Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Poland.
Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Poland.
Auris Nasus Larynx. 2022 Feb;49(1):34-45. doi: 10.1016/j.anl.2021.03.027. Epub 2021 Apr 15.
The purpose was to evaluate magnetic resonance imaging (MRI) classification of endolymphatic hydrops with clinical features, audiological and vestibular tests in patients with definite unilateral Ménière's disease (MD).
Thirty-eight patients were enrolled in this study. The severity of the main clinical symptoms, audiovestibular tests, and MRI, performed 4 hours after intravenous injection of gadobutrol to visualize inner ear compartments, were evaluated. Endolymphatic space dilatation was assessed using Barath and Bernaerts grading systems, and the correlation between the grade of the hydrops and clinical features was evaluated.
Using the Barath system, cochlear hydrops was visualized in 81.6% of affected ears, while vestibular was 63.2%. Sensitivity increased to 94.7% using Bernaerts' modification. Vestibular hydrops involving the utricle was present only among patients with cochlear and saccular endolymphatic space dilatation. There was a significant relationship between the hearing level and the vestibular hydrops degree in the Bernaerts scale. The grade of the hydrops correlated neither with the duration of MD nor with the severity of main clinical symptoms. Our study proved MRI to be a sensitive diagnostic tool in MD. The endolymphatic hydrops' grade correlates with the hearing level, which confirms endolymphatic space dilatation's role in hearing loss.
In our study, two similar MRI grading systems were used; however, several differences were found compared to one another. The Bernaerts scale was more sensitive than the Barath scale, and several relationships between the radiological and clinical data were found. Therefore, several MRI evaluating scales and correlating them with the clinical features are needed. The increased perilymphatic enhancement of the cochlea and an extra low-grade vestibular hydrops distinguished in the Bernaerts scale may increase MD diagnosis sensitivity. Magnetic resonance findings in MD support the clinical diagnosis and may help to understand MD pathophysiology better. This study adds to the knowledge and diagnostics in MD for healthcare to improve patients' treatment.
评估磁共振成像（MRI）分类内淋巴积水与临床特征、听力学和前庭测试在有明确单侧梅尼埃病（MD）的患者中。
本研究纳入 38 名患者。评估主要临床症状、听觉前庭测试和 MRI 的严重程度，MRI 是在静脉注射钆布醇后 4 小时进行的，以显示内耳室。使用 Barath 和 Bernaerts 分级系统评估内淋巴空间扩张，并评估积水程度与临床特征的相关性。
使用 Barath 系统，受影响耳朵的耳蜗积水可见于 81.6%，而前庭积水为 63.2%。使用 Bernaerts 改良后，敏感性增加至 94.7%。前庭积水仅涉及前庭器，存在于耳蜗和球囊内淋巴空间扩张的患者中。Bernaerts 分级中的听力水平与前庭积水程度之间存在显著关系。积水程度与 MD 的持续时间或主要临床症状的严重程度均无相关性。本研究证明 MRI 是 MD 的一种敏感诊断工具。内淋巴积水的程度与听力水平相关，这证实了内淋巴空间扩张在听力损失中的作用。
在本研究中，使用了两种相似的 MRI 分级系统，但彼此之间存在一些差异。Bernaerts 分级比 Barath 分级更敏感，并且发现了一些放射学和临床数据之间的关系。因此，需要对几种 MRI 评估量表进行评估，并与临床特征相关联。Bernaerts 分级中观察到的耳蜗周围液增强和额外的低等级前庭积水可能会提高 MD 诊断的敏感性。MD 的 MRI 发现支持临床诊断，并可能有助于更好地了解 MD 的病理生理学。本研究增加了 MD 的知识和诊断，为改善患者治疗提供了医疗保健。
