Koizumi Toshizo, Seo Toru, Saito Kazuya, Fujita Hiroto, Kitahara Tadashi
Department of Otolaryngology-Head and Neck Surgery Nippon Life Hospital Osaka Japan.
Department of Otolaryngology St. Marianna University Yokohama Seibu Hospital Yokohama Japan.
Laryngoscope Investig Otolaryngol. 2024 Jul 9;9(4):e1295. doi: 10.1002/lio2.1295. eCollection 2024 Aug.
Hybrid of reversed image of positive endolymph signal and negative image of perilymph signal (HYDROPS) in delayed gadolinium-enhanced magnetic resonance imaging (MRI) typically depicts normal inner ear as "white-tone" and endolymphatic hydrops as "black-transparent" appearances, whereas ears with auditory and vestibular disorders are occasionally depicted as "gray-tone." This study aimed to investigate the pathological basis of sudden sensorineural hearing loss (SSNHL) patients with "gray-tone" appearances on HYDROPS.
Delayed gadolinium-enhanced MRI examinations were conducted on 29 subjects with unilateral SSNHL. We mainly analyzed positive perilymph image (PPI) and positive endolymph image (PEI), which were components HYDROPS.
On PPI, signal intensity (SI) values extracted from the cochlear and vestibular region of interest (ROI) were higher in the SSNHL ears with dizziness/vertigo symptom at the first visit compared to the healthy ear. Additionally, the PPI/PEI enhancement pattern in the vestibule was associated with a high prevalence of hearing and vestibular deteriorations at the first visit and poor hearing improvement after treatment.
Enhancement on PPI/PEI may result from leakage of gadolinium into the inner ear following breakdown of the blood-labyrinth barrier, with high SI being correlated with the amount of leakage. Particularly, a significant leakage into the endolymphatic space, defined as PPI+/PEI+, indicates severe inner ear pathology. Ultimately, we emphasize that the "gray-tone" appearance in the inner ear on HYDROPS comprises enhancements on both PPI and PEI and propose a new classification for evaluating SSNHL Peri- and Endolymphatic image Enhancement pattern in Delayed gadolinium-enhanced MRI (SPEED).
在延迟钆增强磁共振成像（MRI）中，内淋巴正信号的反转图像与外淋巴负信号的混合图像（HYDROPS）通常将正常内耳描绘为“白色调”，内淋巴积水描绘为“黑色透明”外观，而伴有听觉和前庭障碍的耳朵偶尔会被描绘为“灰色调”。本研究旨在探讨在HYDROPS上呈现“灰色调”外观的突发性感音神经性听力损失（SSNHL）患者的病理基础。
对29例单侧SSNHL患者进行延迟钆增强MRI检查。我们主要分析了HYDROPS的组成部分，即外淋巴正图像（PPI）和内淋巴正图像（PEI）。
在PPI上，初次就诊时有头晕/眩晕症状的SSNHL耳，从耳蜗和前庭感兴趣区域（ROI）提取的信号强度（SI）值高于健康耳。此外，前庭的PPI/PEI增强模式与初次就诊时听力和前庭功能恶化的高发生率以及治疗后听力改善不佳相关。
PPI/PEI增强可能是由于血迷路屏障破坏后钆漏入内耳所致，高SI与漏出量相关。特别是，大量漏入内淋巴间隙，定义为PPI+/PEI+，表明内耳病理严重。最终，我们强调HYDROPS上内耳的“灰色调”外观包括PPI和PEI的增强，并提出了一种新的分类方法，用于评估延迟钆增强MRI中SSNHL的外淋巴和内淋巴图像增强模式（SPEED）。
4级。
