Choi Ji Eun, Kim Yi-Kyung, Cho Young Sang, Lee Kieun, Park Hyun Woo, Yoon Sung Hoon, Kim Hyung-Jin, Chung Won-Ho
Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University Hospital, Cheonan, Republic of Korea.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
PLoS One. 2017 Nov 30;12(11):e0188301. doi: 10.1371/journal.pone.0188301. eCollection 2017.
The purpose of this study was to prove the hypothesis that caloric response in Ménière's disease (MD) is reduced by hydropic expansion of the vestibular labyrinth, not by vestibular hypofunction, by evaluating the correlation morphologically using an intravenous Gadolinium (IV-Gd) inner ear MRI. In study I, the prevalence of abnormal video Head Impulse Test (vHIT) results among the patients with definite unilateral MD (n = 24) and vestibular neuritis (VN) (n = 22) were investigated. All patients showed abnormal canal paresis (CP) (> 26%) on caloric tests. The prevalence of abnormal vHIT in patients with abnormal CP was significantly lower in MD patients (12.5%) than that in VN patients (81.8%) (p < 0.001). In study II, morphological correlation between caloric tests and vestibular hydrops level was evaluated in unilateral MD patients (n = 16) who had normal vHIT results. Eleven patients (61%) had abnormal CP. After taking the images of IV-Gd inner ear MRI, the vestibular hydrops ratio (endolymph volume/total lymph volume = %VH) was measured. In addition, the relative vestibular hydrops ratio (%RVH = (%VHaffected ear-%VHunaffected ear) / (%VHaffected ear + %VHunaffected ear)) was calculated. Each ratio (%VH and %RVH) was compared with average peak slow phase velocity (PSPV) and CP, respectively. In the MD patients, %VH of the affected ear correlated significantly with mean PSPV on the same side (rs = -0.569, p = 0.024), while %RVH correlated significantly with CP (rs = 0.602, p = 0.014). In most MD patients (87.5%) compared to VN patients, vHIT results were normal even though the caloric function was reduced. In addition, the reduced caloric function with normal vHIT was related to the severity of the vestibular hydrops measured by the IV-Gd inner ear MRI. These findings concluded that the abnormal caloric tests with normal vHIT in MD indicated severe endolymphatic hydrops rather than vestibular hypofunction.
本研究的目的是通过静脉注射钆（IV-Gd）内耳磁共振成像（MRI）进行形态学相关性评估，以证明梅尼埃病（MD）中热量反应降低是由前庭迷路的积水扩张引起的，而非前庭功能减退这一假设。在研究I中，调查了确诊为单侧MD（n = 24）和前庭神经炎（VN）（n = 22）患者的视频头脉冲试验（vHIT）结果异常的发生率。所有患者在冷热试验中均显示出异常的半规管轻瘫（CP）（> 26%）。CP异常的MD患者中vHIT异常的发生率（12.5%）显著低于VN患者（81.8%）（p < 0.001）。在研究II中，对vHIT结果正常的单侧MD患者（n = 16）的冷热试验与前庭积水水平之间的形态学相关性进行了评估。11名患者（61%）CP异常。在获取IV-Gd内耳MRI图像后，测量前庭积水比率（内淋巴体积/总淋巴体积 = %VH）。此外，计算相对前庭积水比率（%RVH = （患耳%VH - 健耳%VH） / （患耳%VH + 健耳%VH））。分别将每个比率（%VH和%RVH）与平均峰值慢相速度（PSPV）和CP进行比较。在MD患者中，患耳的%VH与同侧的平均PSPV显著相关（rs = -0.569，p = 0.024），而%RVH与CP显著相关（rs = 0.602，p = 0.014）。与VN患者相比，大多数MD患者（87.5%）尽管冷热功能降低，但vHIT结果正常。此外，vHIT正常但冷热功能降低与IV-Gd内耳MRI测量的前庭积水严重程度有关。这些发现得出结论，MD患者中vHIT正常但冷热试验异常表明存在严重的内淋巴积水而非前庭功能减退。
