Radiation dose reduction and image quality improvement with ultra-high resolution temporal bone CT using deep learning-based reconstruction: An anatomical study

PURPOSE

The purpose of this study was to evaluate the achievable radiation dose reduction of an ultra-high resolution computed tomography (UHR-CT) scanner using deep learning reconstruction (DLR) while maintaining temporal bone image quality equal to or better than high-resolution CT (HR-CT).

MATERIALS AND METHODS

UHR-CT acquisitions were performed with variable tube voltages and currents at eight different dose levels (volumic CT dose index [CTDIvol] range: 4.6-79 mGy), 10242 matrix, and 0.25 mm slice thickness and reconstructed using DLR and hybrid iterative reconstruction (HIR) algorithms. HR-CT images were acquired using a standard protocol (120 kV/220 mAs; CTDI vol, 54.2 mGy, 5122 matrix, and 0.5 mm slice thickness). Two radiologists rated the image quality of seven structures using a five point confidence scale on six cadaveric temporal bone CTs. A global image quality score was obtained for each CT protocol by summing the image quality scores of all structures.

RESULTS

With DLR, UHR-CT at 120 kV/220 mAs (CTDIvol, 50.9 mGy) and 140 kV/220 mAs (CTDIvol, 79 mGy) received the highest global image quality scores (4.88 ± 0.32 [standard deviation (SD)] [range: 4-5] and 4.85 ± 0.35 [range: 4-5], respectively; P = 0.31), while HR-CT at 120 kV/220 mAs and UHR-CT at 120 kV/20 mAs received the lowest (i.e., 3.14 ± 0.75 [SD] [range: 2-5] and 2.97 ± 0.86 [SD] [range: 1-5], respectively; P = 0.14). All the DLR protocols had better image quality scores than HR-CT with HIR.

CONCLUSION

UHR-CT with DLR can be performed with up to a tenfold reduction in radiation dose compared to HR-CT with HIR while maintaining or improving image quality.

Ultra-high-resolution CT of the temporal bone: The end of stapes prosthesis dimensional error and correlation with patient symptoms

PURPOSE

To describe the reliability of ultra-high-resolution computed tomography (UHR-CT) in the measurement of titanium stapes prostheses using manufacturer data as a reference.

MATERIALS AND METHODS

This retrospective study included patients treated by stapedectomy with titanium prostheses who underwent UHR-CT between January 2020 and October 2023. Images were acquired using an ultra-high-resolution mode (slice thickness: 0.25 mm; matrix, 1024 × 1024). Two radiologists independently evaluated the length, diameter, and intra-vestibular protrusion of the prosthesis. Post-operative air-bone gaps (ABGs) were recorded.

RESULTS

Fourteen patients were enrolled (mean age, 44.3 ± 13.8 [SD] years, 9 females), resulting in 16 temporal bone UHR-CTs. The exact length was obtained in 81.3 % (n = 13/16) and underestimated by 0.1 to 0.3 mm in the remaining 18.7 % (n = 3/16) CT scans for both readers (mean misestimation: -0.02 ± 0.06 [SD] mm, overall underestimation of 0.43 %). The exact diameter was reported in 75 % (n = 12/16) and 87.5 % (n = 14/16) of the CT scans for readers 1 and 2, respectively, and was off by 0.1 mm in all discrepancies (mean misestimation: 0.01 ± 0.04 [SD] mm, overall overestimation of 2.43 %). Intravestibular prosthesis protrusion was of 0.5 ± 0.43 [SD] mm (range: 0-1) and 0.49 ± 0.44 [SD] mm (range: 0-1.1) for readers 1 and 2, respectively, and did not correlate with ABGs (r = 0.25 and 0.22; P = 0.39 and 0.47 for readers 1 and 2, respectively). Intra and interobserver agreements were excellent.

CONCLUSION

UHR-CT provides 99.6 % and 97.6 % accuracy for prosthesis length and diameter measurements, respectively.

Ultra-high-resolution CT of the temporal bone: Comparison between deep learning reconstruction and hybrid and model-based iterative reconstruction

PURPOSE

The purpose of this study was to evaluate the ability of ultra-high-resolution computed tomography (UHR-CT) to assess stapes and chorda tympani nerve anatomy using a deep learning (DLR), a model-based, and a hybrid iterative reconstruction algorithm compared to simulated conventional CT.

MATERIALS AND METHODS

CT acquisitions were performed with a Mercury 4.0 phantom. Images were acquired with a 1024 × 1024 matrix and a 0.25 mm slice thickness and reconstructed using DLR, model-based, and hybrid iterative reconstruction algorithms. To simulate conventional CT, images were also reconstructed with a 512 × 512 matrix and a 0.5 mm slice thickness. Spatial resolution, noise power spectrum, and objective high-contrast detectability were compared. Three radiologists evaluated the clinical acceptability of these algorithms by assessing the thickness and image quality of the stapes footplate and superstructure elements, as well as the image quality of the chorda tympani nerve bony and tympanic segments using a 5-point confidence scale on 13 temporal bone CT examinations reconstructed with the four algorithms.

RESULTS

UHR-CT provided higher spatial resolution than simulated conventional CT at the penalty of higher noise. DLR and model-based iterative reconstruction provided better noise reduction than hybrid iterative reconstruction, and DLR had the highest detectability index, regardless of the dose level. All stapedial structure thicknesses were thinner using UHR-CT by comparison with conventional simulated CT (P < 0.009). DLR showed the best visualization scores compared to the other reconstruction algorithms (P < 0.032).

CONCLUSION

UHR-CT with DLR results in less noise than UHR-CT with hybrid iterative reconstruction and significantly improves stapes and tympanic chorda tympani nerve depiction compared to simulated conventional CT and UHR-CT with iterative reconstruction.

Local budesonide therapy in the management of persistent hyposmia in suspected non-severe COVID-19 patients: Results of a randomized controlled trial

OBJECTIVES

Consequences of COVID-19 on olfactory functions remained unclear during the pandemic. We assessed the efficacy of local budesonide in addition to olfactory rehabilitation when managing non-severe COVID-19 patients with persistent hyposmia.

METHODS

A multicentric, randomized, superiority trial was conducted (ClinicalTrials.gov NCT04361474). The experimental group (EG) received budesonide and physiological saline nasal irrigations administered via three syringes of 20 ml in each nasal cavity in the morning and evening for 30 days. The control group (CG) received a similar protocol without budesonide. Patients were included if they were >18 years old, with a SARS-CoV-2 infection and presenting an isolated hyposmia persisting 30 days after symptom onset. The primary endpoint was the percentage of patients with improvement of more than two points on the ODORATEST score after 30 days of treatment.

RESULTS

In total, 123 patients were included and randomized (EG: 62 vs CG: 61). Two patients from the EG met the primary endpoint with no statistical difference between the two groups (P = 0.5).

