经静脉内耳延迟增强3D-CUBE-FLAIR MRI内淋巴积水与外淋巴强化鉴别诊断梅尼埃病

Endolymphatic hydrops and perilymphatic enhancement on intravenous delayed-enhanced 3D-CUBE-FLAIR MRI of inner ear for differentiating Ménière's disease

目的观察经静脉内耳延迟增强三维快速液体衰减反转恢复序列(3D-CUBE-FLAIR)MRI所示内淋巴积水(EH)和外淋巴强化(PE)鉴别梅尼埃病(MD)与其他眩晕相关内耳疾病的价值。方法回顾性分析55例眩晕患者内耳延迟增强3D-CUBE-FLAIR MRI,根据MD临床实践指南将其分为MD组(n=19)及非MD组(n=36),分别包含20及45只患耳;评估EH及PE并计算其占比,比较组间差异,分析其鉴别诊断价值。结果MD组20只患耳中,15只(15/20,75.00%)存在前庭EH,包括Ⅰ°、Ⅱ°EH各6只及Ⅲ°EH 3只,其中6只同时存在耳蜗EH(Ⅰ°、Ⅱ°EH各3只);10只(10/20,50.00%)可见PE,其中9只(9/20,45.00%)同时可见EH及PE。非MD组共45只患耳中,9只(9/45,20.00%)存在前庭EH,包括4只Ⅰ°、5只Ⅱ°EH,其中3只同时存在耳蜗Ⅰ°EH;25只(25/45,55.56%)可见PE,其中6只(6/45,13.33%)同时存在EH及PE。组间EH占比及同时出现EH+PE占比差异均有统计学意义(P均<0.05)。以EH、PE及EH+PE鉴别MD与其他眩晕相关内耳疾病的敏感度分别为75.00%、50.00%及45.00%,特异度分别为80.00%、44.44%及86.67%。结论经静脉内耳延迟增强3D-CUBE-FLAIR MRI EH和PE征象有助于鉴别MD与其他眩晕相关内耳疾病。

Objective To observe the value of endolymphatic hydrops(EH)and perilymphatic enhancement(PE)on intravenous delayed-enhanced three-dimensional cube fluid-attenuated inversion recovery sequence(3D-CUBE-FLAIR)MRI of inner ear for differentiating Ménière's disease(MD)from other vertigo-associated inner ear diseases.Methods Inner ear delayed enhanced 3D-CUBE-FLAIR MRI data of 55 patients with dizziness were retrospectively analyzed.The patients were divided into MD group(19 cases with 20 affected ears)or non MD group(36 cases with 45 affected ears)according to MD clinical practice guidelines.EH and PE were evaluated,the ratio of EH,PE and EH+PE were calculated and compared between groups,and the differential diagnostic values were explored.Results In 20 affected ears of MD group,vestibular EH was observed in 15 ears(15/20,75.00%),including 6 ofⅠ°,6 ofⅡ°and 3 ofⅢ°EH,and cochlear EH was simultaneously noted in 6 ears,3 withⅠ°and 3 withⅡ°EH.PE was detected in 10 ears(10/20,50.00%),among which 9(9/20,45.00%)with EH.In 45 affected ears of non MD group,vestibular EH was found in 9 ears(9/45,20.00%),among which 3 were found with cochlear EH simultaneously,25(25/45,55.56%)with PE and 13.33%(6/45)with both EH and PE.Among 9 ears with vestibular EH(4 withⅠ°and 5 withⅡ°)in non MD group,3 ears complicated with cochlear EH ofⅠ°.Significant differences of the proportion of EH and EH+PE were found between groups(both P<0.05).The sensitivity of EH,PE and EH+PE for differentiating MD from other vertigo-associated inner ear diseases was 75.00%,50.00%and 45.00%,respectively,and the specificity was 80.00%,44.44%and 86.67%,respectively.Conclusion EH and PE on inner ear intravenous delayed-enhanced 3D-CUBE-FLAIR MRI were helpful for differentiating MD from other vertigo-associated inner ear diseases.