Zanetti Diego, Conte Giorgio, Scola Elisa, Casale Silvia, Lilli Giorgio, Di Berardino Federica
Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Audiology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Front Surg. 2021 Aug 23;8:700271. doi: 10.3389/fsurg.2021.700271. eCollection 2021.
The diagnosis of "definite" Méniére's disease (MD) relies upon its clinical manifestations. MD has been related with Endolymphatic Hydrops (EH), an enlargement of the endolymphatic spaces (ES) (cochlear duct, posterior labyrinth, or both). Recent advances in Magnetic Resonance (MR) imaging justify its increasing role in the diagnostic workup: EH can be consistently recognized in living human subjects by means of 3-dimensional Fluid-Attenuated Inversion-Recovery sequences (3D-FLAIR) acquired 4 h post-injection of intra-venous (i.v.) Gadolinium-based contrast medium, or 24 h after an intratympanic (i.t.) injection. Different criteria to assess EH include: the comparison of the area of the vestibular ES with the whole vestibule on an axial section; the saccule-to-utricle ratio ("SURI"); and the bulging of the vestibular organs toward the inferior 1/3 of the vestibule, in contact with the stapedial platina ("VESCO"). An absolute link between MD and EH has been questioned, since not all patients with hydrops manifest MD symptoms. In this literature review, we report the technical refinements of the imaging methods proposed with either i.t. or i.v. delivery routes, and we browse the outcomes of MR imaging of the ES in both MD and non-MD patients. Finally, we summarize the following imaging findings observed by different researchers: blood-labyrinthine-barrier (BLB) breakdown, the extent and grading of EH, its correlation with clinical symptoms, otoneurological tests, and stage and progression of the disease.
“确诊”梅尼埃病（MD）的诊断依赖于其临床表现。MD与内淋巴积水（EH）有关，内淋巴积水是内淋巴间隙（ES）（蜗管、后半规管或两者）的扩大。磁共振（MR）成像的最新进展证明了其在诊断检查中日益重要的作用：通过静脉注射（i.v.）钆基造影剂后4小时或鼓室内注射（i.t.）后24小时采集的三维液体衰减反转恢复序列（3D-FLAIR），可以在活体人类受试者中持续识别EH。评估EH的不同标准包括：在轴位切片上比较前庭ES的面积与整个前庭的面积；球囊与椭圆囊的比值（“SURI”）；以及前庭器官向前庭下1/3突出，与镫骨底板接触（“VESCO”）。MD与EH之间的绝对联系受到质疑，因为并非所有积水患者都表现出MD症状。在这篇文献综述中，我们报告了通过i.t.或i.v.给药途径提出的成像方法的技术改进，并浏览了MD患者和非MD患者ES的MR成像结果。最后，我们总结了不同研究人员观察到的以下成像结果：血迷路屏障（BLB）破坏、EH的程度和分级及其与临床症状、耳神经学检查以及疾病分期和进展的相关性。
