolutional neural network (CNN)based deep-learning model named INHEARIT (INner ear Hydrops Estimation via ARtificial InTelligence) for the automatic segmentation of the cochlea and vestibule, and calculation of the EH ratio in the segmented region. Measurement of the EH ratio was performed manually by a neuro-otologist and neuro-radiologist and by estimation with the INHEARIT model and were highly consistent (intraclass correlation coefficient = 0.971). This is the first study to demonstrate that automated EH ratio measurements are possible, which is important in the current clinical context where the usefulness of IV-Gd inner-ear MRI for MD diagnosis is increasing. Ménière's disease (MD) is a multifactorial disorder with typical symptoms of recurrent spontaneous attacks of vertigo, fluctuating hearing loss, tinnitus, and sensations of ear fullness. Endolymphatic hydrops (EH) is a pathological finding where the endolymphatic spaces are distended by enlargements of endolymphatic volume, a histologic hallmark of MD 1-3. According to a 1995 consensus statement from the Committee on Hearing and Equilibrium of the American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS), "certain" MD cases can only be confirmed by the histological demonstration of EH in postmortem temporal bone specimens 4. Therefore in 2015, a committee of the Bárány Society revised the diagnostic criteria to remove the concept of "certain MD" 5. Thus far, the diagnostic criteria have been changed due to the lack of tools to objectively find EH during life. However, with the advancement of imaging technology, MRI can be used to identify endolymphatic hydrops in MD patients as an objective marker. In 2004, Duan et al. succeeded in visualizing EH in vivo for the first time in a guinea pig using 4.7 T MRI 6. Nakashima et al. succeeded in confirming EH after injecting contrast media through intratympanic (IT) and intravenous (IV) injections into MD patients using 3 T MRI 7,8. Recently, many reports have been published regarding the use of MRI to assess EH. In particular, IV gadolinium (Gd)-enhanced inner-ear MRI has shown good results 9,10. We have also proven through previous studies that IV-Gd inner-ear MRI is very useful for diagnosing MD by demonstrating the correlation of hydrops with

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“…As a result, the time required to apply pressure on the BM surface is too short to consider repeated calculation for the BM stiffness due to the gradually increased BM deformation. Furthermore, according to previous imaging studies [9, 29], there is significant deformation due to the EH in Reissner’s membrane (which is the boarder membrane between SV and SM) rather than BM. Also, according to MRI studies using 3D FLAIR sequences, EH is visualized with sensorineural hearing loss >45 dB, and this supports the hypothesis that EH will develop when medium and high frequencies are involved in MD [30, 31].…”

Section: Discussionmentioning

confidence: 89%

“…They concluded that EH is necessary but not sufficient for a display of the full triad of MD symptoms: vertigo, balance, and hearing disease. Specifically, Cho et al [9] analyzed the correlation between EH seen in MRI and various audio-vestibular tests and showed the various correlation according to each studied case. Although tests other than audiometry were not used in the diagnosis of MD, the EH of cochlea was not sufficient to account for all MD symptoms including hearing loss.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Endolymphatic Hydrops and Symptoms of Meniere Disease in Acoustic Hearing

Lim

Cho

et al. 2021

ORL

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Hypothesis: The endolymphatic hydrops (EH) does not affect hearing loss significantly at low frequencies, whereas the hydrops affects the diplacusis. Background: There have been many arguments whether the EH cause the Meniere disease. Despite a lot of experimental studies to investigate the Meniere disease, there have been little modeling studies, which are helpful to understand the mechanism. Methods: A 3D finite element model of the human cochlea and the middle ear was used for investigation of the relationship between EH and hearing loss at low frequencies and diplacusis (2 specific symptoms of Meniere disease). While the cochlear geometry was simplified as a tapered box shape, the middle ear was based on the real geometry obtained from μCT images. EH is implemented by prestress on the basilar membrane surface in the simulation. Results: The EH did not cause significant hearing loss at low frequencies in both air- and bone-conducted hearing. Rather, this disorder caused a shift in best frequency (BF) position to the base at low frequencies below about 250 Hz. The BF shift can explain the diplacusis because a low-frequency sound can be perceived as a slightly higher frequency so that Meniere patients can perceive 2 different frequency sounds corresponding to a given single-frequency sound. Conclusion: The EH cannot be a sufficient condition for Meniere disease, whereas the hydrops can cause the diplacusis.

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

Cited by 26 publications

References 39 publications

The Correlation of a 2D Volume-Referencing Endolymphatic-Hydrops Grading System With Extra-Tympanic Electrocochleography in Patients With Definite Ménière's Disease

The Correlation of a 2D Volume-Referencing Endolymphatic-Hydrops Grading System With Extra-Tympanic Electrocochleography in Patients With Definite Ménière's Disease

Automated measurement of hydrops ratio from MRI in patients with Ménière’s disease using CNN-based segmentation

Relationship between Endolymphatic Hydrops and Symptoms of Meniere Disease in Acoustic Hearing

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