Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle–Delayed 3D-FLAIR Sequences in Menière Disease

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The authors compared the degree of perilymphatic enhancement and the detection rate of endolymphatic hydrops using constant and variable flip angle sequences in 16 patients with 3T MR imaging. Both for symptomatic and asymptomatic ears, the median signal intensity ratio was significantly higher with the constant flip angle than with the heavily-T2 variable flip angle. Cochlear blood-labyrinth barrier impairment was observed in 4/18 symptomatic ears with the heavily-T2 variable flip angle versus 8/19 with constant flip angle sequences. They conclude that 3D-FLAIR constant flip angle sequences provide a higher signal intensity ratio and are superior to heavily-T2 variable flip angle sequences in reliably evaluating the cochlear blood-labyrinth barrier impairment.

Abstract

BACKGROUND AND PURPOSE

Figure 1 from Nahmani et al
A 42-year-old woman with right possible MD. Axial 3D-FLAIR CFA at the level of the lateral semicircular canal (A) shows a normal utricle (white arrow) and lateral ampulla (right dotted arrow). C, Axial 3D-FLAIR CFA through the inferior part of the vestibule shows a normal saccule (white arrow) and posterior ampulla (white dotted arrow). Axial 3D-FLAIR heavily-T2 VFA at the level of the lateral semicircular canal (B) shows a normal utricle (white arrow), while the lateral ampulla (right dotted arrow) is barely visible. D, Axial 3D-FLAIR heavily-T2 VFA through the inferior part of the vestibule shows a normal saccule (white arrow) and posterior ampulla (white dotted arrow).

Endolymphatic hydrops in patients with Menière disease relies on delayed postcontrast 3D-FLAIR sequences. The purpose of this study was to compare the degree of perilymphatic enhancement and the detection rate of endolymphatic hydrops using constant and variable flip angles sequences.

MATERIALS AND METHODS

This was a retrospective study performed in 16 patients with Menière disease who underwent 3T MR imaging 4 hours after gadolinium injection using two 3D-FLAIR sequences with a constant flip angle at 140° for the first and a heavily-T2 variable flip angle for the second. The signal intensity ratio was measured using the ROI method. We graded endolymphatic hydrops and evaluated the cochlear blood-labyrinth barrier impairment.

RESULTS

Both for symptomatic and asymptomatic ears, the median signal intensity ratio was significantly higher with the constant flip angle than with the heavily-T2 variable flip angle (7.16 versus 1.54 and 7.00 versus 1.45, P < .001). Cochlear blood-labyrinth barrier impairment was observed in 4/18 symptomatic ears with the heavily-T2 variable flip angle versus 8/19 with constant flip angle sequences. With heavily-T2 variable flip angle sequences, endolymphatic hydrops was observed in 7–10/19 symptomatic ears versus 12/19 ears with constant flip angle sequences. We found a significant association between the clinical symptomatology and the presence of endolymphatic hydrops with constant flip angle but not with heavily-T2 variable flip angle sequences. Interreader agreement was always perfect with constant flip angle sequences while it was fair-to-moderate with heavily-T2 variable flip angle sequences.

CONCLUSIONS

3D-FLAIR constant flip angle sequences provide a higher signal intensity ratio and are superior to heavily-T2 variable flip angle sequences in reliably evaluating the cochlear blood-labyrinth barrier impairment and the endolymphatic space.

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Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle–Delayed 3D-FLAIR Sequences in Menière Disease
Jeffrey Ross
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