内耳内淋巴积液MR诊断中的测量差异及方法回顾
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摘要
目的探讨两种MR扫描增强扫描方法在梅尼埃患者内淋巴积液中的作用价值及差异。方法 31例单侧型梅尼埃患者,每位患者均提前24 h接受双耳稀释8倍的钆对比剂(马根维显)鼓室注药后行MRI,对3D-real IR、3DFLAIR两种序列所显示的外半规管环完全显露的前庭最下方层面及后半规管部分显影的前庭层面内淋巴积液的程度进行评价和显示,并回顾了目前国内外显示内淋巴积液的扫描技术及测量方法。结果选取外半规管环完全显露的前庭最下方层面在两种序列(3D-real IR,3D-flair)并测量内淋巴积液程度,两组内淋巴间隙百分比分别为(39.48±18.35)%和(29.30±17.17)%,差异有统计学意义(P=0.004),经MPR处理后显示后半规管部分显影的层面,3D-real IR序列和3DFLAIR序列所测得的前庭区内淋巴液占总淋巴液范围比例分别为(48.29±10.03)%和(40.18±13.87)%,差异有统计学意义(P=0.002)。3D-real IR序列获得图像中分别选取外半规管环完全显露的前庭最下方层面及和后半规管部分显影的前庭层面,两者所测得内淋巴积液程度有统计学差异(P=0.004)。3D-FLAIR序列中选取外半规管环完全显露的前庭最下方层面进行测量和后半规管部分显影的层面,两者所测得内淋巴积液程度也存在统计学差异(P<0.05),在中重度内淋巴积液的患者中更为明显。结论 3D-real IR和3D-FLAIR两种序列对不同层面测量前庭内淋巴积液范围的评估存在差异,在中重度内淋巴积水患者中差异更明显。
Objective To compare the endolymphatic hydrops measurement methods in Meniere 's Disease(MD). Methods Three-dimensional fluid-attenuated inversion recovery(3D-FLAIR) and 3D real inversion recovery(IR) MRI was performed on 31 patients with unilateral MD at 24 hours after bilateral intratympanic injection of gadolinium. The ratios of endolymph fluid to the total fluid-filled areas were measured in the inferior slice of vestibule where the lateral semicircular canal was visible and in the slice at the level of the posterior semicircular canal. Results The percentage of endolymphatic hydrops at the vestibule level was significantly higher(P =0.004, 0.002) on IR-(39.48 ±18.35%, 48.29 ±10.03%) than that on FLAIR-(29.30 ±17.17%, 40.18 ±13.87%)weighted sequences at both the levels of vestibule and posterior semicircular canal, respectively. Significant difference was also found in the measurements of endolymphatic hydrops between the two slice positions on both IR (P =0.004) and FLAIR(P <0.05) imaging.Conclusion Measurements of endolymphatic hydrops vary with MRI slice position and pulse sequences.
Objective To compare the endolymphatic hydrops measurement methods in Meniere 's Disease(MD). Methods Three-dimensional fluid-attenuated inversion recovery(3D-FLAIR) and 3D real inversion recovery(IR) MRI was performed on 31 patients with unilateral MD at 24 hours after bilateral intratympanic injection of gadolinium. The ratios of endolymph fluid to the total fluid-filled areas were measured in the inferior slice of vestibule where the lateral semicircular canal was visible and in the slice at the level of the posterior semicircular canal. Results The percentage of endolymphatic hydrops at the vestibule level was significantly higher(P =0.004, 0.002) on IR-(39.48 ±18.35%, 48.29 ±10.03%) than that on FLAIR-(29.30 ±17.17%, 40.18 ±13.87%)weighted sequences at both the levels of vestibule and posterior semicircular canal, respectively. Significant difference was also found in the measurements of endolymphatic hydrops between the two slice positions on both IR (P =0.004) and FLAIR(P <0.05) imaging.Conclusion Measurements of endolymphatic hydrops vary with MRI slice position and pulse sequences.