CONCLUSION

To our knowledge, this is the first study evaluating local budesonide for COVID-19 related hyposmia treatment even though previous trials were performed with other local corticosteroids. Local budesonide efficacy was not demonstrated for persistent hyposmia related to COVID-19.

Iterative Denoising Accelerated 3D FLAIR Sequence for Hydrops MR Imaging at 3T

BACKGROUND AND PURPOSE

3D FLAIR sequences have become the criterion standard for identifying endolymphatic hydrops, but scan time remains an important limitation to their widespread use. Our purpose was to evaluate the diagnostic performance and image quality of an accelerated 3D FLAIR sequence combined with an iterative denoising algorithm.

MATERIALS AND METHODS

This was a retrospective study performed on 30 patients with clinical suspicion of endolymphatic hydrops who underwent 3T MR imaging 4 hours after gadolinium injection using two 3D FLAIR sequences. The first (conventional FLAIR) was accelerated with a conventional turbo factor of 187. The second was accelerated with an increased turbo factor of 263, resulting in a 33% scan time reduction (5 minutes 36 seconds versus 8 minutes 15 seconds, respectively). A sequence was reconstructed in-line immediately after the accelerated 3D FLAIR acquisition from the same raw data with iterative denoising (accelerated-FLAIR iterative denoising). The signal intensity ratio image quality score and endolymphatic hydrops diagnosis were evaluated.

RESULTS

The mean signal intensity ratio for symptomatic and asymptomatic ears of accelerated-FLAIR iterative denoising was significantly higher than the mean SNR of conventional FLAIR (29.5 versus 19 and 25.9 versus 16.3, P < .001). Compared with the conventional FLAIR sequence, the image-quality score was higher with accelerated-FLAIR iterative denoising (mean image-quality score, 3.8 [SD, 0.4] versus 3.3 [SD, 0.6] for accelerated-FLAIR iterative denoising and conventional FLAIR, respectively, P = .003). There was no significant difference in the diagnosis of endolymphatic hydrops between the 2 sequences. Interreader agreement was good-to-excellent.

CONCLUSIONS

The iterative denoising algorithm applied to an accelerated 3D FLAIR sequence for exploration of endolymphatic hydrops enabled significantly reducing the scan time without compromising image quality and diagnostic performance.

Infliximab for the Treatment of Inflammatory Labyrinthitis: A Retrospective Cohort Study

Inflammatory labyrinthitis is defined as a fluctuant vestibulo-cochlear syndrome associated with an impairment of the blood-labyrinthine barrier (BLB) on delayed FLAIR MRI sequences. Systemic and intratympanic corticosteroids are the gold standard treatment but their effect is frequently insufficient. The objective is here to determine whether infliximab could be of value in the treatment of bilateral inflammatory labyrinthitis. A retrospective monocentric study was conducted between January 2013 and December 2021. All patients included in the study were affected with a bilateral vestibulo-cochlear syndrome associated with bilateral blood-labyrinthine barrier impairment. Patients were administered infliximab at the dose of 5 mg/kg every 6 weeks for 6 months. Audiometry, MRI with delayed FLAIR sequences on the labyrinth, and corticosteroid doses still required were assessed both before and after treatment with infliximab was completed. Pure-tone average (PTA) was the primary outcome. The secondary outcomes were the speech recognition threshold (SRT), the Dizziness Handicap Inventory (DHI) score, and the corticosteroid (CS) dose. A total of nine patients including five men and four women were enrolled in the study. Thirteen ears were analyzed. After a 6-month period of treatment, the mean PTA (54 ± 24 db versus 66 ± 22 db; p = 0.027), SRT (54 ± 37 db versus 66 ± 32 db; p = 0.041) and DHI score (27 ± 15 versus 9 ± 2; p = 0.032) significantly improved. After the 6-month treatment period, the mean CS dose decreased from 38 ± 33 to 6 ± 5 mg/day (p = 0.003). We conclude that infliximab substantially improves the vestibulo-cochlear function in patients with bilateral inflammatory labyrinthitis and could be of value in corticosteroid-dependent cases.

Otosclerosis: audiometric results and quality of life after stapedectomy with interposition or CO2 laser-calibrated stapedotomy without interposition

BACKGROUND

The surgical treatment of otosclerosis consists of the replacement of the stapes using a piston.

AIMS/OBJECTIVES

The objective of this study is to assess the audiometric results and quality of life (QOL) of patients who underwent surgery for otosclerosis by stapedectomy with fascia interposition (STIP) or by stapedotomy using CO₂ laser (SLaser) without fascia interposition.

MATERIAL AND METHODS

Ninety-one patients operated on for otosclerosis by STIP (40 patients) and by SLaser (51 patients) were included. Audiometric results were graphically displayed using the Amsterdam Hearing Evaluation Plot and were compared to the Common Otology Database (COD) comprising 660 patients. The patients' QOL was assessed with an otological validated survey. The significance level was p < .05.

RESULTS

There was no significant difference in hearing improvement between SLaser and STIP-operated patients. There was no significant difference between our results and that of COD. QOL was significantly improved (+3.5/10) postoperatively for both STIP and SLaser in both social and professional fields.

CONCLUSIONS AND SIGNIFICANCE

By comparing QOL and hearing gain of STIP and SLaser, our results suggest that both surgical techniques are a safe and successful treatment for otosclerotic stapes fixation. Further studies aiming at comparing larger series may confirm and refine these results.

Pulsatile Tinnitus Due to Stenosis of the Marginal Sinus: Diagnosis and Endovascular Treatment

BACKGROUND AND PURPOSE

Venous pulsatile tinnitus is a disabling condition mainly caused by a stenosis of the lateral sinus. Here, we aimed to report a novel cause of venous pulsatile tinnitus, stenosis of the marginal sinus.

MATERIALS AND METHODS

We retrospectively analyzed patients with isolated venous pulsatile tinnitus for which the suspected cause was a stenosis of the marginal sinus, treated or not, between January 2017 and December 2020. Patient charts and imaging were systematically reviewed. All patients underwent noncontrast temporal bone CT and MR imaging.

RESULTS

Eight patients (7 women; median age, 36 years) were included. Six patients (75%) were overweight, and 1 patient had idiopathic intracranial hypertension. All patients presented with a typical venous pulsatile tinnitus. The stenosis of the marginal sinus was detected using oblique reconstructions on postcontrast 3D MR imaging. There was no other pathologic finding except ipsilateral stenosis of the lateral sinus in 3 patients. Four patients underwent endovascular therapy with placement of a stent in the marginal sinus, leading to complete resolution of the pulsatile tinnitus for all of them. No complication occurred. Of note, the symptoms of intracranial hypertension also regressed after stent placement in that patient.

