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Research ArticleHead & Neck

Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle–Delayed 3D-FLAIR Sequences in Menière Disease

S. Nahmani, A. Vaussy, C. Hautefort, J.-P. Guichard, A. Guillonet, E. Houdart, A. Attyé and M. Eliezer
American Journal of Neuroradiology April 2020, 41 (4) 706-711; DOI: https://doi.org/10.3174/ajnr.A6483
S. Nahmani
aFrom the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
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A. Vaussy
cSiemens Healthineers (A.V.), Saint-Denis, France
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C. Hautefort
bHead and Neck Surgery (C.H.), Lariboisiere University Hospital, Paris, France
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J.-P. Guichard
aFrom the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
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A. Guillonet
aFrom the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
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E. Houdart
aFrom the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
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A. Attyé
dDepartment of Neuroradiology and MRI (A.A.), Grenoble Alpes University Hospital, SFR RMN Neurosciences, Grenoble, France.
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M. Eliezer
aFrom the Departments of Neuroradiology (S.N., J.-P.G., A.G., E.H., M.E.), and
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Abstract

BACKGROUND AND PURPOSE: Endolymphatic hydrops in patients with Menière disease relies on delayed postcontrast 3D-FLAIR sequences. The purpose of this study was to compare the degree of perilymphatic enhancement and the detection rate of endolymphatic hydrops using constant and variable flip angles sequences.

MATERIALS AND METHODS: This was a retrospective study performed in 16 patients with Menière disease who underwent 3T MR imaging 4 hours after gadolinium injection using two 3D-FLAIR sequences with a constant flip angle at 140° for the first and a heavily-T2 variable flip angle for the second. The signal intensity ratio was measured using the ROI method. We graded endolymphatic hydrops and evaluated the cochlear blood-labyrinth barrier impairment.

RESULTS: Both for symptomatic and asymptomatic ears, the median signal intensity ratio was significantly higher with the constant flip angle than with the heavily-T2 variable flip angle (7.16 versus 1.54 and 7.00 versus 1.45, P < .001). Cochlear blood-labyrinth barrier impairment was observed in 4/18 symptomatic ears with the heavily-T2 variable flip angle versus 8/19 with constant flip angle sequences. With heavily-T2 variable flip angle sequences, endolymphatic hydrops was observed in 7–10/19 symptomatic ears versus 12/19 ears with constant flip angle sequences. We found a significant association between the clinical symptomatology and the presence of endolymphatic hydrops with constant flip angle but not with heavily-T2 variable flip angle sequences. Interreader agreement was always perfect with constant flip angle sequences while it was fair-to-moderate with heavily-T2 variable flip angle sequences.

CONCLUSIONS: 3D-FLAIR constant flip angle sequences provide a higher signal intensity ratio and are superior to heavily-T2 variable flip angle sequences in reliably evaluating the cochlear blood-labyrinth barrier impairment and the endolymphatic space.

ABBREVIATIONS:

BLB
blood-labyrinth barrier
CFA
constant flip angle
EH
endolymphatic hydrops
hVFA
heavily-T2 variable flip angle
MD
Menière disease
SIR
signal intensity ratio
VFA
variable flip angle
  • © 2020 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 41 (4)
American Journal of Neuroradiology
Vol. 41, Issue 4
1 Apr 2020
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Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle–Delayed 3D-FLAIR Sequences in Menière Disease
S. Nahmani, A. Vaussy, C. Hautefort, J.-P. Guichard, A. Guillonet, E. Houdart, A. Attyé, M. Eliezer
American Journal of Neuroradiology Apr 2020, 41 (4) 706-711; DOI: 10.3174/ajnr.A6483

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Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle–Delayed 3D-FLAIR Sequences in Menière Disease
S. Nahmani, A. Vaussy, C. Hautefort, J.-P. Guichard, A. Guillonet, E. Houdart, A. Attyé, M. Eliezer
American Journal of Neuroradiology Apr 2020, 41 (4) 706-711; DOI: 10.3174/ajnr.A6483
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