Rofo 2014; 186(3): 225-229
DOI: 10.1055/s-0033-1356221
Rapid Communication
© Georg Thieme Verlag KG Stuttgart · New York

HR 3 Tesla MRI for the Diagnosis of Endolymphatic Hydrops and Differential Diagnosis of Inner Ear Tumors – Demonstrated by two Cases with Similar Symptoms

HR-3-Tesla-MRT zur Diagnose des endolymphatischen Hydrops und Differentialdiagnose von Innenohrtumoren – demonstiert an zwei Fällen mit ähnlicher Symptomatik
G. Homann
1   Department of Clinical Radiology, University Hospital Münster
,
D. Fahrendorf
1   Department of Clinical Radiology, University Hospital Münster
,
T. Niederstadt
1   Department of Clinical Radiology, University Hospital Münster
,
N. Nagelmann
1   Department of Clinical Radiology, University Hospital Münster
,
W. Heindel
1   Department of Clinical Radiology, University Hospital Münster
,
B. Lütkenhöner
2   ENT Clinic, University Hospital Münster
,
Y. Böckenfeld
2   ENT Clinic, University Hospital Münster
,
T. Basel
2   ENT Clinic, University Hospital Münster
,
V. Vieth
1   Department of Clinical Radiology, University Hospital Münster
› Author Affiliations
Further Information

Publication History

04 August 2013

05 November 2013

Publication Date:
22 January 2014 (online)

Abstract

The synchronous appearance of different inner ear pathologies with a nearly equivalent clinical manifestation such as Menière’s disease and vestibular schwannoma is very rare but leads to a relevant dilemma concerning therapy options. MRI is the method of choice to detect intralabyrinthine tumors. Since endolymphatic hydrops is considered the morphological equivalent of Menière’s disease, magnetic resonance imaging including hT2w-FLAIR sequences 4 h after i. v. administration of gadolinium-based contrast agents (GBCA) allows the diagnosis and grading of endolymphatic hydrops in vivo synchronous to diagnosis and monitoring of ILT. To this day, only a few cases of intralabyrinthine schwannoma could be shown to appear simultaneously with endolymphatic hydrops by MRI, but to our knowledge the dedicated distinction of endolymphatic space has not been previously demonstrated. The aim of this work was not only to detect the coincidence of endolymphatic hydrops and vestibular schwannoma, but also to differentiate tumor tissue from endolymphatic space by 3 Tesla MRI. This enables therapy options that are originally indicated for Menière’s disease. The aim of this work was to describe the feasibility and usefulness of endolymphatic hydrops MRI on intralabyrinthal tumors in a special case of intravestibular schwannoma to demonstrate the high clinical relevance and impact in therapeutic decision-making for the synchronous appearance of endolymphatic hydrops and intralabyrinthine tumors. Therefore, we present a typical case of Menière's disease in contrast to a patient with an intralabyrinthine schwannoma and Menière-like symptoms.

Citation Format:

• Homann G, Fahrendorf D, Niederstadt T et al. HR 3 Tesla MRI for the Diagnosis of Endolymphatic Hydrops and Differential Diagnosis of Inner Ear Tumors – Demonstrated by two Cases with Similar Symptoms. Fortschr Röntgenstr 2014; 186: 225 – 229

Zusammenfassung

Das gleichzeitige Auftreten von verschiedenen Innenohrpathologien mit ähnlicher Klinik wie dem Morbus Menière und vestibulären Schwannomen ist sehr selten, führt aber bislang aufgrund der reduzierten diagnostischen Möglichkeiten in Bezug auf die der Therapieentscheidung zu einem Dilemma. Die Magnetresonanztomografie ist Goldstandard bei der Detektion und Verlaufskontrolle von intralabyrinthären Tumoren. Ergänzend bieten sich stark T2-gewichtete FLAIR-Sequenzen (4 h nach i. v.-Injektion gadoliniumhaltiger Kontrastmittel) zur Diagnostik des Morbus Menière an, welche sowohl den Perilymph- als auch den beim Morbus Menière im Sinne eines endolymphatischen Hydrops distendierten Endolymphraum in vivo abbilden können. Bis heute wurden nur wenige Fälle eines synchronen Vorliegens intralabyrinthiner Schwannome mit einem endolymphatischen Hydrops berichtet, allerdings liegt unseres Wissens keine Studie mit dedizierter Darstellung von Endolymph- und Perilymphraum vor. Ziel dieser Studie war, nicht nur die Koinzidenz des endolymphatischen Hydrops und des vestibulären Schwannoms darzustellen, sondern darüberhinaus erstmalig Tumorgewebe und Endolymphe voneinander mittels 3-Tesla-MRT zu differenzieren. Dies ist wesentlich für primär dem Morbus Menière zugedachten Therapien. Mit der vorliegenden Arbeit beschreiben wir den Nutzen und die Anwendbarkeit der MRT auf intralabyrinthäre Tumoren an dem Beispiel einer Patientin mit einem intravestibulären Schwannom. Um die klinische Relevanz und den Einfluss auf die klinische Entscheidungsfindung zu demonstrieren, wird dieser Fall exemplarisch einem typischen Beispiel eines Patienten mit Morbus Menière entgegengestellt.

 
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