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Detection of intralabyrinthine abnormalities using post-contrast delayed 3D-FLAIR MRI sequences in patients with acute vestibular syndrome

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Abstract

Purpose

3D-FLAIR sequences with delayed acquisition after contrast medium injection have demonstrated new insights into blood-labyrinthine barrier (BLB) abnormalities in various diseases. The aim of this study was to assess the BLB in patients referred with unilateral acute vestibular syndrome (UAVS).

Materials and methods

In this retrospective multicenter imaging study, we performed 3D-FLAIR and steady-state free precession (SSFP) sequences 4 h after contrast medium administration in 26 healthy volunteers and in 30 patients with UAVS. Two radiologists, blinded to the clinical data, independently assessed the asymmetrical enhancement of the labyrinthine structures and the vestibular nerve on 3D-FLAIR sequences, and the signal of the labyrinthine structures on SSFP sequences. Inter-reader agreement tests were performed.

Results

An asymmetrical enhancement of the semicircular canals was observed in 26 out of 30 ears (86.6%, p < 0.001) and never observed in healthy subjects. An asymmetrical enhancement of the vestibular nerve was never observed in either patients or healthy subjects. An asymmetrical enhancement of the cochlea was observed on the 3D-FLAIR sequence in 6 out of 30 ears only in the patients’ group (20%, p = 0.03) and always associated with an enhancement of at least one semicircular canal. A low signal on SSFP sequences was observed only in 11 out of 30 symptomatic ears (36.7%, p < 0.001), involving the utricle in 7 ears and the superior semicircular canal in 4 ears.

Conclusion

Patients with typical UAVS presented with semicircular canal enhancement on MRI, while an asymmetrical enhancement of the vestibular nerve was not displayed.

Trial registration

NCT02529475

Key Points

• Patients with typical vestibular neuronitis presented with semicircular canal enhancement on MRI in 87% of cases.

• An enhancement of the vestibular nerve was never displayed.

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Abbreviations

BLB:

Blood-labyrinthine barrier

MD:

Menière’s disease

SSFP:

Steady-state free precession

UAVS:

Unilateral acute vestibular syndrome

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Acknowledgements

We thank Pamela Haylock (Lariboisiere University Hospital) for critically editing the manuscript.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Neuroradiology and MR Unit, Rouen University Hospital, 7600, Rouen, France

    Michael Eliezer, Julien Horion & Nicolas Magne

  2. Department of Neuroradiology, Lariboisière University Hospital, Paris, France

    Michael Eliezer

  3. Department of Head and Neck Surgery, Rouen University Hospital, Rouen, France

    Charles Maquet & Benoit Bolognini

  4. Department of Biostatistics, Rouen University Hospital, Rouen, France

    André Gillibert

  5. Centre d’Explorations Fonctionnelles Otoneurologiques, Paris, France

    Michel Toupet

  6. Department of Head and Neck Surgery, Lariboisiere University Hospital, Paris, France

    Laureline Kahn & Charlotte Hautefort

  7. Department of Neuroradiology and MRI, Grenoble Alpes University Hospital – SFR RMN Neurosciences, Grenoble, France

    Arnaud Attyé

Authors
  1. Michael Eliezer
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  2. Charles Maquet
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  3. Julien Horion
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  7. Nicolas Magne
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  10. Arnaud Attyé
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Corresponding author

Correspondence to Michael Eliezer.

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Guarantor

The scientific guarantor of this publication is Michael Eliezer.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Attyé et al, Eur Radiol 2017, https://doi.org/10.1007/s00330-016-4701-z.

Methodology

• retrospective

• case-control study

• multicenter study

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Eliezer, M., Maquet, C., Horion, J. et al. Detection of intralabyrinthine abnormalities using post-contrast delayed 3D-FLAIR MRI sequences in patients with acute vestibular syndrome. Eur Radiol 29, 2760–2769 (2019). https://doi.org/10.1007/s00330-018-5825-0

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  • DOI: https://doi.org/10.1007/s00330-018-5825-0

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