引文
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[8]Naganawa S,Satake H,Kawamura M,et al.Separate visualization of endolymphatic space,perilymphatic space and bone by a single pulse sequence;3D-inversion recovery imaging utilizing real reconstruction after intratympanic Gd-DTPA administration at 3 Tesla.Eur Radiol,2008,18:920-924.
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[10]Wang F,Lyu H,Zhao M,et al.Assessment of Cochlea Endolymphatic Hydrops Using 3-D FLAIR and 3-D Real IRSequence in Guinea Pigs via 3T MRI After Intratympanic Gadolinium:A Histopathological Comparison.Otol Neurotol,2017,38:585-590.
[11]Shi H,Li Y,Yin S,et al.The predominant vestibular uptake of gadolinium through the oval window pathway is compromised by endolymphatic hydrops in Ménière's disease.Otol Neurotol,2014,35:315-322.
[12]Gürkov R,Flatz W,Louza J,et al.In vivo visualized endolymphatic hydrops and inner ear functions in patients with electrocochleographically confirmed Ménière's disease.Otol Neurotol,2012,33:1040-1045.
[13]Liu F,Huang W,Meng X,et al.Comparison of noninvasive evaluation of endolymphatic hydrops in Meniere's disease and endolymphatic space in healthy volunteers using magnetic resonance imaging.Acta Otolaryngol,2012,132:234-240.
[14]Kato M,Teranishi M,Katayama N,et al.Association between endolymphatic hydrops as revealed by magnetic resonance imaging and caloric response.Otol Neurotol,2011,32:1480-1485.
[15]Fukuoka H,Tsukada K,Miyagawa M,et al.Semi-quantitative evaluation of endolymphatic hydrops by bilateral intratympanic gadolinium-based contrast agent(GBCA)administration with MRI for Meniere's disease.Acta Otolaryngol,2010,130:10-16.
[16]Fang ZM,Chen X,Gu X,et al.A new magnetic resonance imaging scoring system for perilymphatic space appearance after intratympanic gadolinium injection,and its clinical application.J Laryngol Otol,2012,126:454-459.
[17]Naganawa S,Ishihara S,Iwano S,et al.Three-dimensional(3D)visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPA:optimization of a 3D-real inversionrecovery turbo spin-echo(TSE)sequence and application of a32-channel head coil at 3T.J Magn Reson Imaging,2010,31:210-214.
[18]Nakada T,Yoshida T,Suga K,et al.Endolymphatic space size in patients with vestibular migraine and Ménière's disease.JNeurol,2014,261:2079-2084.
[19]Naganawa S,Yamazaki M,Kawai H,et al.Imaging of Ménière's disease by subtraction of MR cisternography from positive perilymph image.Magn Reson Med Sci,2012,11:303-309.
[20]Naganawa S,Kawai H,Taoka T,et al.Improved 3D-real Inversion Recovery:A Robust Imaging Technique for Endolymphatic Hydrops after Intravenous Administration of Gadolinium.Magn Reson Med Sci,2019,18:105-108.
[21]AttyéA,Eliezer M,Boudiaf N,et al.MRI of endolymphatic hydrops in patients with Meniere's disease:a case-controlled study with a simplified classification based on saccular morphology.Eur Radiol,2017,27:3138-3146.
[2]Patel VA,Oberman BS,Zacharia TT,et al.Magnetic resonance imaging findings in Ménière's disease.J Laryngol Otol,2017,131:602-607.
[3]Counter SA,Bjelke B,Klason T,et al.Magnetic resonance imaging of the cochlea,spiral ganglia and eighth nerve of the guinea pig.Neuroreport,1999,10:473-479.
[4]中华医学会耳鼻咽喉科学分会.梅尼埃病的诊断依据和疗效评估(2006年,贵阳).中华耳鼻咽喉头颈外科杂志,2007,42:163.
