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Research ArticleHead & Neck

Detection and Grading of Endolymphatic Hydrops in Menière Disease Using MR Imaging

K. Baráth, B. Schuknecht, A. Monge Naldi, T. Schrepfer, C.J. Bockisch and S.C.A. Hegemann
American Journal of Neuroradiology July 2014, 35 (7) 1387-1392; DOI: https://doi.org/10.3174/ajnr.A3856
K. Baráth
aFrom the Medizinisches Radiologisches Institut (MRI Bethanien/Bahnhofplatz/Stadelhofen) Zurich (K.B., B.S.), Zurich, Switzerland
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B. Schuknecht
aFrom the Medizinisches Radiologisches Institut (MRI Bethanien/Bahnhofplatz/Stadelhofen) Zurich (K.B., B.S.), Zurich, Switzerland
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A. Monge Naldi
bDepartment of Oto-Rhino-Laryngology (A.M.N., T.S.), University Hospital of Zurich, Zurich, Switzerland
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T. Schrepfer
bDepartment of Oto-Rhino-Laryngology (A.M.N., T.S.), University Hospital of Zurich, Zurich, Switzerland
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C.J. Bockisch
cDepartments of Neurology, Ophthalmology and Oto-Rhino-Laryngology (C.J.B.)
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S.C.A. Hegemann
dOto-Rhino-Laryngology, Interdisciplinary Center for Vertigo and Balance Disorders (S.C.A.H.), University Hospital of Zurich, Zurich, Switzerland.
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    Fig 1.

    A, Normal labyrinth: interscalar septum (thin arrow), scala tympani (large arrowhead), osseous spiral lamina/cochlear duct (thick arrow), scala vestibuli (small arrowhead), saccule (dashed arrow), and utricle (dotted arrow). B, Cochlear hydrops grade I with irregular dilation and partial obstruction of the scala vestibuli (arrows). In vestibular hydrops grade I, dilation of the endolymphatic space (dotted arrow) encompasses >50% of the vestibulum. A circular perilymphatic space (dashed arrow) remains visible. C, Cochlear hydrops grade II with total obliteration of the scala vestibuli (arrows). In vestibular hydrops grade II, dilation of the endolymphatic space leads to effacement of the perilymphatic space (dotted arrow).

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    Fig 2.

    A 3D-IR sequence depicts cochlear EH grade II (thin arrow) and vestibular EH grade II (thick arrow) on the right. EH is not visible on the corresponding 3D T2-weighted spatial and chemical-shift encoded excitation (SPACE) sequence. No EH on the normal left side is seen. Normal anatomy is shown at different levels (below the midmodiolar, midmodiolar, and above the midmodiolar sections) on the 3D-IR (0.8 mm) and 3D heavily T2-weighted SPACE (0.4 mm) sequence: interscalar septum (thin dashed arrow), anterior ampulla (thick dashed arrow), utricle/common crus (thick dotted arrow), and the lateral ampulla (arrowhead).

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    Fig 3.

    EH is present in 22% (10/45) of clinically normal ears and in 90% (55/61) of clinically diseased ears (irrespective of clinical score) (A) and in 73% of ears with possible (11/15), in 100% in ears with probable (3/3), and in 95% (41/43) of ears with definite MD (B).

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    Fig 4.

    Predominant saccular dilation: 3D-IR sequence (right and left side of the same patient). The right side shows a dilated saccule (arrow) and a slightly distended utricle (dashed arrow) with grade I cochlear hydrops (dotted arrow). Note increased contrast enhancement of the perilymph on the symptomatic right side compared with the normal left labyrinth.

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    Fig 5.

    Predominant utricular dilation: 3D-IR sequence left side. Marked distention of the utricle (dashed arrow) and sparing of the normal-sized saccule (arrow) leave the perilymphatic space visible (grade I) with no cochlear hydrops. The interscalar septum (dotted arrow) should not be mistaken for a slight cochlear hydrops.

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American Journal of Neuroradiology: 35 (7)
American Journal of Neuroradiology
Vol. 35, Issue 7
1 Jul 2014
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Cite this article
K. Baráth, B. Schuknecht, A. Monge Naldi, T. Schrepfer, C.J. Bockisch, S.C.A. Hegemann
Detection and Grading of Endolymphatic Hydrops in Menière Disease Using MR Imaging
American Journal of Neuroradiology Jul 2014, 35 (7) 1387-1392; DOI: 10.3174/ajnr.A3856

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Detection and Grading of Endolymphatic Hydrops in Menière Disease Using MR Imaging
K. Baráth, B. Schuknecht, A. Monge Naldi, T. Schrepfer, C.J. Bockisch, S.C.A. Hegemann
American Journal of Neuroradiology Jul 2014, 35 (7) 1387-1392; DOI: 10.3174/ajnr.A3856
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