Research Article: Semi-Quantitative vs. Volumetric Determination of Endolymphatic Space in Menière’s Disease Using Endolymphatic Hydrops 3T-HR-MRI after Intravenous Gadolinium Injection

Date Published: March 13, 2015

Publisher: Public Library of Science

Author(s): Georg Homann, Volker Vieth, Daniel Weiss, Konstantin Nikolaou, Walter Heindel, Mike Notohamiprodjo, Yvonne Böckenfeld, Russell R. Lonser.


Magnetic resonance imaging enhances the clinical diagnosis of Menière’s disease. This is accomplished by in vivo detection of endolymphatic hydrops, which are graded using different semi-quantitative grading systems. We evaluated an established, semi-quantitative endolymphatic hydrops score and with a quantitative method for volumetric assessment of the endolymphatic size. 11 patients with Menière’s disease and 2 healthy subjects underwent high resolution endolymphatic hydrops 3 Tesla MRI with highly T2 weighted FLAIR and T2DRIVE sequences. The degree of endolymphatic hydrops was rated semi-quantitatively and compared to the results of 3D-volumetry. Moreover, the grade of endolymphatic hydrops was correlated with pure tone audiometry. Semi-quantitative grading and volumetric evaluation of the endolymphatic hydrops are in accordance (r = 0.92) and the grade of endolymphatic hydrops correlates with pure tone audiometry. Patients with a sickness duration of ≥ 30 months showed a significant higher total labyrinth fluid volume (p = 0.03). Fast, semi-quantitative evaluation of endolymphatic hydrops is highly reliable compared to quantitative/volumetric assessment. Endolymphatic space is significantly higher in patients with longer sickness duration.

Partial Text

Menière’s disease is a chronic disease with recurrent vertigo attacks, progressive hearing loss, tinnitus and/or aural fullness. Its etiology is still not fully understood, but the endolymphatic hydrops (EH) is considered as the morphological correlate for the symptoms. Several different, neither fully proven nor disproven theories exist regarding the formation of the endolymphatic hydrops: overproduction or an outflow obstruction of the endolymphatic fluid may influence the complex electrophysiological environment of the inner ear [1] and thereby the signal transduction of the cochlear and vestibular hair cells [2]. Some other theories regard ischemia as a cause, possibly stemming from vascular disorders [3].

We were able to show that established semi-quantitative MR evaluation and volumetry of endolymphatic hydrops by magnetic resonance imaging after i.v.-administration of Gadolinium-based contrast agents (GBCA) both are relevant and useful for the diagnosis of endolymphatic hydrops. Moreover, we were able to show that the semi-quantitative grading system proposed by Naganawa et al. [7], which can be deployed relatively quickly, is reliable.