Zou Jing, Zhao Zikai, Li Hongbin, Zhang Guoping, Zhang Qing, Lu Jianping, Pyykkö Ilmari
Department of Otolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland.
J Otol. 2022 Jul;17(3):164-174. doi: 10.1016/j.joto.2022.02.002. Epub 2022 Mar 4.
Intratympanic administration of gadolinium chelate allows for a better visualization of endolymphatic hydrops (EH) using MRI than intravenous injection and was recently further improved to facilitate high-quality imaging of EH in 7 min. The aim of the present study was to simplify the intratympanic administration protocol by mixing gadolinium chelate with therapeutic dexamethasone and to evaluate the effects of this mixture on the visualization of EH in MRI.
In an in vitro study, the potential impact of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) on the stability of dexamethasone was evaluated by analyzing dynamic changes in dexamethasone with high-performance liquid chromatography (HPLC) after mixing with Gd-DTPA. Ten patients with definite Meniere's disease (MD) were recruited to study the potential interference of dexamethasone on MRI visualization of EH, and 49 patients with MD were recruited to evaluate the effect of intratympanic injection of Gd-DTPA mixed with dexamethasone on MRI of EH using a 3T MR machine and a novel heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed using a magnitude plus zero-filled interpolation (hTFLAIR-MZFI) sequence.
The retention times and peak area of dexamethasone in HPLC were not modified by the addition of Gd-DTPA. EH grading in the cochlea and vestibule was not influenced in any ear by intratympanic injection of dexamethasone. Excellent inner ear images were obtained from all patients, and EHs with various grades were displayed. There were significant correlations between diagnosis and cochlear EH (p < 0.01, Spearman's Rho), between diagnosis and vestibular EH (p < 0.01, Spearman's Rho), and between cochlear and vestibular EH (p < 0.01, Spearman's Rho). The distribution of Gd-DTPA plus dexamethasone negatively correlated with the grade of vestibular EH. Injury of the endolymph-perilymph barrier was detected in one cochlea and three vestibules of 59 inner ears with MD.
Intratympanic administration of Gd-DTPA plus dexamethasone yielded high-quality MRI images of EH in patients with MD using a novel 7-min protocol and simplified the clinical application. Intratympanic administration of Gd-DTPA plus dexamethasone might be used to test its therapeutic effect in future work.
与静脉注射相比，鼓室内注射钆螯合物能使磁共振成像（MRI）更好地显示内淋巴积水（EH），且最近有了进一步改进，可在7分钟内实现EH的高质量成像。本研究的目的是通过将钆螯合物与治疗用的地塞米松混合来简化鼓室内给药方案，并评估这种混合物对MRI中EH可视化的影响。
在一项体外研究中，通过高效液相色谱法（HPLC）分析地塞米松与钆二乙三胺五乙酸（Gd-DTPA）混合后地塞米松的动态变化，评估Gd-DTPA对其稳定性的潜在影响。招募了10例确诊梅尼埃病（MD）的患者，研究地塞米松对EH的MRI可视化的潜在干扰，并招募了49例MD患者，使用3T MR机器和一种新型的使用幅度加零填充插值重建的重T2加权三维液体衰减反转恢复序列（hTFLAIR-MZFI），评估鼓室内注射Gd-DTPA与地塞米松的混合物对EH的MRI的影响。
添加Gd-DTPA后，HPLC中地塞米松的保留时间和峰面积未发生改变。鼓室内注射地塞米松对任何一只耳朵的耳蜗和前庭的EH分级均无影响。所有患者均获得了优质的内耳图像，显示了不同分级的EH。诊断与耳蜗EH之间（p < 0.01，Spearman相关系数）、诊断与前庭EH之间（p < 0.01，Spearman相关系数）以及耳蜗与前庭EH之间（p < 0.01，Spearman相关系数）均存在显著相关性。Gd-DTPA加地塞米松的分布与前庭EH分级呈负相关。在59只患有MD的内耳中，有1个耳蜗和3个前庭检测到内淋巴-外淋巴屏障损伤。
鼓室内注射Gd-DTPA加地塞米松，采用新型的7分钟方案，可为MD患者提供高质量的EH的MRI图像，并简化了临床应用。鼓室内注射Gd-DTPA加地塞米松在未来的工作中可能用于测试其治疗效果。
3级。
