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

Abstract

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.

Chinese abstract

背景：延迟的3D-FLAIR序列可以用来区分胞囊和球囊。

目的：探讨无可见球囊（NVS）的患者在4小时后增强磁共振成像（MRI）上的临床和影像学表现。

材料与方法：回顾性分析400例接受延迟内耳MRI检查的的患者的NVS征象。

结果：我们报告了28例NVS患者。这群患者的NVS患侧：14例有孤立性感觉神经性听力损失（SNHL）；4例患有波动性耳蜗前庭病；3例有明确的梅尼埃病；3例有轻微综合征；2例有迟发性内淋巴积水（EH）；2例有内耳畸形；1例镫骨手术后突然出现耳蜗前庭缺损；1例有外淋巴瘘, 1例有对侧SNHL波动。28例患者中16例（57.1%）在NVS一侧有耳蜗积水, 10例（35.7%）对侧有囊状积水。7例NVS侧出现孤立性血迷路屏障（BLB）损伤。两位患者（7.1%）的大前庭导水管和NVS在同一侧；一位患者有外淋巴瘘。

结论和意义：NVS可能是多因素的, 可能与耳积水病、第三活动窗病变和先天畸形有关。

Keywords:

• MRI
• endolymphatic hydrops
• Menière’s disease

Disclosure statement

The authors report no conflict of interest.