三维快速液体衰减反转恢复序列增强后延迟扫描对内耳淋巴积水磁共振成像的探讨

Magnetic resonance imaging study of endolymphatic hydrops based on 3D-FLAIR sequence after single-dose intravenous gadolinium injection

目的通过常规静脉注射单倍剂量钆对比剂,行内耳磁共振三维快速液体衰减反转恢复序列(3D-FLAIR)延迟扫描,初步探讨耳源性眩晕患者内淋巴成像的可行性,并进一步评估内淋巴积水情况。方法分析2017年10月至2018年6月就诊于首都医科大学附属北京同仁医院单侧耳源性眩晕患者30例,其中男16例、女14例,年龄30-68(53±10)岁,患者均经静脉注射单倍剂量(0.1mmol/kg)钆喷酸葡胺(Gd-DTPA),8h后行内耳3D-FLAIR序列扫描,观察外淋巴显影情况,由两名影像医师独立判断内淋巴有无积水及积水部位,并定量分析评估内淋巴积水程度。采用一致性检验对两名医师内淋巴积水部位、积水程度评估结果进行分析;使用配对t检验比较患侧与健侧内淋巴间隙面积的差异。结果30例患者内耳3D-FLAIR磁共振图像清晰显示钆对比剂分布于耳蜗、前庭外淋巴间隙,并能准确地勾勒出内、外淋巴间隙的界限。本组26例患者(26/30,86.7%)发现单侧内淋巴积水,其中轻度积水18例,显著积水8例,且两名医师对内淋巴积水程度评估一致性非常好(kappa值为0.864,组内相关系数为0.959);本组26例内淋巴积水患者3D-FLAIR磁共振图像中,球囊(26/26,100%)较耳蜗(16/26,61.5%)及椭圆囊(14/26,53.8%)对内淋巴积水显示率更高,两名医师对于内淋巴积水部位评估一致性非常好(kappa值为0.820);本组研究患侧与健侧内淋巴间隙的面积差异有统计学意义(P<0.01)。结论经静脉注射单倍剂量钆对比剂内耳3D-FLAIR磁共振成像技术是可行的,能够预估耳源性眩晕患者的内淋巴积水,并可对积水程度进行精准定量分级。

Objective To investigate the visualization of endolymph in patients with otogenic vertigo by intravenous administration of single dose of gadolinium contrast agents and magnetic resonance three-dimensional fluid-attenuated inversion recovery sequence (3D-FLAIR MRI), and further assess the extent of endolymphatic hydrops. Methods From Beijing Tongren Hospital of Capital Medical University between October 2017 and June 2018, 30 patients (16 males, 14 females) with unilateral otogenic vertigo were involved in this study, with the age of 30 to 68 years, mean age of (53±10) years. Eight hours after intravenous administration of single dose (0.1 mmol/kg, body weight) of gadopentetate (Gd-DTPA), 3D-FLAIR sequence was performed in 30 patients. The location of endolymphatic hydrops was observed and then the degree of hydrops was quantitatively elevated by two radiologists. The consistency test was used to analyze the location and degree of endolymphatic hydrops in the two radiologists and the paired t-test was used to compare the difference between the affected and healthy side of endolymphatic spaces of the patients with otogenic vertigo. Results In 30 patients, the gadolinium distributed in all parts of the perilymph inside the inner ear, and can accurately outline the boundaries of the peri-and endolymph. Twenty-six patients (26/30, 86.7%) were found to have unilateral endolymphatic hydrops, including 18 mild hydrops, 8 significant hydrops. The two radiologists had a very good agreement on the assessment of endolymphatic hydrops(kappa=0.864, ICC=0.959). In the 3D-FLAIR MR images of 26 patients with endolymphatic hydrops, the saccule (26/26, 100%) had a higher rate of hydrops than the cochlea and utricle(16/26, 61.5%;14/26, 53.8%), and two radiologists had a very good agreement on the location of endolymphatic hydrops(kappa=0.820). Moreover, there was a significantly statistical difference between the affected and healthy area of the endolymphatic space in this study (P<0.01). Conclusion The technique of 3D-FLAIR MR imaging through single dose intravenous gadolinium injection is feasible, which can estimate endolymphatic hydrops in patients with otogenic vertigo, and accurately classify the degree of hydrops.