CONCLUSIONS

Marginal sinus stenosis is a novel cause of venous pulsatile tinnitus, which can be easily detected on MR imaging. Marginal sinus stent placement is safe and efficient. We hypothesized that the marginal sinus stenosis pathophysiology is similar to that of lateral sinus stenosis, which is a common and well-known cause of venous pulsatile tinnitus, explaining the similar clinical presentation and endovascular management.

Increased signal intensity with delayed post contrast 3D-FLAIR MRI sequence using constant flip angle and long repetition time for inner ear evaluation

PURPOSE

The purpose of this study was to compare the degree of perilymphatic enhancement between 4 hour post-contrast constant flip angle three-dimensional fluid attenuated inversion recovery (3D-FLAIR) images obtained with short repetition time (TR) and those obtained with long TR.

MATERIALS AND METHODS

This single-center, prospective study included patients who underwent MRI of the inner ear with heavily T2-weighted sequence, 3D-FLAIR sequence with a "short" TR of 10,000 ms (s3D-FLAIR) and with a "long" TR of 16,000 ms (l3D-FLAIR). Signal intensity ratio (SIR) and contrast-to-noise ratio (CNR) obtained with s3D-FLAIR and l3D-FLAIR were quantitatively assessed using region of interest (ROI) method and compared. The morphology of the endolymphatic space on both sequences was also evaluated.

RESULTS

From March 2020 to July 2020, 20 consecutive patients were enrolled (9 women and 11 men; mean age, 52.1 ± 14.5 [SD] years; age range: 29-75 years). On l3D-FLAIR images, mean SIR (21.1 ± 8.8 [SD]; range: 7.6-46.1) was significantly greater than that on s3D-FLAIR images (15.7 ± 6.7 [SD]; range: 5.9-33.4) (P < 0.01). On l3D-FLAIR images, mean CNR (17 ± 8.5 [SD]; range: 2-40) was significantly greater than that on s3D-FLAIR images (12 ± 6.3 [SD]; range: 3.2-29.8) (P < 0.01). Kappa value for inter-rater agreement for endolymphatic hydrops, vestibular atelectasis and perilymphatic fistula were 0.93 (95% CI: 0.74-1), 1 (95% CI: 0.85-1) and 1 (95% CI: 0.85-1) respectively.

CONCLUSION

This study demonstrates that the sensitivity of 3D-FLAIR sequences to low concentration gadolinium in the perilymphatic space is improved by elongation of the TR, with SIR and CNR increased by +34.4% and +41.3% respectively.

MRI characteristics of intralabyrinthine schwannoma on post-contrast 4 h-delayed 3D-FLAIR imaging

PURPOSE

The purpose of this study was to describe the MRI characteristics of intralabyrinthine schwannoma (ILS) on post contrast three-dimensional (3D) fluid-attenuation-inversion-recovery (FLAIR) images obtained four hours after intravenous administration of a gadolinium-based contrast agent (4h-3D-FLAIR).

MATERIALS AND METHODS

This IRB-approved retrospective multi-center study included patients presenting with typical ILS from January 2016 to October 2020. All medical charts were systematically collected. All MRI examinations, including 4h-3D-FLAIR images, were reviewed by two board-certified neuroradiologists. Main outcome measures were location, signal intensity and associated anomalies of ILS.

RESULTS

Twenty-seven out of 8730 patients (0.31%) referred for the investigation of a cochleovestibular disorder had a final diagnosis of ILS. There were 13 men and 14 women with a mean age of 52 ± 17 (SD) years (age range: 20-86 years). The most common clinical presentation was unilateral progressive sensorineural hearing loss (16/27; 59%). All ILS were unilateral and 15 (15/27; 55%) were intracochlear. All ILS presented as a hypointense filling defect within the labyrinth on T2-weighted images that enhanced on post-contrast T1-weighted images. On 4h-3D-FLAIR images, all ILS presented as a hypointense filling defect, associated with diffuse perilymphatic hyperintensity. Two patients (2/27; 7%) presented with ipsilateral endolymphatic hydrops.

CONCLUSION

ILS displays consistent features on post-contrast 4h-3D-FLAIR images. ILS should not be confused with endolymphatic hydrops and requires a systematic analysis of the corresponding T2-weighted images.

Iterative denoising accelerated 3D SPACE FLAIR sequence for brain MR imaging at 3T

PURPOSE

The purpose of this study was to prospectively evaluate image quality of three-dimensional fluid attenuated inversion recovery (3D-FLAIR) sequence acquired with a high acceleration factor and reconstructed with iterative denoising (ID) for brain magnetic resonance imaging (MRI) at 3-T.

MATERIAL AND METHODS

Patients with brain tumor who underwent brain MRI were consecutively included. Two 3D-FLAIR sequences were successively performed for each patient. A first conventional FLAIR acquisition (conv-FLAIR) was performed with an acceleration factor of 6. The second acquisition was performed with an increased acceleration factor of 9. Two series one without ID (acc-FLAIR) and one with ID (acc-FLAIR-ID) were reconstructed. Two neuroradiologists independently assessed image quality, deep brain nuclei visualization and white matter/gray matter (WM/GM) differentiation on a 4-point scale.

RESULTS

Thirty patients with brain tumor were consecutively included in this study. There were 16 women and 14 men with a mean age of 54 ± 17 (SD) years (range: 22-78 years). Scanning time of Acc-FLAIR-ID and Acc-FLAIR (4 min 40 sec) was 37% shorter than that of conv-FLAIR (2 min 50 sec) (P < 0.01). Improved image quality score was significantly different for both conv-FLAIR and acc-FLAIR-ID compared to acc-FLAIR (P < 0.01 for both). WM/GM differentiation score of conv-FLAIR was not significantly different compared to acc-FLAIR-ID (P = 0.10). Improved WM/GM differentiation score was different for both sequences compared to acc-FLAIR (P = 0.017 and P < 0.001). Deep brain nuclei visualization score was not different between conv-FLAIR and acc-FLAIR-ID (P = 0.71). However, the improved deep brain nuclei visualization score was significantly different for both sequences compared to acc-FLAIR (P < 0.001 for both).

CONCLUSION

Scanning time of 3D-FLAIR sequence using a high acceleration factor reconstructed with ID algorithm can be reduced by 37% while preserving image quality for brain MRI.

Endovascular treatment of infectious intracranial aneurysms complicating infective endocarditis: a series of 31 patients with 55 aneurysms

PURPOSE

Endovascular treatment (EVT) has become a major option in management of infectious intracranial aneurysms (IIAs) complicating infective endocarditis. We report a retrospective, single-center series of consecutive patients with IIAs treated by EVT.

METHODS

Patients were included from January 2009 to July 2020. IIAs were diagnosed on DSA. Each patient underwent a neurological assessment before and after EVT and was followed up by imaging within 15 days of EVT. Safety was assessed on the evolution of NIHSS score. A minor stroke was defined as a worsening of NIHSS < 4 points. Efficacy was defined as the absence of hemorrhagic event during cardiac surgery and the exclusion of the IIA on control imaging.

