Ishii Masanori, Tanaka Hiroshi, Asai Ryuichi, Kanai Yasuhisa, Kato Yujin, Ito Yusuke, Mochizuki Fumihiro, Yoneyama Masami, Ishiyama Gail, Ishiyama Akira
Department of Otorhinolaryngology Japan Community Healthcare Organization (JCHO) Tokyo Shinjuku Medical Center Tokyo Japan.
Department of Neurotology Advanced Imaging Center (AIC) Yaesu Clinic Tokyo Japan.
Laryngoscope Investig Otolaryngol. 2024 Aug 10;9(4):e1314. doi: 10.1002/lio2.1314. eCollection 2024 Aug.
Three-tesla MRI with gadolinium-based contrast agents is important in diagnosing Ménière's disease. However, contrast agents cannot be used in some patients. By using the compositional difference between the inner ear endolymph and perilymph, we performed basic and clinical research focused on potassium ions and protein to find the optimal parameters for visualizing endolymphatic hydrops on MRI without contrast. We then examined the relationship between severity stage and visualization rate of endolymphatic hydrops.
In phantom experiments simulating the endolymph and perilymph, we explored MRI parameters that could be used to separate endolymph from perilymph by gradually changing the inversion time. We then used these parameters to perform both new non-contrast MRI and contrast MRI on the same day in Ménière's disease patients, and we compared the visualization rates of endolymphatic hydrops under the two modalities. Fifty patients were selected from 478 patients with Ménière's disease of different severity stages; 12 patients had asthma and allergy to contrast agents.
The higher the disease stage, the higher the endolymphatic hydrops visualization rate. The new non-contrast MRI gave significantly higher ( < .01) visualization rates of endolymphatic hydrops on the affected side in patients at Stage 3 or above than in Stages 1 and 2 combined.
New non-contrast MRI with parameters focusing on the endolymph-perilymph difference in the density of protons surrounding the potassium ions and protein can produce images consistent with endolymphatic hydrops. We believe that this groundbreaking method will be useful for diagnosing Ménière's disease in patients.
Clinical studies are at evidence level 3 in non-randomized controlled trials.
使用基于钆的造影剂进行的3特斯拉磁共振成像（MRI）对梅尼埃病的诊断很重要。然而，某些患者不能使用造影剂。通过利用内耳内淋巴和外淋巴之间的成分差异，我们开展了以钾离子和蛋白质为重点的基础及临床研究，以寻找在无造影剂的情况下MRI显示内淋巴积水的最佳参数。然后，我们研究了内淋巴积水的严重程度分期与显示率之间的关系。
在模拟内淋巴和外淋巴的模型实验中，我们通过逐渐改变反转时间来探索可用于将内淋巴与外淋巴分离的MRI参数。然后，我们使用这些参数在同一天对梅尼埃病患者进行新的无造影剂MRI和造影剂MRI检查，并比较两种方式下内淋巴积水的显示率。从478例不同严重程度分期的梅尼埃病患者中选取了50例；12例患者患有哮喘且对造影剂过敏。
疾病分期越高，内淋巴积水显示率越高。新的无造影剂MRI在3期及以上患者患侧的内淋巴积水显示率显著高于1期和2期患者的合并显示率（<0.01）。
聚焦于围绕钾离子和蛋白质的质子密度的内淋巴-外淋巴差异参数的新的无造影剂MRI能够生成与内淋巴积水相符的图像。我们认为，这种开创性的方法将有助于诊断梅尼埃病患者。
临床研究在非随机对照试验中处于证据水平3。
