Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Sci Rep. 2021 Sep 6;11(1):17738. doi: 10.1038/s41598-021-97213-7.
Intravenous gadolinium-enhanced inner-ear magnetic resonance imaging (IV-Gd inner-ear MRI) has been used to visualize endolymphatic hydrops (EH) in clinical diagnosis of Ménière's disease (MD). However, lack of histological validation has led to several concerns regarding how best to interpret the resulting images. Here, we compared hydropic changes in temporal bone specimens with the results of IV-Gd inner-ear MRI in patients with MD. Histopathologic images of temporal bones from 37 patients with MD and 10 healthy controls were collected from the National Temporal Bone Bank of the Massachusetts Eye and Ear Infirmary in the United States. The EH ratios in the vestibule and cochlea were calculated from temporal bones using the methods used for IV-Gd inner-ear MRI, and the degree to which the saccular and utricular hydrops contributed to vestibular hydrops was measured. The presence of hydropic change in each semicircular canal was assessed using temporal bone images and compared with IV-Gd inner-ear MRI scans of 74 patients with MD. Based on human temporal bone imagery, the EH ratios in the cochlea and the vestibule on the affected side were 0.314 and 0.757, respectively. In the healthy control group, the ratio was 0.064 for the cochlea and 0.289 for the vestibule; these values were significantly different from those for the affected side of MD patients. The values for the affected ear were similar to the ratios from the IV-Gd inner-ear MRI scans in MD patients. In the vestibule, saccular hydrops were more common than utricular hydrops. The average EH ratios in the saccule and utricle were 0.513 and 0.242, respectively. No significant hydropic change from each of three semicircular canals was evident in temporal bone histopathology. However, herniation of otolithic organs (saccule or utricle) into the lateral semicircular canal was found in 44.4% of the patients, with saccular herniation (24.8%) more common than utricular herniation (16.7%). Although IV-Gd inner-ear MRI might not reflect fully the results of actual histopathology due to the limited resolution of MRI and image-processing techniques, the measured EH ratios from temporal bone specimens and IV-Gd inner-ear MRI scans were similar. Hydropic change in the three semicircular canals was not significant at either the ampullated or nonampullated end. Canal invasion of vestibular hydrops seen on MRI also appeared in temporal bone histopathology, and saccular invasion was dominant.
静脉内钆增强内耳磁共振成像（IV-Gd 内耳 MRI）已用于临床诊断梅尼埃病（MD）中内淋巴积水（EH）的可视化。然而，由于缺乏组织学验证，如何最好地解释由此产生的图像存在一些问题。在这里，我们比较了 MD 患者的颞骨标本中与 IV-Gd 内耳 MRI 结果相关的积水变化。从美国马萨诸塞州眼耳医院国家颞骨库收集了 37 例 MD 患者和 10 例健康对照者的颞骨组织病理学图像。使用 IV-Gd 内耳 MRI 中使用的方法，从颞骨计算前庭和耳蜗的 EH 比值，并测量球囊和椭圆囊积水对前庭积水的贡献程度。使用颞骨图像评估每个半规管中积水的存在，并将其与 74 例 MD 患者的 IV-Gd 内耳 MRI 扫描进行比较。基于人类颞骨图像，受影响侧耳蜗和前庭的 EH 比值分别为 0.314 和 0.757。在健康对照组中，耳蜗的比值为 0.064，前庭为 0.289；这些值与 MD 患者受影响侧的数值明显不同。受影响耳的值与 MD 患者的 IV-Gd 内耳 MRI 扫描比值相似。在前庭中，球囊积水比椭圆囊积水更常见。球囊和椭圆囊的平均 EH 比值分别为 0.513 和 0.242。颞骨组织病理学中没有明显的任何三个半规管的积水变化。然而，在 44.4%的患者中发现了耳石器官（球囊或椭圆囊）向外侧半规管的疝出，其中球囊疝出（24.8%）比椭圆囊疝出（16.7%）更常见。尽管由于 MRI 和图像处理技术的分辨率有限，IV-Gd 内耳 MRI 可能无法完全反映实际组织病理学的结果，但从颞骨标本和 IV-Gd 内耳 MRI 扫描中测量的 EH 比值相似。在壶腹和非壶腹端，三个半规管的积水变化均不明显。MRI 上观察到的前庭积水的管腔侵犯也出现在颞骨组织病理学中，并且球囊侵犯占主导地位。
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