RESULTS

Sixty-two IIAs (30 ruptured) were diagnosed in 31 patients. Fifty-six IIAs were diagnosed on the first DSA and 6 on the early control exploration. EVT was achieved in 55 IIAs by parent artery occlusion with glue in 52 distal IIAs and coils in 3 proximal IIAs. IIAs were located in 90.9% of cases on a fourth-division branch of a cerebral artery. The neurological examination remained unchanged in 29 patients (93.5%), and 2 patients suffered minor stroke. EVT was performed before cardiac surgery in 20/22 patients. All treated IIAs were excluded on follow-up imaging. No hemorrhage was observed during cardiac surgery or in the aftermath. Seven (11.3%) unruptured IIAs were not embolized.

CONCLUSION

EVT of IIAs by occlusion of the parent artery is effective in preventing rupture and carries no significant neurological risk.

Imaging of endolymphatic hydrops: A comprehensive update in primary and secondary hydropic ear disease

BACKGROUND

Since the first description by Hallpike and Cairns, the excess of endolymphatic fluid, also known as endolymphatic hydrops (EH), has been established as being the main biomarker in patients with Menière's disease. Recently, the concept of primary (PHED) and secondary hydropic ear disease (SHED) has been introduced. PHED corresponded to Menière's disease while SHED was defined as the presence of EH in patients with pre-existing inner ear disease.

OBJECTIVE

In this article, we would like to summarize the methodology of hydrops exploration using MRI and the previously published radiological findings in patients with PHED and SHED.

RESULTS

Before the emergence of delayed inner ear MRI, the presence of EH was assumed based on clinical symptoms. However, because of the recent technical developments, inner ear MRI became an important tool in clinical settings for identifying EH in vivo, in patients with PHED and SHED. The presence of EH on MRI is related with the degree of sensorineural hearing loss whether in patients with PHED or SHED. By contrast, in PHED or SHED patients without sensorineural hearing loss, MRI showed no sign of EH.

CONCLUSIONS

Thanks to the recent technical developments, inner ear MRI became an important tool in clinical settings for identifying EH in vivo, in patients with PHED and SHED.

Present and future of the labyrinth imaging: Focus on the use of T2-weighted and contrast-enhanced delayed FLAIR (1 h) sequences

OBJECTIVE

Part of the recent progress in the labyrinth imaging has been made possible by the rise of contrast-free T2-weighted and delayed (1h) FLAIR sequences. The aim of this article is to review evidence for the use of these two sequences to image the inner ear, especially the posterior membranous labyrinth.

MATERIAL AND METHODS

We analyzed MRI-based papers (2007-2020)using high-resolution T2-weighted or contrast-enhanced FLAIR (1h) sequences to image the inner ear.

RESULTS

T2-weighted sequences (3T MRI)enabled the visualization of the posterior membranous labyrinth with good correlation when compared to corresponding histological slices.Significant progress has been made, especially in terms of scanning time, aiming at reducing it, in order to decrease motions artifacts. The saccule is visible on a 3T MRI without significant motion artifacts. Its shape is ovoid, with a maximum height and width of 1.6 and 1.4 mm, respectively. An enlarged saccule was observed in 84%of patients with unilateral Meniere's disease, in 28%of patients with vestibular schwannomas (VS) and 47%of patients with intralabyrinthine schwannomas. VS obstructing the internal auditory canal caused a decrease of the perilymphatic signal (more moderate decrease in meningiomas) on T2 gradient-echo images. Contrast-enhanced FLAIR sequences are useful to image vestibular/facial neuritis and inflammatory inner ear diseases.

CONCLUSION

Precise analysis of the posterior membranous labyrinth, in terms of size, shape and signal intensity, is possible on a 3T MRI using high-resolution gradient-echo T2-weighted sequences. Such sequences are an interesting add-on to delayed (4h30) FLAIR-based protocols for labyrinth imaging.

Results of transvenous embolization of intracranial dural arteriovenous fistula: a consecutive series of 136 patients with 142 fistulas

OBJECTIVE

Intracranial dural arteriovenous fistula (DAVF) is mainly treated with an endovascular approach. Two major treatment advances include transvenous embolization (TVE) with coils in 1989 and, more recently, transarterial embolization with Onyx. The aim of this study was to present a large monocentric series of patients with DAVF treated with TVE. This series reports more than 20 years of experience and describes the evolution of the medical management of these patients, as well as current indications for this treatment at the authors' center.

METHODS

Consecutive patients treated for intracranial DAVFs with TVE from 1995 to 2018 were included. Clinical and imaging data were systematically collected. Univariate and multivariate analyses were performed to identify factors that were significantly associated with adverse clinical course or complications.

RESULTS

In this study of 136 patients with 142 DAVFs treated with TVE, the occlusion rate was 90%. The median length of follow-up was 11 months. The rate of permanent complications was 5.1%, and the procedure-related mortality rate was 1.5%. Procedure-related mortality was associated with extension of thrombosis that was observed early in our experience. The introduction of a postoperative anticoagulation regimen has drastically decreased the occurrence of this complication. Other minor complications included cochleovestibular syndrome after embolization of lateral sinus DAVF and oculomotor nerve damage after embolization of cavernous sinus DAVF.

CONCLUSIONS

TVE allows efficient occlusion of DAVF. It remains a valid option for DAVF located on a sinus that does not participate in normal venous drainage of the brain.

Embolization of Internal Carotid Artery Branches in Juvenile Nasopharyngeal Angiofibroma

OBJECTIVE

Preoperative embolization of juvenile nasopharyngeal angiofibroma (JNA) is usually performed by the occlusion of branches of the external carotid artery (ECA). However, a significant proportion of JNAs also receive blood from the internal carotid artery (ICA). The objective of this study was to report on the feasibility and clinical impact of superselective embolization of ICA branches in complex cases of JNA.

METHODS

This was a single-center retrospective study of all patients operated on for JNA between 2000 and 2018. The patients treated with embolization of branches of the ICA were identified. The results in terms of complications, intraoperative blood loss, and rate of residual disease were analyzed and compared to those of a control group of patients treated only with embolization of ECA branches and matched by age, stage, angiographic pattern, surgical approach, and previous surgery.

RESULTS

Ninety-two patients were included. Embolization of branches of the ICA was attempted in 14 cases of advanced or recurrent tumors and was ultimately possible in nine cases. There were no complications after embolization. The mean intraoperative blood loss was 1428 mL. Residual disease was found in three cases (33%). There was no significant difference compared with the control group (mean intraoperative blood loss = 1355 mL, residual disease = 4 (44%); all P > .05).

CONCLUSION

In this retrospective study, we report the feasibility of superselective embolization of ICA branches in selected cases of JNA. There was no observed benefit of this technique in terms of intraoperative bleeding or decreased risk of residual disease.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E775-E780, 2021.

