MR Imaging in Menière Disease: Is the Contact between the Vestibular Endolymphatic Space and the Oval Window a Reliable Biomarker?

Abstract

Background and purpose: No reliable MR imaging marker for the diagnosis of Menière disease has been reported. Our aim was to investigate whether the obliteration of the inferior portion of the vestibule and the contact with the stapes footplate by the vestibular endolymphatic space are reliable MR imaging markers in the diagnosis of Menière disease.

Materials and methods: We retrospectively enrolled 49 patients, 24 affected by unilateral sudden hearing loss and 25 affected by definite Menière disease, who had undergone a 4-hour delayed 3D-FLAIR sequence. Two readers analyzed the MR images investigating whether the vestibular endolymphatic space bulged in the third inferior portion of the vestibule contacting the stapes footplate. This sign was defined as the vestibular endolymphatic space contacting the oval window.

Results: We analyzed 98 ears: 27 affected by Menière disease, 24 affected by sudden sensorineural hearing loss, and 47 that were healthy. The vestibular endolymphatic space contacting the oval window showed an almost perfect interobserver agreement (Cohen κ = 0.87; 95% CI, 0.69-1). The vestibular endolymphatic space contacting oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 88%, and negative predictive value = 93% in differentiating Menière disease ears from other ears. The vestibular endolymphatic space contacting the oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 96%, negative predictive value = 82% in differentiating Menière disease ears from sudden sensorineural hearing loss ears.

Conclusions: The vestibular endolymphatic space contacting the oval window has high specificity and positive predictive value in differentiating Menière disease ears from other ears, thus resulting in a valid tool for ruling in Menière disease in patients with mimicking symptoms.

© 2018 by American Journal of Neuroradiology.

Figures

Fig 1.

Left ear, A, Flat panel CT scan (isotropic voxel, 0.15-mm resolution) of a cadaver temporal bone specimen with a superimposed 3D colored schematic representation of the normal VES on the oblique sagittal plane parallel to the superior semicircular canal. On this plane, the normal saccule (dotted arrow) is more medially and posteriorly located compared with the utricle. The utricle does not protrude into the inferior portion of the vestibule, and the VES does not contact the round (asterisk) and oval (arrowhead) windows. B, MR imaging oblique sagittal reconstruction parallel to the superior semicircular canal of a healthy ear shows superiorly the VES and inferiorly the perilymph filling the inferior third of the vestibule with preservation of the perilymph signal medial to the oval window (arrowhead) and round window (asterisk). C, MR imaging axial reconstruction parallel to the lateral semicircular canal at the inferior third of the vestibule in a healthy subject, showing the vestibule filled by the perilymph (arrow).

Fig 2.

Left ear. A, Flat panel CT scan (isotropic voxel, 0.15-mm resolution) of a cadaver temporal bone specimen with superimposed 3D colored schematic representation of the VES on the oblique sagittal plane parallel to the superior semicircular canal, as suggested in patients with MD. The utricle bulges into the inferior third of the vestibule, and the saccule (dotted arrow) bulges more medially; thus, the VES contacts the oval window (arrowhead). The asterisk indicates the round window and the dotted arrow indicates the saccule. B, MR imaging oblique sagittal reconstruction parallel to the superior semicircular canal of an MD ear shows enlargement of the VES bulging into the inferior third of the vestibule and contacting the oval window (arrowhead), with the consequent absence of the normal perilymph signal behind the stapes footplate (asterisk indicates the round window). C, MR imaging axial reconstruction parallel to the lateral semicircular canal at the inferior third of the vestibule in a patient with MD shows the VES contacting the oval window (arrow indicates enlargement of the VES bulging into the inferior third of the vestibule and contacting the oval window).

Fig 3.

Four-hour-delayed postcontrast 3D-FLAIR MR axial image through the basal turns of the cochleae. The right (R) MD ear shows cochlear hydrops (arrowhead) and marked contrast enhancement (arrow) compared with the contralateral (L indicates left) healthy ear (dotted arrow), suggesting BLB breakdown.