Reliability of magnetic resonance imaging performed after intratympanic administration of gadolinium in the identification of endolymphatic hydrops in patients with Ménière's disease

Francesco Fiorino, Francesca B Pizzini, Alberto Beltramello, Barbara Mattellini, Franco Barbieri
Otology & Neurotology 2011, 32 (3): 472-7

OBJECTIVE: To evaluate the reliability of magnetic resonance imaging performed after intratympanic gadolinium administration in evidencing endolymphatic hydrops in patients with Ménière's disease (MD).

PATIENTS: A total of 26 patients (18 male and 8 female subjects, aged 25-78 yr; median age, 56 yr) with definite MD and 12 subjects (8 male and 4 female subjects, aged 31-75 yr; median age, 51 yr) with various unilateral non-MD disorders of the inner ear were examined.

INTERVENTION: A 0.6-ml solution of gadobutrol (1 mmol/ml), diluted 1:7 in saline, was injected in the affected ear through the inferior-posterior quadrant of the tympanic membrane, using a 22-gauge spinal needle. In 9 MD patients, the contralateral ear also was injected. The patient was kept with the head rotated 45 degrees contralaterally for 30 minutes after each injection. Twenty-four hours later, a 3-dimensional fluid-attenuated inversion recovery magnetic resonance imaging using a 3 Tesla unit was performed.

MAIN OUTCOME MEASURE: Perilymphatic enhancement was evaluated in different portions of the labyrinth in MD ears and compared with the outcomes obtained in the non-MD ears.

RESULTS: All MD ears showed impaired perilymphatic enhancement of variable degrees. No enhancement defects could be observed in all examined contralateral unaffected ear of the patients with MD, as well as in 11 of the 12 ears of the subjects with various unilateral non-MD disorders.

CONCLUSION: Perilymphatic enhancement defect of variable degrees is observed in the pathologic ear of every patient with MD. The consistency of this phenomenon in MD ears and the complete enhancement in most of the ears without MD safely enable to attribute these findings to endolymphatic hydrops. It is likely in the near future that imaging may be used to achieve a certain diagnosis of MD in life.

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