On the role of nuclear magnetic resonance imaging of endolymphatic hydrops in the diagnosis of Menière’s disease

Introduction 

The diagnosis of Menière’s disease is based on clinical and audiometric criteria, which, although internationally acknowledged, are still subject to discussion. The patient’s history is complemented by functional investigations, while in recent years imaging of endolymphatic hydrops has been accomplished by means of nuclear magnetic resonance (NMR).

Material, Patients and Methods 

22 patients (10m, 12f) fulfilling clinical criteria of Menière’s disease, were investigated for presence of endolymphatic hydrops by NMR imaging between 2019 and 2021. The procedure consists of two steps with administration of Gadolinium intravenously while images are taken at t=0 and t= +4 hours. Parameters include 3 Tesla, T2-weighted images with FLAIR-suppression of cerebrospinal fluid signal.

Results 

In 7 out of 22 cases (4 m, 3 f) endolymphatic hydrops was present in NMR imaging but could not be elicited in the rest of cases. In 6 out of 7 patients hydrops was unilateral and in one case bilateral. In 6 cases the extent of hydrops was mild, whereas in the bilateral case it was moderate.

Discussion 

The two-step examination by NMR requires considerable effort and resources. However, under targeted question and with clinically fulfilled criteria for Menière’s disease, NMR imaging is a valuable adjunct to corroboration of diagnosis in such cases, particularly when surgical intervention is considered. Possible explanations for the limited number of positive results can be a) the learning curve for image acquisition and evaluation, b) fluctuating hydrops and c) heterogeneity of underlying causes for Menière’s disease resulting in similar clinical signs and symptoms.

Publication History

Article published online:
24 May 2022