Steve Connor1,2,3, Kate Hulley4, Christian Burd2, Nikul Amin5, Irumee Pai1,5. 1. School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London, UK. 2. Department of Radiology, Guy's and St Thomas' Hospital, London, UK. 3. Neuroradiology Department, King's College Hospital, London, UK. 4. Department of Radiology, Medway Maritime Hospital, Kent, Gillingham, UK. 5. Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, UK.
Abstract
OBJECTIVES: Delayed post-gadolinium 3D fluid-attenuated inversion recovery (FLAIR) MRI is used to support a diagnosis of Ménière's disease (MD) with the ratio of the endolymphatic space (ES) to the sum of the endolymphatic and perilymphatic spaces (SEPS) on a cross-section through the vestibule being a key diagnostic criterion. It was hypothesised that the exact definition of the vestibular cross-section would influence the ES: SEPS ratio, its ability to diagnose MD, and its reproducibility. METHODS: Following institutional approval, 22 patients (five male, 17 female; mean age 52.1) with unilateral MD and delayed post-gadolinium 3D FLAIR MRI were retrospectively analysed. Two observers measured the ES and SEPS on predefined axial (superior and inferior) and sagittal vestibular cross-sections. Receiver operating characteristic (ROC) curves, Bland-Altman plots and intraclass correlation (ICC) were analysed for the ES:SEPS ratios. RESULTS: The area under the curve (AUC) was decreased for the ES:SEPS ratios on the superior axial section through the vestibule (AUC 0.737) compared to the inferior axial (AUC 0.874) and sagittal sections (AUC 0.878). The resulting optimal thresholds (sensitivities/specificities) were 0.21 (0.66/0.75), 0.16 (0.77/0.9) and 0.285 (0.75/0.96). The reproducibility was excellent for all measures with ICCs of 0.97, 0.98 and 0.99. CONCLUSION: Inferior axial or sagittal vestibular cross-sections are more accurate for the diagnosis of MD ears and have excellent reproducibility. ADVANCES IN KNOWLEDGE: The choice of vestibular cross-section influences both the ability to distinguish MD from asymptomatic contralateral ears, and the optimum threshold ES:SEPS value.
OBJECTIVES: Delayed post-gadolinium 3D fluid-attenuated inversion recovery (FLAIR) MRI is used to support a diagnosis of Ménière's disease (MD) with the ratio of the endolymphatic space (ES) to the sum of the endolymphatic and perilymphatic spaces (SEPS) on a cross-section through the vestibule being a key diagnostic criterion. It was hypothesised that the exact definition of the vestibular cross-section would influence the ES: SEPS ratio, its ability to diagnose MD, and its reproducibility. METHODS: Following institutional approval, 22 patients (five male, 17 female; mean age 52.1) with unilateral MD and delayed post-gadolinium 3D FLAIR MRI were retrospectively analysed. Two observers measured the ES and SEPS on predefined axial (superior and inferior) and sagittal vestibular cross-sections. Receiver operating characteristic (ROC) curves, Bland-Altman plots and intraclass correlation (ICC) were analysed for the ES:SEPS ratios. RESULTS: The area under the curve (AUC) was decreased for the ES:SEPS ratios on the superior axial section through the vestibule (AUC 0.737) compared to the inferior axial (AUC 0.874) and sagittal sections (AUC 0.878). The resulting optimal thresholds (sensitivities/specificities) were 0.21 (0.66/0.75), 0.16 (0.77/0.9) and 0.285 (0.75/0.96). The reproducibility was excellent for all measures with ICCs of 0.97, 0.98 and 0.99. CONCLUSION: Inferior axial or sagittal vestibular cross-sections are more accurate for the diagnosis of MD ears and have excellent reproducibility. ADVANCES IN KNOWLEDGE: The choice of vestibular cross-section influences both the ability to distinguish MD from asymptomatic contralateral ears, and the optimum threshold ES:SEPS value.
Authors: J M van Steekelenburg; A van Weijnen; L M H de Pont; O D Vijlbrief; C C Bommeljé; J P Koopman; B M Verbist; H M Blom; S Hammer Journal: AJNR Am J Neuroradiol Date: 2020-02-06 Impact factor: 3.825
Authors: G Conte; L Caschera; S Calloni; S Barozzi; F Di Berardino; D Zanetti; C Scuffi; E Scola; C Sina; F Triulzi Journal: AJNR Am J Neuroradiol Date: 2018-10-18 Impact factor: 3.825