Clinical application of MIIRMR as a salvage method in gadolinium-enhanced MRI after intra-tympanic injection

Abstract

Background

Three-dimensional fluid-attenuated inversion-recovery (3 D-FLAIR) and real inversion-recovery (3 D-real IR) sequences are used to detect endolymphatic hydrops (EH), but medium inversion-time inversion-recovery imaging with magnitude reconstruction (MIIRMR) may be more sensitive.

Aims

We investigated the inner-ear visualisation success rate and EH detection rates of 3 D-FLAIR and 3 D-real IR, and whether salvage MIIRMR could improve EH detection.

Materials and Methods

Fifty-one patients (102 ears) with episodic or chronic vestibular syndrome were injected intra-tympanically with 8-fold diluted gadolinium, and 3 D-FLAIR and 3 D-real IR images obtained 24-h post-injection. If 3 D-FLAIR inner-ear visualisation failed, additional MIIRMR was performed. The success and EH detection rate increase by MIIRMR was calculated. The diagnostic performance of combined MIIRMR + 3D-FLAIR + 3D-real IR for Meniere’s disease (MD) was evaluated.

Results

The success rates of 3 D-FLAIR and 3 D-real IR were 88.90% and 72.55%, respectively. MIIRMR increased the success and EH detection rates by 11.10% and 6.86%, respectively. In MD, MIIRMR increased these rates by 10.53% and 10.53%, respectively. 3 D-FLAIR + 3D-real IR + MIIRMR had 92.11% sensitivity, 79.68% specificity, 72.92% positive-predictive value, and 94.44% negative-predictive value for MD diagnosis.

Conclusion and significance

MIIRMR can improve success and EH detection rates when 3 D-FLAIR fails. Combined MIIRMR + 3D-FLAIR + 3D-real IR is more valuable for diagnosing MD than conventional sequences.

Chinese Abstract

背景：三维流体衰减反转恢复 (3D-FLAIR) 和真实反转恢复 (3D-real IR) 序列用于检测内淋巴水肿 (EH), 但具幅度重建的中等反转时间反转恢复成像 (MIIRMR) 可能更敏感。

目的：我们研究了 3D-FLAIR和3 D-real IR 的内耳可视化成功率和 EH 检出率, 探讨了挽救性 MIIRMR 是否可以改善 EH 检测。

材料和方法：51 例（102 只耳）发作性或慢性前庭综合征患者鼓室内注射 8 倍稀释的钆, 并在注射后 24 小时拍得 3D-FLAIR 和 3D-real IR 图像。如果 3D-FLAIR 内耳可视化失败, 则再进行一次 MIIRMR。计算因MIIRMR 而提高的成功率和 EH 检测率。评估了组合的 MIIRMR + 3D-FLAIR + 3D-real IR 对梅尼埃病 (MD) 的诊断性能。

结果：3D-FLAIR和3D-real IR的成功率分别为88.90%和72.55%。 MIIRMR成功率和 EH 检测率分别提高了 11.10% 和 6.86%。对于梅尼埃病, MIIRMR将这些比率分别提高了 10.53% 和 10.53%。对于MD诊断, 3D-FLAIR + 3D-real IR + MIIRMR 具有92.11% 敏感性、79.68% 特异性、72.92% 阳性预测值和 94.44% 阴性预测值价值。

结论与意义：MIIRMR 可提高成功率和 EH 检出率, 而3D-FLAIR 却做不到。组合 MIIRMR + 3D-FLAIR + 3D-real IR 对于诊断 MD 比传统序列更有价值。

Keywords:

• 3D-FLAIR
• 3D- real IR
• MIIRMR
• gadolinium-enhanced MRI
• endolymphatic hydrops

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Guangxi Science and Technology Base and Talent Project;Independent research project on Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor.