The vestibular aqueduct sign: Magnetic resonance imaging can detect abnormalities in both ears of patients with unilateral Meniere's disease - 23/11/18

Doi : 10.1016/j.neurad.2018.10.003

Arnaud Attyé ^a,^b,^c,^⁎ , Marion Barma ^a, Sébastien Schmerber ^b,^d, Georges Dumas ^b,^d, Michael Eliezer ^e, Alexandre Krainik ^a,^b,^c
^a Department of neuroradiology and MRI, Grenoble university hospital, 38000 Grenoble France
^b University Grenoble Alpes, 38000 Grenoble, France
^c IRMaGe, inserm US 17, CNRS UMS 3552, 38000 Grenoble, France
^d Department of otolaryngology, Grenoble university hospital, 38000 Grenoble, France
^e Department of radiology, Lariboisiere university hospital, 75000 Paris, France

^⁎Corresponding author at: Neuroradiology and MRI Department, CS 10217, Grenoble university hospital, 38043 Grenoble cedex 9, France.Neuroradiology and MRI Department, CS 10217, Grenoble university hospitalGrenoble cedex 938043France

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Highlights

•	Vestibular aqueduct obstruction with MRI is frequent in Meniere's Disease.
•	It can be seen in both ears of patients with unilateral Meniere's Disease.
•	Vestibular aqueduct morphology can be analyzed without contrast media injection.

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Abstract

Background and purpose

In patients with Meniere's disease (MD), saccular hydrops can only be studied by magnetic resonance imaging (MRI) at a late stage when the disease is already responsible for moderate to severe hearing loss. However, these patients may also present vestibular aqueduct (VA) abnormalities.

Materials and methods

In this prospective study (38RC14.428 for healthy subjects/38RC15.173 for patients), imaging was carried out on a 3T MRI scanner. Twenty healthy subjects (13 women, median age 53.5 [52.2–66.7]) and twenty MD patients (9 women, median age 54.5 [52–66.7]) had MRI scans with 3D-FLAIR sequences without injection, then 4 hours after a single intra-venous dose of contrast agent. Two radiologists independently ranked the morphology of the VA in the healthy subjects and in MD patients, using a three-level score (completely visible, discontinuous and not visible). Each subject was then graded, based on both the VA's appearance and on saccular hydrops presence. Inter-reader agreement tests were performed.

Results

In controls and patients, VA modifications were symmetrical without significant difference between the symptomatic and asymptomatic ears. The presence of at least one ear with discontinuous VA showed a correlation with clinical MD (P < 0.001) with a sensitivity of 90%. Ten patients had saccular hydrops, but only in the symptomatic ears.

The evaluation of VA did not differ between MRI, both within MRI series or between the two radiologists (kappa without and with contrast agent = 0.9 and 0.92 respectively).