Loss of smell in patients with COVID-19

Objective

To assess the physiopathology of olfactory function loss (OFL) in patients with coronavirus disease 2019 (COVID-19), we evaluated the olfactory clefts (OC) on MRI during the early stage of the disease and 1 month later.

Methods

This was a prospective, monocentric, case-controlled study. Twenty severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)–infected patients with OFL were included and compared to 20 age-matched healthy controls. All infected patients underwent olfactory function assessment and 3T MRI, performed both at the early stage of the disease and at the 1-month follow-up.

Results

At the early stage, SARS-CoV2–infected patients had a mean olfactory score of 2.8 ± 2.7 (range 0–8), and MRI displayed a complete obstruction of the OC in 19 of 20 patients. Controls had normal olfactory scores and no obstruction of the OC on MRI. At the 1 month follow-up, the olfactory score had improved to 8.3 ± 1.9 (range 4–10) in patients, and only 7 of 20 patients still had an obstruction of the OC. There was a correlation between olfactory score and obstruction of the OC (p = 0.004).

Conclusion

OFL in SARS-CoV2–infected patients is associated with a reversible obstruction of the OC.

Plasma Serotonin is Elevated in Adult Patients with Sudden Sensorineural Hearing Loss

Background The roles of thrombophilia and cardiovascular risk factors in sudden sensorineural hearing loss (SSNHL) remain controversial. Cochlear microthrombosis and vasospasm have been hypothesized as possible pathogenic mechanisms of SSNHL. This article investigates the circulating serotonin and homocysteine levels besides thrombophilia screening in patients with idiopathic SSNHL.

Methods A total of 133 SSNHL patients and age- and sex-matched controls were investigated (discovery cohort). Measurement included common inherited natural coagulation inhibitors, factor VIII, von Willebrand factor (VWF), antiphospholipid antibodies, homocysteine, and serotonin (whole blood, platelet, and plasma) levels, along with frequent relevant genetic variants. A validation cohort (128 SSNHL patients) was studied for homocysteine and serotonin levels.

Results and Conclusion In the discovery cohort, 58.6% of patients exhibited thrombophilia, of which most had a low to moderate titers of antiphospholipid antibodies and high levels of factor VIII/VWF. Twenty-seven patients (20%) had mild-to-moderate hyperhomocysteinemia or were homozygous for the methylenetetrahydrofolate reductase (MTHFR) C677T mutation. Regarding serotonin, SSNHL patients had elevated whole blood levels that remained within the normal range and normal platelet content. However, approximately 90% patients of both cohorts had elevated plasma serotonin. Elevated plasma serotoninemia was accompanied by serotonylation of platelet rhoA protein. This study shows that increased plasma serotonin appears as a biomarker of SSNHL (specificity: ∼96%, sensitivity: ∼90%) and could participate in the pathophysiology of SSNHL.

Efficacy of local budesonide therapy in the management of persistent hyposmia in COVID-19 patients without signs of severity: A structured summary of a study protocol for a randomised controlled trial

OBJECTIVES

To assess the efficacy of local intranasal treatment with budesonide (nasal irrigation), in addition to olfactory rehabilitation, in the management of loss of smell in COVID-19 patients without signs of severity and with persistent hyposmia 30 days after the onset of symptoms. To search for an association between the presence of an obstruction on MRI and the severity of olfactory loss, at inclusion and after 30 days of treatment.

TRIAL DESIGN

Two center, open-label, 2-arm (1:1 ratio) parallel group randomized controlled superiority trial.

PARTICIPANTS

Inclusion criteria - Patient over 18 years of age; - Patient with a suspected SARS-CoV-2 infection, whether or not confirmed by PCR, or close contact with a PCR-confirmed case, typical chest CT scan (unsystematic frosted glass patches with predominantly sub-pleural appearance, and at a later stage, alveolar condensation without excavation or nodules or masses) or positive serology ; - Patient with isolated sudden onset hyposmia persisting 30 days after the onset of symptoms of CoV-2 SARS infection; - Affiliate or beneficiary of a social security scheme; - Written consent to participate in the study. Non-inclusion criteria - Known hypersensitivity to budesonide or any of the excipients; - Hemostasis disorder or epistaxis; - Oral-nasal and ophthalmic herpes virus infection; - Long-term corticosteroid treatment; - Treatment with potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin, telithromycin, nefazodone and HIV protease inhibitors); - Severe forms of SARS-CoV-2 with respiratory or other signs; - Hyposmia persisting for more than 90 days after the onset of symptoms - Other causes of hyposmia found on interrogation or MRI; - Patient benefiting from a legal protection measure; - Pregnant or breastfeeding women. The participants will be recruited from: Hôpital Fondation Adolphe de Rothschild and Hôpital Lariboisière in Paris, France INTERVENTION AND COMPARATOR: Intervention: Experimental group: Nasal irrigation with budesonide and physiological saline (Budesonide 1mg/2mL diluted in 250mL of physiological saline 9°/00): 3 syringes of 20mL in each nasal cavity, morning and evening, for 30 days, in addition to olfactory rehabilitation twice a day.

CONTROL GROUP

Nasal irrigation with physiological saline 9°/00 only: 3 syringes of 20cc in each nasal cavity, morning and evening, for 30 days, in addition to olfactory rehabilitation twice a day.

MAIN OUTCOMES

Percentage of patients with an improvement of more than 2 points on the ODORATEST score after 30 days of treatment.

RANDOMISATION

Patients will be randomized (1:1) between the experimental and control groups, using the e-CRF. The randomization list will be stratified by centre.

BLINDING (MASKING)

Participants and caregivers are aware of the group assignment. People assessing the outcomes are blinded to the group assignment Numbers to be randomised (sample size) 120 patients are planned to be randomized into two groups of 60 patients.

TRIAL STATUS

MDL_2020_10. Version number 2, May 22, 2020. Recruitment started on May 22, 2020. The trial will finish recruiting by August 2020.

TRIAL REGISTRATION

EUDRACT number: 2020-001667-85; date of trial registration: 15 May 2020 Protocol registered on ClinicalTrial.gov, registration number: NCT04361474 ; date of trial registration: 24 April 2020.

FULL PROTOCOL

The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

MRI evaluation of the endolymphatic space in otosclerosis and correlation with clinical findings

PURPOSE

The purpose of this study was to investigate the clinical features of ears with otosclerosis and their correlation with endolymphatic hydrops and blood-labyrinth barrier (BLB) impairment on 3T magnetic resonance imaging (MRI).

