Practical imaging for Ménière's disease

Abstract

Ménière's disease (MD) is a chronic disorder of the inner ear characterized by vertigo, hearing loss, tinnitus, and aural fullness. The pathophysiology of MD involves endolymphatic hydrops, an abnormal accumulation of endolymph fluid, although the exact cause remains unclear, potentially involving genetic, environmental, and autoimmune factors. Recent advancements in magnetic resonance imaging have significantly enhanced diagnostic capabilities. This technique uses gadolinium-based contrast agents to differentiate between endolymph and perilymph. Imaging techniques such as 3-dimensional fluid-attenuated inversion recovery and 3-dimensional-real-inversion recovery sequences are used to classify endolymphatic hydrops into grades based on the severity of dilation in the cochlea and vestibule. The degree of perilymphatic enhancement, indicative of blood-labyrinthine barrier breakdown, further aids in diagnosing MD. Accurate diagnosis relies on distinguishing between perilymphatic and endolymphatic enhancement patterns and recognizing mimicking conditions.