经静脉内耳钆造影证实的梅尼埃病的临床特征及钆造影特点

Clinical features and imaging characteristics of Meniere＇s disease verified by intravenous gadolinium contrast-enhanced magnetic resonance imaging

目的总结分析经静脉钆造影证实有内淋巴积水（EH）的梅尼埃病（MD）患者临床特征，并探讨其内耳造影特点。 方法2016年3月至2017年10月就诊于复旦大学附属眼耳鼻喉科医院耳科门诊的174例MD患者，经静脉注射钆喷酸葡胺造影剂行内耳三维快速液体衰减反转恢复磁共振成像（3D－FLAIR MRI），均存在EH且临床特征可疑MD。详细分析所有患者的临床特征，应用Nakashima分级标准对积水程度进行分级并评估其与临床表现的相关性。 结果174例患者中，男88例，女86例，就诊年龄7～83（51.0±15.0）岁；发病年龄7～83（44.6±16.6）岁；病程36.0（12.0，111.0）个月（2 d～70年）。MRI显示均存在EH，169例（97.1%）为中重度积水，139例（79.9%）为单耳EH，35例（20.1%）存在双耳EH。174例患者的临床症状表现不一，不完全符合已有的诊断标准。与单耳积水患者相比，双耳积水患者的首发症状耳的积水程度更严重。积水程度与听力下降程度相关（P〈0.05）。 结论经静脉内耳钆造影可对EH程度及分布进行有效地评估；由钆造影MRI检查证实有EH的MD患者，临床特征并非完全符合已有的诊断标准；将EH列入MD的诊断标准可提高MD的诊断率；EH的积水程度及分布与听力下降程度相关。

ObjectiveTo analyze the clinical features and imaging characteristics of Meniere′s disease（MD）verified by intravenous gadolinium contrast-enhanced magnetic resonance imaging（MRI）. MethodsA total of 174 patients with Meniere′s disease were involved in this study between March 2016 and October 2017.All of them underwent 3D-fluid attenuated inversion recovery（FLAIR）MRI and presented endolymphatic hydrops and clinical characteristics of suspected Meniere′s disease.The clinical characteristics,the grades of endolymphatic hydrops（EH）using Nakashima grading standard were analyzed,and the correlation between grade and clinical features was evaluated. ResultsThere were totally 174 patients（88 males,86 females）,with the age of 7-83 years[mean age of（51.0±15.0）]years.Age of onset and disease course was 7-83 years[mean age of（44.6±16.6）years],36.0（12.0,111.0）months（from 2 days to 70 years）,respectively.EH was found in all the patients,and 169 cases（97.1%）manifested as modest or severe hydrops.Among the 174 patients,139 cases（79.9%）presented unilateral EH,and 35 cases（20.1%）presented bilateral EH.The degree of EH in the latter was more serious than the former.For 174 patients,clinical characteristics were inconsistent,which was not in accord with the existing diagnostic criteria.Furthermore,there was a correlation between degree of hydrops and degree of hearing loss（P〈0.05）. ConclusionsEH in Meniere′s disease can be measured objectively by intravenous gadolinium contrast-enhanced MRI.Clinical characteristics in MD verified by EH are not accordant with the existing criteria,which means the significance of EH in diagnosis of MD.Moreover,there′s a correlation between degree and distribution of hydrops and degree of hearing loss.