Endolymphatic hydrops imaging: Differential diagnosis in patients with Meniere disease symptoms

Diagn Interv Imaging. 2017 Oct;98(10):699-706. doi: 10.1016/j.diii.2017.06.002. Epub 2017 Jun 20.

Abstract

Purpose: The goal of this retrospective study was to investigate the differential diagnosis of endolymphatic hydrops in patients with Meniere's disease (MD) symptoms by using magnetic resonance imaging (MRI) with intravenous injection of gadolinium chelate and delayed acquisition.

Material and method: Two hundred patients (133 women, 67 men; mean age=67.2±11 ([SD] years) with unilateral MD underwent MRI at 3-T, between 4.5 and 5.5hours after intravenous administration of gadoterate meglumine at a dose of 0.1mmol/kg. MR images were analyzed for the presence of saccular hydrops, perilymphatic fistulae, inner ear malformations, semicircular canal (SCC) abnormal enhancement and brain lesions. We also tested the potential relationship between past history of gentamicin intratympanic administration and perilymphatic fistula presence and SCC aspect.

Results: Saccular hydrops were found in 96/200 patients with MD (48%). Three patients (1.5%) had perilymphatic fistulas associated with saccular hydrops, as confirmed by surgery. There was a correlation between the presence of perilymphatic fistula and past history of intratympanic gentamicin administration (P=0.02). We detected inner ear malformations in 5 patients (2.5%), SCC local enhancement in 15 patients (7.5%) always on the same side than the clinical symptoms of MD. There was a correlation between the presence of SCC abnormal enhancement and past intratympanic gentamicin administration (P=0.001). Five patients (2.5%) had brain lesions along central cochleovestibular pathways.

Conclusion: MRI may reveal brain lesions, SCC abnormalities and perilymphatic fistulae in patients with clinical MD.

Keywords: Differential diagnosis; Endolymphatic hydrops; Magnetic resonance imaging (MRI); Meniere disease.

MeSH terms

  • Aged
  • Brain Diseases / diagnostic imaging
  • Case-Control Studies
  • Cochlear Diseases / diagnostic imaging
  • Contrast Media
  • Diagnosis, Differential
  • Ear, Inner / abnormalities
  • Ear, Inner / diagnostic imaging
  • Endolymphatic Hydrops / diagnostic imaging*
  • Female
  • Fistula / diagnostic imaging
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Meniere Disease / complications*
  • Retrospective Studies
  • Semicircular Canals / abnormalities
  • Semicircular Canals / diagnostic imaging

Substances

  • Contrast Media