梅尼埃病的内淋巴积水和积水程度3D FLAIR MRI显影

Detection and grading of endolymphatic hydrops in Ménière′s disease using 3D FLAIR MRI

目的:通过双侧经鼓室注射钆喷酸葡胺注射液,行内耳三维快速液体衰减反转恢复序列核磁共振(3DFLAIR MRI)成像,探讨梅尼埃病膜迷路积水在前庭和耳蜗显像的阳性率,评价3DFLAIR MRI成像在梅尼埃病诊断中的应用价值。方法:收集确诊为单侧梅尼埃病的48例患者,经鼓膜注射8倍稀释的钆喷酸葡胺注射液,24h后在3T场强下行内耳3DFLAIR MRI扫描,观察内、外淋巴间隙的显影情况,对内、外淋巴间隙显影范围进行测量,分析并评估内淋巴积水的程度。结果:3DFLAIR MRI显示造影剂分布到内耳外淋巴间隙,使外淋巴液显影增强,从而区分出内、外淋巴间隙。48例受试者中患耳前庭处外淋巴间隙均清晰显影,可清晰对比显示前庭处的内淋巴积水征象,其中轻度积水8例,中度积水17例,重度积水23例。达到梅尼埃病诊断标准的中度及重度积水患者共40例,诊断率为83.3%(40/48);8例(16.7%)可清晰显示耳蜗处积水。48例受试者行经鼓室钆喷酸葡胺注射后,除少数出现短暂眩晕外,均未见鼓膜穿孔、感染等并发症发生。结论:经鼓室钆喷酸葡胺注射内耳成像技术检查梅尼埃病患者膜迷路积水具有较高的阳性率,并且可以对积水程度进行轻、中和重度分级,虽为有创性检查但不良反应少,可为梅尼埃病的诊断提供直接的影像学参考依据。

Objective：To evaluate the extent of endolymphatic hydrops as shown by three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging（3DFLAIR MRI）performed 24 hours after bilateral intratympanic gadolinium administration and discuss the positive rate of endolymphatic hydrops in vestibule and cochlea.Method：Twenty-four hours after bilateral intra-tympanic 8times diluted gadolinium administration,threedimensional fluid-attenuated inversion recovery MRI,using a three-Tesla unit,was performed in 48 patients,and then assessed the extent of endolymphatic hydrops in the MRI images.Result：Forty-eight patients showed different levels of enhancement of perilymth in the inner ear.In these patients,obvious signs of endolymphatic hydrops were visualized in vestibule,including 8slight hydrops,17 mild hydrops and 23 severe hydrops with a diagnostic rate of 83.3%.There were almost no complications in all 48 patients after bilateral intra-tympanic injection except short vertigo in some of them.Conclusion：3DFLAIR MRI resonance imaging has a high positive diagnostic rate in assessing endolymphatic hydrops of Ménière′s disease and provides direct imaging evidence for diagnosing Ménière′s disease.