From the Neuroradiology Unit (G.C., E.S., C. Sina, F.T.), Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
Postgraduation School of Radiodiagnostics (L.C., S.C.).
AJNR Am J Neuroradiol. 2018 Nov;39(11):2114-2119. doi: 10.3174/ajnr.A5841. Epub 2018 Oct 18.
No reliable MR imaging marker for the diagnosis of Menière disease has been reported. Our aim was to investigate whether the obliteration of the inferior portion of the vestibule and the contact with the stapes footplate by the vestibular endolymphatic space are reliable MR imaging markers in the diagnosis of Menière disease.
We retrospectively enrolled 49 patients, 24 affected by unilateral sudden hearing loss and 25 affected by definite Menière disease, who had undergone a 4-hour delayed 3D-FLAIR sequence. Two readers analyzed the MR images investigating whether the vestibular endolymphatic space bulged in the third inferior portion of the vestibule contacting the stapes footplate. This sign was defined as the vestibular endolymphatic space contacting the oval window.
We analyzed 98 ears: 27 affected by Menière disease, 24 affected by sudden sensorineural hearing loss, and 47 that were healthy. The vestibular endolymphatic space contacting the oval window showed an almost perfect interobserver agreement (Cohen κ = 0.87; 95% CI, 0.69-1). The vestibular endolymphatic space contacting oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 88%, and negative predictive value = 93% in differentiating Menière disease ears from other ears. The vestibular endolymphatic space contacting the oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 96%, negative predictive value = 82% in differentiating Menière disease ears from sudden sensorineural hearing loss ears.
The vestibular endolymphatic space contacting the oval window has high specificity and positive predictive value in differentiating Menière disease ears from other ears, thus resulting in a valid tool for ruling in Menière disease in patients with mimicking symptoms.
目前尚无可靠的磁共振成像（MRI）标志物可用于梅尼埃病的诊断。本研究旨在探讨内淋巴囊下缘是否闭塞且与镫骨足板相接触能否作为梅尼埃病诊断的可靠 MRI 标志物。
本研究回顾性纳入 49 例单侧突发性聋患者（24 例）和 25 例明确诊断的梅尼埃病患者（25 例），所有患者均接受了 4 小时延迟的 3D-FLAIR 序列 MRI 检查。2 名观察者分析 MRI 图像，以评估前庭内淋巴间隙是否在第 3 个前庭下部膨出并与镫骨足板接触。如果存在该征象，则定义为前庭内淋巴间隙接触卵圆窗。
本研究共分析了 98 耳，其中 27 耳为梅尼埃病患者，24 耳为突发性聋患者，47 耳为健康对照者。前庭内淋巴间隙接触卵圆窗的征象具有极好的观察者间一致性（Cohen κ=0.87；95%CI：0.69~1）。在区分梅尼埃病耳与其他耳时，前庭内淋巴间隙接触卵圆窗的诊断性能为：敏感度为 81%，特异度为 96%，阳性预测值为 88%，阴性预测值为 93%。在区分梅尼埃病耳与突发性聋耳时，前庭内淋巴间隙接触卵圆窗的诊断性能为：敏感度为 81%，特异度为 96%，阳性预测值为 96%，阴性预测值为 82%。
前庭内淋巴间隙接触卵圆窗在区分梅尼埃病耳与其他耳方面具有较高的特异度和阳性预测值，因此可作为一种有价值的工具，用于在有类似症状的患者中辅助诊断梅尼埃病。
