Connor Steve, Pai Irumee, Touska Philip, Price David, Ourselin Sebastien, Hajnal Joseph V
School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Department of Neuroradiology, King's College Hospital, London, UK.
Eur Radiol. 2025 Mar;35(3):1290-1302. doi: 10.1007/s00330-024-11218-0. Epub 2024 Dec 3.
To compare the performance and optimal combination of MRI descriptors used for the diagnosis of Ménière's disease (MD) between a real-IR sequence with "zero-point" endolymph (ZPE), and an optimised real-IR sequence with negative signal endolymph (NSE).
This retrospective single-centre cross-sectional study evaluated delayed post-gadolinium ZPE and NSE real-IR MRI in consecutive patients with Ménièriform symptoms (8/2020-10/2023). Two observers assessed 14 MRI descriptors. "Definite MD" (2015 criteria) and "all MD" ears (wider clinical criteria) were compared to controls. Cohen's kappa and risk ratios (RR) were evaluated for each descriptor. Forward stepwise logistic regression established which combination of descriptors best predicted MD.
The study included 132 patients (57 men; mean age 57.7 ± 13.6), with 87 "all MD" (56 "definite") and 39 control ears. The NSE sequence demonstrated increased perilymph SNR, and improved both diagnostic performance and reliability for 9/14 descriptors. However, ZPE demonstrated superior diagnostic performance for the best descriptor of "saccule absent, large as or confluent with the utricle" (RR 6.571, ZPE; 6.300, NSE) and that of "asymmetric perilymphatic enhancement" (RR 3.628, ZPE; 2.903, NSE). Both sequences combined these two descriptors in the optimal predictive model for "definite MD", with "grade 2 cochlear hydrops" also significant for NSE. ZPE and NSE descriptor combinations both correctly classified 95.8% of ears. The ZPE descriptor combination performed better for "all MD" (ZPE, AUC-ROC 0.914; NSE, AUC-ROC 0.893).
Parameter optimisation with NSE Real-IR influenced the optimal selection of MRI descriptors but did not improve their diagnostic performance in definite MD.
Question Delayed post-gadolinium ZPE (FLAIR) and NSE (REAL-IR) sequences are widely applied for diagnosing MD, but their relative benefits remain unclear. Findings Optimised NSE sequences improve perilymphatic depiction and influence the selection of the optimal MRI descriptors, but do not improve diagnostic performance. Clinical relevance Radiologists may continue to apply either ZPE or NSE sequences since they offer similar diagnostic abilities, but the choice of the sequence will influence which MRI features should be evaluated to support the diagnosis of MD.
比较用于梅尼埃病（MD）诊断的MRI描述符在具有“零点”内淋巴（ZPE）的真实IR序列和具有负信号内淋巴（NSE）的优化真实IR序列之间的性能及最佳组合。
这项回顾性单中心横断面研究评估了连续患有梅尼埃样症状患者（2020年8月至2023年10月）钆剂注射后延迟的ZPE和NSE真实IR MRI。两名观察者评估了14个MRI描述符。将“确诊MD”（2015年标准）和“所有MD”耳（更宽泛的临床标准）与对照组进行比较。对每个描述符评估了科恩kappa系数和风险比（RR）。向前逐步逻辑回归确定哪些描述符组合能最佳预测MD。
该研究纳入了132例患者（57名男性；平均年龄57.7±13.6岁），有87只“所有MD”耳（56只“确诊”）和39只对照耳。NSE序列显示外淋巴信噪比增加，并且14个描述符中的9个在诊断性能和可靠性方面均有改善。然而，ZPE在“球囊缺失，与椭圆囊大小相同或融合”这一最佳描述符（RR 6.571，ZPE；6.300，NSE）以及“不对称外淋巴强化”（RR 3.628，ZPE；2.903，NSE）方面表现出更好的诊断性能。在“确诊MD”的最佳预测模型中，两个序列都将这两个描述符结合在一起，对于NSE序列，“2级耳蜗积水”也具有显著性。ZPE和NSE描述符组合均正确分类了95.8%的耳。ZPE描述符组合在“所有MD”方面表现更好（ZPE，AUC-ROC 0.914；NSE，AUC-ROC 0.893）。
使用NSE真实IR进行参数优化影响了MRI描述符的最佳选择，但在确诊MD中并未提高其诊断性能。
问题钆剂注射后延迟的ZPE（液体衰减反转恢复序列）和NSE（真实IR）序列广泛应用于MD诊断，但其相对优势仍不明确。发现优化后的NSE序列改善了外淋巴的显示，并影响了最佳MRI描述符的选择，但未提高诊断性能。临床意义放射科医生可以继续应用ZPE或NSE序列，因为它们具有相似的诊断能力，但序列的选择将影响为支持MD诊断而应评估的MRI特征。