[5]Nakashima T,Naganawa S,Pyykko I,et al.Grading of endolymphatic hydrops using magnetic resonance imaging.Acta Otolaryngol Suppl,2009:5-8.
[6]路虹,李书玲,徐鸥,等.伴有眩晕的突发性聋患者内耳MRI水成像观察和研究.临床耳鼻咽喉科杂志,2005,19:468-469.
[7]Nakashima T,Naganawa S,Sugiura M,et al.Visualization of endolymphatic hydrops in patients with Meniere's disease.Laryngoscope,2007,117:415-420.
[8]Naganawa S,Satake H,Kawamura M,et al.Separate visualization of endolymphatic space,perilymphatic space and bone by a single pulse sequence;3D-inversion recovery imaging utilizing real reconstruction after intratympanic Gd-DTPA administration at 3 Tesla.Eur Radiol,2008,18:920-924.
[9]Nakashima T,Naganawa S,Katayama N,et al.Clinical significance of endolymphatic imaging after intratympanic gadolinium injection.Acta Otolaryngol Suppl,2009:9-14.
[10]Wang F,Lyu H,Zhao M,et al.Assessment of Cochlea Endolymphatic Hydrops Using 3-D FLAIR and 3-D Real IRSequence in Guinea Pigs via 3T MRI After Intratympanic Gadolinium:A Histopathological Comparison.Otol Neurotol,2017,38:585-590.
[11]Shi H,Li Y,Yin S,et al.The predominant vestibular uptake of gadolinium through the oval window pathway is compromised by endolymphatic hydrops in Ménière's disease.Otol Neurotol,2014,35:315-322.
[12]Gürkov R,Flatz W,Louza J,et al.In vivo visualized endolymphatic hydrops and inner ear functions in patients with electrocochleographically confirmed Ménière's disease.Otol Neurotol,2012,33:1040-1045.
[13]Liu F,Huang W,Meng X,et al.Comparison of noninvasive evaluation of endolymphatic hydrops in Meniere's disease and endolymphatic space in healthy volunteers using magnetic resonance imaging.Acta Otolaryngol,2012,132:234-240.
[14]Kato M,Teranishi M,Katayama N,et al.Association between endolymphatic hydrops as revealed by magnetic resonance imaging and caloric response.Otol Neurotol,2011,32:1480-1485.
[15]Fukuoka H,Tsukada K,Miyagawa M,et al.Semi-quantitative evaluation of endolymphatic hydrops by bilateral intratympanic gadolinium-based contrast agent(GBCA)administration with MRI for Meniere's disease.Acta Otolaryngol,2010,130:10-16.
[16]Fang ZM,Chen X,Gu X,et al.A new magnetic resonance imaging scoring system for perilymphatic space appearance after intratympanic gadolinium injection,and its clinical application.J Laryngol Otol,2012,126:454-459.
[17]Naganawa S,Ishihara S,Iwano S,et al.Three-dimensional(3D)visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPA:optimization of a 3D-real inversionrecovery turbo spin-echo(TSE)sequence and application of a32-channel head coil at 3T.J Magn Reson Imaging,2010,31:210-214.
[18]Nakada T,Yoshida T,Suga K,et al.Endolymphatic space size in patients with vestibular migraine and Ménière's disease.JNeurol,2014,261:2079-2084.
[19]Naganawa S,Yamazaki M,Kawai H,et al.Imaging of Ménière's disease by subtraction of MR cisternography from positive perilymph image.Magn Reson Med Sci,2012,11:303-309.
[20]Naganawa S,Kawai H,Taoka T,et al.Improved 3D-real Inversion Recovery:A Robust Imaging Technique for Endolymphatic Hydrops after Intravenous Administration of Gadolinium.Magn Reson Med Sci,2019,18:105-108.
[21]AttyéA,Eliezer M,Boudiaf N,et al.MRI of endolymphatic hydrops in patients with Meniere's disease:a case-controlled study with a simplified classification based on saccular morphology.Eur Radiol,2017,27:3138-3146.