Using magnetic resonance imaging to improve diagnosis of peripheral vestibular disorders

Utility and Challenges of Imaging in Peripheral Vestibular Disorder Diagnosis: A Narrative Review

This review focuses on the contribution of medical imaging in the diagnosis of peripheral vestibular disorders. This is a narrative review based on a focused literature search conducted using PubMed and the Cochrane Library. Imaging is not usually recommended in initial consultations for vestibular disorders because only 5-10% of MRI scans reveal findings directly related to the disease. The study is a review of the literature that highlights the utility and limitations of imaging such as computed tomography (CT) and magnetic resonance imaging (MRI). It follows the diagnostic approach from history and physical examination to laboratory tests and imaging. Some conditions like vestibular neuritis and benign paroxysmal positional vertigo (BPPV) have limited imaging utility due to the fine details required. Conversely, high-resolution CT and MRI are important for diagnosing Meniere's disease, acoustic neuroma, and superior canal dehiscence. The role of imaging varies a lot among specific conditions. Advances in imaging technology, particularly high-resolution MRI, promise enhanced diagnostic capabilities.

Contrast Agent Uptake in Endolymphatic Sac and Duct: Inverse Relation to Endolymphatic Hydrops

OBJECTIVES

Ménière's disease (MD) and vestibular migraine (VM) can be associated with endolymphatic hydrops (ELH). The differential role of the endolymphatic sac and duct (ES/ED) system for the development of ELH is poorly understood.

METHODS

On 251 delayed, contrast-enhanced inner ear MRI (iMRI) datasets from neurotological patients and healthy control participants, we evaluated (1) the visibility of the ES/ED system using a novel semi-quantitative scale, and (2) the dimensions of ELH, calculated using volumetric local thresholding (VOLT). Afterwards, statistical analysis of ES/ED radiologic visibility in relation to the grade of ELH, the degree of clinical symptoms, and audiometric findings was performed.

RESULTS

Patients were divided into an MD cohort (n = 68, 34 females, mean age 54.5 ± 14.8 years) and a VM cohort (n = 67, 42 females, 45.9 ± 15.5 years). The remaining datasets did not fulfill diagnostic criteria for definite diagnoses (n = 64, 27 females, mean age 51.3 ± 16.6) or were from healthy controls (HC; n = 52, 27 females, 49.0 ± 18.1 years). MD patients showed the lowest ES/ED-visibility scores on the affected side (ANOVA F(172,2): 20.60, p < 0.001), while the ES/ED-visibility on the non-affected side in MD patients was still significantly lower than in VM and HC (ANOVA F(172,2): 6.80, p 1.44 × 10-3). The ES/ED-visibility score and ELH volume (determined by VOLT, in mm3) correlated inversely (Spearman's rho: -0.32, Fisher's z -0.34, p < 0.001).

CONCLUSION

ES/ED radiologic visibility in iMRI is inversely associated with ELH volumes. Patients with MD show substantially decreased ES/ED visibility on the affected ear and (less pronounced) on the unaffected ear, while VM and HC exhibit normal ES/ED visibility.

LEVEL OF EVIDENCE: 3