MATERIALS AND METHODS

This was a single-center retrospective imaging study. Thirty-nine ears from 29 patients (17 men, 12 women; mean age 52±12 [SD] years; range 27-74 years) with non-operated otosclerosis were included. All patients underwent three-dimensional fluid attenuated inversion recovery (FLAIR) MRI sequences performed 4hours after the intravenous administration of a single dose of gadolinium-based contrast material. MRI examinations were analyzed by two radiologists for the presence of saccular hydrops (SH) and BLB impairment. Results of MRI examinations were compared with clinical findings, hearing levels and extent of otosclerotic lesions based on high-resolution computed tomography findings. BLB impairment was evaluated using the signal intensity ratio, ratio of intensities between the basal turn of the cochlea and the medulla.

RESULTS

SH was observed in 1/39 (3%) otosclerotic ears and BLB impairment in 8/39 (21%) while 8/29 patients with otosclerosis (28%) had vertigo. No significant associations were found between SH or BLB impairment on MRI, and the presence of vertigo or the degree of sensorineural hearing loss.

CONCLUSION

Clinical manifestations of otosclerosis (sensorineural hearing loss and rotatory vertigo) were not significantly associated with MRI findings such as BLB impairment and endolymphatic hydrops. SH was only observed in one patient with obstruction of the vestibular aqueduct by an otosclerotic focus.

Clinical and radiological characteristics of patients with collapse or fistula of the saccule as evaluated by inner ear MRI

Background: Delayed 3D-FLAIR sequences enable the distinction between the utricle and the saccule.Aims/objectives: We sought to evaluate the clinical and radiological findings in patients with no visible saccule (NVS) on 4-hour post-contrast MRI.Material and Methods: We retrospectively assessed the presence of NVS signs in 400 patients who underwent delayed inner ear MRI.Results: We reported on 28 patients with NVS. Among this group, on the NVS affected side: 14 had isolated sensorineural hearing loss (SNHL); 4 had fluctuating cochleo-vestibular disease; 3 had definite Menière's disease; 3 had Minor syndrome; 2 had delayed endolymphatic hydrops (EH); 2 had inner ear malformations; 1 had sudden cochleo-vestibular deficit following stapes surgery; 1 had a perilymphatic fistula and 1 had a contralateral fluctuating SNHL. Sixteen out of these 28 patients (57.1%) had cochlear hydrops on the same side as the NVS, while 10 patients (35.7%) had saccular hydrops on the contralateral side. Moreover, isolated blood labyrinth barrier (BLB) impairment on the NVS side was observed in 7 patients. Two patients (7.1%) had large vestibular aqueduct and NVS on the same side and one patient had perilymphatic fistula.Conclusions and significance: NVS seems to be multifactorial and could be linked to hydropic ear disease, third-mobile window pathologies and congenital malformation.

Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle-Delayed 3D-FLAIR Sequences in Menière Disease

BACKGROUND AND PURPOSE

Endolymphatic hydrops in patients with Menière disease relies on delayed postcontrast 3D-FLAIR sequences. The purpose of this study was to compare the degree of perilymphatic enhancement and the detection rate of endolymphatic hydrops using constant and variable flip angles sequences.

MATERIALS AND METHODS

This was a retrospective study performed in 16 patients with Menière disease who underwent 3T MR imaging 4 hours after gadolinium injection using two 3D-FLAIR sequences with a constant flip angle at 140° for the first and a heavily-T2 variable flip angle for the second. The signal intensity ratio was measured using the ROI method. We graded endolymphatic hydrops and evaluated the cochlear blood-labyrinth barrier impairment.

RESULTS

Both for symptomatic and asymptomatic ears, the median signal intensity ratio was significantly higher with the constant flip angle than with the heavily-T2 variable flip angle (7.16 versus 1.54 and 7.00 versus 1.45, P < .001). Cochlear blood-labyrinth barrier impairment was observed in 4/18 symptomatic ears with the heavily-T2 variable flip angle versus 8/19 with constant flip angle sequences. With heavily-T2 variable flip angle sequences, endolymphatic hydrops was observed in 7-10/19 symptomatic ears versus 12/19 ears with constant flip angle sequences. We found a significant association between the clinical symptomatology and the presence of endolymphatic hydrops with constant flip angle but not with heavily-T2 variable flip angle sequences. Interreader agreement was always perfect with constant flip angle sequences while it was fair-to-moderate with heavily-T2 variable flip angle sequences.

CONCLUSIONS

3D-FLAIR constant flip angle sequences provide a higher signal intensity ratio and are superior to heavily-T2 variable flip angle sequences in reliably evaluating the cochlear blood-labyrinth barrier impairment and the endolymphatic space.

Selective embolization of the mastoid emissary vein for pulsatile tinnitus treatment: when is it indicated?

Background

Venous pulsatile tinnitus (PT) can be caused by the perception of blood flow through the mastoid emissary vein (MEV). However, the causal relationship of this anomaly has not been established as selective occlusion of this vein has never been performed. The aim of this study was to report on a small series of patients suspected of having PT caused by an MEV, who underwent MEV embolization as treatment for PT, and to identify the correct indications for this procedure.

Methods

This was a single center retrospective study (CNIL 2215065) including six patients with isolated disabling PT treated by embolization of the MEV, recruited between December 2017 and August 2019. Patient charts were systematically reviewed. All patients underwent non-contrast temporal bone CT and MRI.

Results

Mean age of the patients (five women, one male) was 56.3 years (range 40–71 years). Two patients presented with venous PT and four had neutral PT. The MEV was in direct contact with the mastoid air cells on temporal bone CT in all patients. Based on clinical examination, two patients presented with venous PT while four patients had neutral PT. In all cases of venous PT, selective embolization of the MEV caused the tinnitus to disappear, suggesting technical success. In contrast, embolization of the MEV had no effect in patients with neutral PT.

Conclusions

We demonstrated that MEV could be a source of venous PT. Embolization of the MEV was effective only in cases of clinical venous PT.

The vestibular aqueduct sign: Magnetic resonance imaging can detect abnormalities in both ears of patients with unilateral Meniere's disease

BACKGROUND AND PURPOSE

In patients with Meniere's disease (MD), saccular hydrops can only be studied by magnetic resonance imaging (MRI) at a late stage when the disease is already responsible for moderate to severe hearing loss. However, these patients may also present vestibular aqueduct (VA) abnormalities.

MATERIALS AND METHODS

In this prospective study (38RC14.428 for healthy subjects/38RC15.173 for patients), imaging was carried out on a 3T MRI scanner. Twenty healthy subjects (13 women, median age 53.5 [52.2-66.7]) and twenty MD patients (9 women, median age 54.5 [52-66.7]) had MRI scans with 3D-FLAIR sequences without injection, then 4 hours after a single intra-venous dose of contrast agent. Two radiologists independently ranked the morphology of the VA in the healthy subjects and in MD patients, using a three-level score (completely visible, discontinuous and not visible). Each subject was then graded, based on both the VA's appearance and on saccular hydrops presence. Inter-reader agreement tests were performed.

