Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China.
Department of Otorhinolaryngology-Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Jiangxi 330006, China.
Neuroimage Clin. 2021;30:102656. doi: 10.1016/j.nicl.2021.102656. Epub 2021 Apr 3.
The origin of vestibular symptoms in patients with vestibular schwannoma (VS) is uncertain. We used intratympanic gadolinium-enhanced magnetic resonance imaging (MRI) to confirm the labyrinthine lesions in patients with VS and to explore the features of endolymphatic hydrops (EH) in these patients.
In total, 66 patients diagnosed with unilateral VS were enrolled in this study and underwent intratympanic gadolinium-enhanced MRI. The borders of the vestibule and endolymph were mapped on the axial MRI images, and the area and volume of vestibule and endolymph were automatically calculated using Osirix software, and the area and volume percentage of vestibular endolymph were obtained.
The area and volume percentages of vestibular endolymph on the affected side were significantly larger than those on the healthy side (both p < 0.001). Using Kendall's W test, we found that the area and volume percentages of vestibular endolymph on the affected side were consistent (p < 0.001), but the consistency was moderate (k = 0.574). The healthy side was also consistent (p < 0.001), and the degree of consistency was moderate (k = 0.444). We used 19.1% as the cut-off point to distinguish the presence or absence of vestibular EH; that is, the volume percentage of vestibular endolymph that was more than 19.1% were defined as the subgroup with hydrops, while the subgroup without hydrops included patients with a baseline level below 19.1%. No volume classification for vestibular EH was proposed. Based on this standard, 11/66 (16.7%) of the patients with VS in this study had vestibular EH.
The volume percentage of the vestibular endolymph was more accurate than the area percentage for assessing vestibular EH. Using 19.1% as the cut-off point to distinguish the presence or absence of vestibular EH, we found that 16.7% of patients with VS had varying degrees of vestibular EH. We believe that the vestibular symptoms in patients with VS may originate from the peripheral lesions.
前庭神经鞘瘤（VS）患者前庭症状的起源尚不清楚。我们使用鼓室内钆增强磁共振成像（MRI）来证实 VS 患者的迷路病变，并探讨这些患者内淋巴积水（EH）的特征。
共纳入 66 例单侧 VS 患者进行鼓室内钆增强 MRI。在轴位 MRI 图像上绘制前庭和内淋巴的边界，使用 Osirix 软件自动计算前庭和内淋巴的面积和体积，并获得前庭内淋巴的面积和体积百分比。
患侧前庭内淋巴的面积和体积百分比明显大于健侧（均 p<0.001）。使用 Kendall's W 检验，我们发现患侧前庭内淋巴的面积和体积百分比是一致的（p<0.001），但一致性中等（k=0.574）。健侧也一致（p<0.001），一致性中等（k=0.444）。我们将 19.1%作为区分有无前庭 EH 的截断点；即，前庭内淋巴体积百分比超过 19.1%定义为积水亚组，而无积水亚组包括基线水平低于 19.1%的患者。未提出前庭 EH 的容积分类。基于这一标准，本研究中 11/66（16.7%）例 VS 患者存在前庭 EH。
前庭内淋巴体积百分比比面积百分比更能准确评估前庭 EH。使用 19.1%作为区分有无前庭 EH 的截断点，发现 16.7%的 VS 患者存在不同程度的前庭 EH。我们认为 VS 患者的前庭症状可能源自周围病变。
