FV 12 Intravenous delayed Gadolinium-enhanced MR imaging of the inner ear's endolymphatic space: A methodical comparative study. (May 2022)

• Record Type: Journal Article
• Authors: Boegle, R.; Gerb, J.; Kierig, E.; Becker-Bense, S.; Ertl-Wagner, B.; Dieterich, M.; Kirsch, V.
• Is Part Of: Clinical neurophysiology. Volume 137(2022)
• Page Start: e7
• Page End: e8
• Publication Date: 2022-05
• Subjects: Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2022.01.020
• Languages: English
• ISSNs: 1388-2457

Abstract

Abstract : Introduction: Verification of endolymphatic hydrops (ELH) via intravenous delayed Gadolinium (Gd) enhanced magnetic resonance imaging of the inner ear (iMRI) is developing into a standard clinical tool to investigate vestibulo-cochlear syndromes [1, 2]. Methods: 108 participants, 75 patients with Meniere's disease (MD; 55.2±14.9 years) and 33 vestibular healthy controls (HC; 46.4±15.6 years) were included to examine how (i) MR acquisition protocols influence the signal within endolymphatic space (ELS), (ii) ELS quantification methods correlate to each other [3, 4] and clinical data, and finally, (iii) ELS extent influences MR-signals. Results: Semi-quantitative (SQ) and 2D- or 3D-quantifications of the ELS were independent of signal intensity (SI) and signal-to-noise ratio (SNR) within 0.1 to 0.2 mmol/kg Gd dosage and 4h±30 min time delay (FWE corrected, p<0.05, Figure 1). Used methods correlated strongly (0.3-0.8) and were highly reproducible across raters, thresholds. 3D-quantifications showed least variability. Asymmetry indices and normalized ELH were most useful for predicting quantitative clinical data. ELH size influenced SI, but not SNR. SI could not predict the presence of ELH. Conclusion: 1) Gd dosage of 0.1-0.2 mmol/kg after 4h30 min time delay suffices for ELS quantification. 2) A clinical SQ grading classification including a standardized level of evaluation reconstructed to anatomical fixpoints is needed. 3) ELS 3D-quantification methods are best suited for correlations with clinical variables, should include both ears and ELS values reported relative or normalized to size. 4) ELH leads to mild SI increases. However, these signal changes cannot be used to predict the presence of ELH. References: [1] Strupp M, Brandt T, Dieterich M. Vertigo - Leitsymptom Schwindel. 3rd ed. Berlin Heidelberg: Springer-Verlag (2021). doi: 10.1007/978-3-662-61397-9. [2] Pyykkö I, Zou J, Gürkov R, Naganawa S, Nakashima T. "Imaging of Temporal Bone, " in Advances in Oto-Rhino-Laryngology, eds. J. Lea, D. Pothier (S. Karger AG), 12–31. doi:10.1159/000490268. [2] Nakashima T, Naganawa S, Pyykko I, Gibson WPR, Sone M, Nakata S, Teranishi M. Grading of endolymphatic hydrops using magnetic resonance imaging. Acta Otolaryngol Suppl (2009)5–8. doi:10.1080/00016480902729827. [3] Gerb J, Ahmadi SA, Kierig E, Ertl-Wagner B, Dieterich M, Kirsch V. VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI. J Neurol (2020) 267:185–196. doi:10.1007/s00415-020-10062-8. Legend