RESULTS

In controls and patients, VA modifications were symmetrical without significant difference between the symptomatic and asymptomatic ears. The presence of at least one ear with discontinuous VA showed a correlation with clinical MD (P < 0.001) with a sensitivity of 90%. Ten patients had saccular hydrops, but only in the symptomatic ears. The evaluation of VA did not differ between MRI, both within MRI series or between the two radiologists (kappa without and with contrast agent = 0.9 and 0.92 respectively).

CONCLUSION

Analysis of the vestibular aqueduct by MRI detects abnormalities in both ears of patients with unilateral MD.

Electrophysiological and inner ear MRI findings in patients with bilateral vestibulopathy

PURPOSE

Bilateral vestibulopathy (BV) is an uncommon disorder and the etiology remained idiopathic in most cases. Delayed 3D-FLAIR sequences have provided new insights into various inner ear diseases, allowing the evaluation of the endolymphatic space and the permeability of the blood-labyrinthine barrier (BLB). The aim of this study was to assess both the morphology of the endolymphatic space and the permeability of the BLB in patients with BV as evaluated by delayed 3D-FLAIR sequences.

METHODS

In this retrospective study, we performed 3D-FLAIR sequences 4 h after administering contrast media to 42 patients with BV. Two radiologists independently evaluated the morphology of the endolymphatic space (either vestibular atelectasis or endolymphatic hydrops) and the permeability of the BLB.

RESULTS

Morphologic anomalies of the endolymphatic space and vestibular blood-labyrinthine barrier impairment were observed in 59.6% of patients with BV. Bilateral vestibular atelectasis (VA) was found in 21 patients (50%), involving only the utricle and all three ampullas while the saccule was always observed with no sign of collapse: idiopathic BV (n = 19), aminoglycoside administration (n = 1) and few days following abdominal surgery (n = 1). One patient had bilateral vestibular malformation. BLB impairment was observed in five patients (11.9%): paraneoplastic (n = 1), lymphoma (n = 1), autoimmune (n = 1), and vestibular "neuritis" (n = 2). Seventeen patients (40.4%) had normal MRI with no endolymphatic space anomaly or BLB impairment.

CONCLUSION

Patients with BV presented with morphologic anomalies of the endolymphatic space or BLB impairment in 59.6% of patients.

Relationship between video head impulse test, ocular and cervical vestibular evoked myogenic potentials, and compartmental magnetic resonance imaging classification in menière's disease

OBJECTIVES/HYPOTHESIS

Currently, it is possible to assess in vivo the morphology of each compartment of the endolymphatic spaces 4 hours after an intravenous administration of gadolinium on magnetic resonance imaging (MRI). The aim of this study was to assess the correlation between otolithic and ampullar functions (cervical vestibular evoked myogenic potential [cVEMP], ocular vestibular evoked myogenic potential [oVEMP], video head impulse test [VHIT]) and delayed inner ear MRI based on a compartmental, anatomically based classification that included the cochlea, the saccule, the utricle, and the ampullas.

STUDY DESIGN

Retrospective case-control study.

METHODS

In this retrospective study, we performed three-dimensional fluid-attenuated inversion recovery sequences with delayed acquisition in 26 healthy subjects and 31 definite Menière's disease (MD) patients. Each subject was then graded on MRI on the basis on cochlear, saccular, utricular, and ampullar hydrops in MD patients. All patients underwent pure-tone audiometry, VHIT, cVEMP, and oVEMP testing.

RESULTS

Cochlear, saccular, utricular, and ampullar hydrops were found on MRI in 88%, 91%, 50%, and 8.5% respectively. We found no significant correlation between the presence of saccular hydrops versus cVEMP, utricular hydrops versus oVEMP, and ampullar hydrops versus VHIT. However, the severity of endolymphatic hydrops on MRI was correlated to the degree of hearing loss.

CONCLUSIONS

We proposed a compartmental, anatomically based classification for endolymphatic hydrops on MRI, which included the whole vestibular compartment. Using this classification, we observed increasing morphological changes as the disease evolved, affecting first the saccule, then the utricle, and finally the ampullas. The severity of vestibular endolymphatic hydrops is only correlated to hearing loss severity.

LEVEL OF EVIDENCE

3 Laryngoscope, 130:E444-E452, 2020.

Empty Sella Is a Sign of Symptomatic Lateral Sinus Stenosis and Not Intracranial Hypertension

BACKGROUND AND PURPOSE

Empty sella has been reported in patients with idiopathic intracranial hypertension and is thought to be a sign of elevation of intracranial pressure. However, it can also be found in patients with lateral sinus stenosis presenting with isolated pulsatile tinnitus without signs of intracranial hypertension. We hypothesized that the volume of the sella turcica would be similar in both groups of patients undergoing stent placement for lateral sinus stenosis.

MATERIALS AND METHODS

Consecutive patients with idiopathic intracranial hypertension or isolated venous pulsatile tinnitus and undergoing lateral sinus stent placement from January 2012 to December 2017 were included. The primary outcome was the estimated volume of the sella turcica based on preoperative CTA measurements. The ratio of the pituitary gland height/sellar height was calculated on preoperative MR imaging. Sellar volumes were compared among the 3 groups: pulsatile tinnitus, idiopathic intracranial hypertension, and a control group, matched by age and sex.

RESULTS

Eighty-eight patients underwent lateral sinus stent placement. The median age was 37 years, and 94% were women. No difference in age, sex, or body mass index was found among the groups. Patients undergoing venous stent placement had significantly higher sellar volumes than the control group (P < 0.001). There was no difference in the sellar volumes (P = .63) or gland/sellar height ratios (P = .25) between the pulsatile tinnitus and idiopathic intracranial hypertension groups.

CONCLUSIONS

Empty sella is found in 2 differing groups of patients undergoing lateral sinus stent placement, suggesting that it is a radiologic sign of symptomatic hemodynamic lateral sinus stenosis rather than elevated intracranial pressure.

Sensorineural hearing loss in patients with vestibular schwannoma correlates with the presence of utricular hydrops as diagnosed on heavily T2-weighted MRI

PURPOSE

The purpose of this study was to assess whether the volume of the vestibular endolymphatic space correlates with the degree of hearing loss using heavily T2-weighted fast imaging employing steady-state acquisition with cycle phase (FIESTA-C) MRI.

MATERIALS AND METHODS

A total of 23 patients with vestibular schwannoma, as diagnosed on typical image findings, who underwent FIESTA-C MRI were included. There were 13 women and 10 men with a mean age of 63.5±9.3 (SD) years (range: 49-88years). Two radiologists independently evaluated the volume of the utricle and saccule. Correlation between tumor volume, vestibular endolymphatic space volume and degree of hearing loss - as evaluated with the levels of pure-tone average and speech recognition threshold - were searched for.

