Bernaerts Anja, Vanspauwen Robby, Blaivie Cathérine, van Dinther Joost, Zarowski Andrzej, Wuyts Floris L, Vanden Bossche Stephanie, Offeciers Erwin, Casselman Jan W, De Foer Bert
Department of Radiology, GZA Hospitals Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium.
European institute for ORL-HNS, GZA Hospitals Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium.
Neuroradiology. 2019 Apr;61(4):421-429. doi: 10.1007/s00234-019-02155-7. Epub 2019 Feb 5.
There is still a clinical-radiologic discrepancy in patients with Menière's disease (MD). Therefore, the purpose of this study was to investigate the reliability of current MRI endolymphatic hydrops (EH) criteria according to Baráth in a larger study population and the clinical utility of new imaging signs such as a supplementary fourth low-grade vestibular EH and the degree of perilymphatic enhancement (PE) in patients with Menière's disease (MD).
This retrospective study included 148 patients with probable or definite MD according to the 2015 American Academy of Otolaryngology, Head and Neck Surgery criteria who underwent a 4-h delayed intravenous Gd-enhanced 3D-FLAIR MRI between January 2015 and December 2016. Vestibular EH, vestibular PE, cochlear EH, and cochlear PE were reviewed twice by three experienced readers. Cohen's Kappa and multivariate logistic regression were used for analysis.
The intra- and inter-reader reliability for the grading of vestibular-cochlear EH and PE was excellent (0.7 < kappa < 0.9). The two most distinctive characteristics to identify MD are cochlear PE and vestibular EH which combined gave a sensitivity and specificity of 79.5 and 93.6%. By addition of a lower grade vestibular EH, the sensitivity improved to 84.6% without losing specificity (92.3%). Cochlear EH nor vestibular PE showed added-value.
MRI using vestibular-cochlear EH and PE grading system is a reliable technique. A four-stage vestibular EH grading system in combination with cochlear PE assessment gives the best diagnostic accuracy to detect MD.
梅尼埃病（MD）患者仍存在临床与影像学之间的差异。因此，本研究的目的是在更大的研究人群中，根据巴拉特标准调查当前MRI内淋巴积水（EH）标准的可靠性，以及新的影像学征象（如补充性的四级低度前庭EH和外淋巴强化程度（PE））在梅尼埃病（MD）患者中的临床应用价值。
这项回顾性研究纳入了148例根据2015年美国耳鼻咽喉头颈外科学会标准诊断为可能或确诊MD的患者，这些患者在2015年1月至2016年12月期间接受了4小时延迟静脉注射钆增强3D-FLAIR MRI检查。由三位经验丰富的阅片者对前庭EH、前庭PE、耳蜗EH和耳蜗PE进行两次评估。采用科恩kappa系数和多因素逻辑回归进行分析。
前庭-耳蜗EH和PE分级的阅片者内及阅片者间可靠性极佳（0.7＜kappa＜0.9）。识别MD的两个最显著特征是耳蜗PE和前庭EH，两者结合的敏感性和特异性分别为79.5%和93.6%。加上较低级别的前庭EH后，敏感性提高到84.6%，而特异性未降低（92.3%）。耳蜗EH和前庭PE均未显示出额外价值。
使用前庭-耳蜗EH和PE分级系统的MRI是一种可靠的技术。结合耳蜗PE评估的四级前庭EH分级系统在检测MD时具有最佳诊断准确性。