RESULTS

The mean saccular, utricular and tumor volumes were 3.17±1.1 (SD) mm³ (range: 1.45-5.7mm³), 14.55±5 (SD) mm³; (range: 6.6-23.9mm³) and 17.4±5.5 (SD) mm³; (range: 8.3-25.4mm³), respectively. There was a moderate correlation between the volume of the utricle and the degree of hearing loss as evaluated with the levels of pure-tone average (rho=0.5; P=0.015) and speech recognition threshold (rho=0.58; P=0.004). There were no significant correlations between saccular and tumor volumes and the degree of hearing loss.

CONCLUSION

The volume of the utricle in patients with obstructive vestibular schwannoma moderately correlates with the degree of hearing loss.

The vestibular aqueduct sign: Magnetic resonance imaging can detect abnormalities in both ears of patients with unilateral Meniere's disease

BACKGROUND AND PURPOSE

In patients with Meniere's disease (MD), saccular hydrops can only be studied by magnetic resonance imaging (MRI) at a late stage when the disease is already responsible for moderate to severe hearing loss. However, these patients may also present vestibular aqueduct (VA) abnormalities.

MATERIALS AND METHODS

In this prospective study (38RC14.428 for healthy subjects/38RC15.173 for patients), imaging was carried out on a 3T MRI scanner. Twenty healthy subjects (13 women, median age 53.5 [52.2-66.7]) and twenty MD patients (9 women, median age 54.5 [52-66.7]) had MRI scans with 3D-FLAIR sequences without injection, then 4 hours after a single intra-venous dose of contrast agent. Two radiologists independently ranked the morphology of the VA in the healthy subjects and in MD patients, using a three-level score (completely visible, discontinuous and not visible). Each subject was then graded, based on both the VA's appearance and on saccular hydrops presence. Inter-reader agreement tests were performed.

RESULTS

In controls and patients, VA modifications were symmetrical without significant difference between the symptomatic and asymptomatic ears. The presence of at least one ear with discontinuous VA showed a correlation with clinical MD (P < 0.001) with a sensitivity of 90%. Ten patients had saccular hydrops, but only in the symptomatic ears. The evaluation of VA did not differ between MRI, both within MRI series or between the two radiologists (kappa without and with contrast agent = 0.9 and 0.92 respectively).

CONCLUSION

Analysis of the vestibular aqueduct by MRI detects abnormalities in both ears of patients with unilateral MD.

Postoperative MR imaging features after superior semicircular canal plugging in Minor syndrome

PURPOSE

To report the postoperative magnetic resonance imaging (MRI) features after superior semicircular canal plugging in patients with Minor syndrome.

MATERIALS AND METHODS

The MRI examinations with 3D T2-weighted SPACE sequence of 12 patients with superior semicircular canal dehiscence syndrome (SCDS) were retrospectively assessed. Two radiologists independently evaluated the presence of a filling defect of the superior semicircular canal above the superior ampulla and the common crus using an oblique plane parallel to the superior semicircular canal (Pöschl's plane).

RESULTS

Postoperative MRI showed a filling defect above the ampulla of the superior semicircular canal and the common crus in 8/12 patients (67%). Three patients (3/12; 25%) had a filling defect involving also the superior ampulla that caused postoperative labyrinthitis with labyrinthine enhancement on MRI in 2 patients. One patient (1/12; 8%) had incomplete plugging of superior semicircular canal with abnormal functional tests and remaining symptoms.

CONCLUSION

Postoperative MRI shows a normal plugging aspect of the superior semicircular canal in 67% of patients. MRI can reveal complications that may have therapeutic implications.

Imaging of the saccule for the diagnosis of endolymphatic hydrops in Meniere disease, using a three-dimensional T2-weighted steady state free precession sequence: accurate, fast, and without contrast material intravenous injection

BACKGROUND

Endolymphatic hydrops can be studied on magnetic resonance imaging (MRI) using images acquired 4 h after intravenous injection of Gd-chelate. Our aim was to compare high-resolution T2-weighted images of the saccule in normal subjects with histological sections from cadavers and to identify its changes in Meniere disease, compared to healthy volunteers.

METHODS

Sixty-four healthy volunteers without any otologic disease and 64 patients who fulfilled all the criteria for unilateral Meniere disease underwent 3 T MRI using a T2-weighted steady state free precession (SSFP) sequence, without contrast material injection. Images of healthy volunteers were compared with histological sections of normal inner ears from premature foetuses and compared with volunteers.

RESULTS

The normal saccule was easily visible on T2-weighted images in volunteers, with a normal maximal height of 1.6 mm (1.4 ± 0.1 mm, mean ± standard deviation) and a good correlation with reference histological sections, while in Meniere disease the saccule was dilated in 52/62 patients (84%), with a saccular height greater than 1.6 mm (1.69 ± 0.24 mm, p = 0.001), found in 45/52 patients (86%). An associated increased width (greater than 1.4 mm) was found in 23/52 patients (44%). A round shape or the non-visualisation of the saccule were also found in 2/52 (4%) and in 5/62 patients (8%), respectively.

CONCLUSIONS

A T2-weighted sequence is an easy method to diagnose Meniere disease. Saccular abnormalities were found in 84% of the cases: elongation (height > 1.6 mm) in 86%, increased saccular width in 44%, or a missing saccule in 8%.

Endolymphatic hydrops imaging: Differential diagnosis in patients with Meniere disease symptoms

PURPOSE

The goal of this retrospective study was to investigate the differential diagnosis of endolymphatic hydrops in patients with Meniere's disease (MD) symptoms by using magnetic resonance imaging (MRI) with intravenous injection of gadolinium chelate and delayed acquisition.

MATERIAL AND METHOD

Two hundred patients (133 women, 67 men; mean age=67.2±11 ([SD] years) with unilateral MD underwent MRI at 3-T, between 4.5 and 5.5hours after intravenous administration of gadoterate meglumine at a dose of 0.1mmol/kg. MR images were analyzed for the presence of saccular hydrops, perilymphatic fistulae, inner ear malformations, semicircular canal (SCC) abnormal enhancement and brain lesions. We also tested the potential relationship between past history of gentamicin intratympanic administration and perilymphatic fistula presence and SCC aspect.

RESULTS

Saccular hydrops were found in 96/200 patients with MD (48%). Three patients (1.5%) had perilymphatic fistulas associated with saccular hydrops, as confirmed by surgery. There was a correlation between the presence of perilymphatic fistula and past history of intratympanic gentamicin administration (P=0.02). We detected inner ear malformations in 5 patients (2.5%), SCC local enhancement in 15 patients (7.5%) always on the same side than the clinical symptoms of MD. There was a correlation between the presence of SCC abnormal enhancement and past intratympanic gentamicin administration (P=0.001). Five patients (2.5%) had brain lesions along central cochleovestibular pathways.

CONCLUSION

MRI may reveal brain lesions, SCC abnormalities and perilymphatic fistulae in patients with clinical MD.