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Research ArticleHead and Neck Imaging

A Novel MR Imaging Sequence of 3D-ZOOMit Real Inversion-Recovery Imaging Improves Endolymphatic Hydrops Detection in Patients with Ménière Disease

J. Li, L. Sun, N. Hu, L. Li, G. Song, H. Xu, T. Xu, Y. Cheng, L. Xiao, L. Wang, R. Gong and C. Li
American Journal of Neuroradiology April 2023, DOI: https://doi.org/10.3174/ajnr.A7842
J. Li
aFrom the Departments of Radiology (J.L., L.S., N.H., T.X., L.W., R.G.)
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L. Sun
aFrom the Departments of Radiology (J.L., L.S., N.H., T.X., L.W., R.G.)
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N. Hu
aFrom the Departments of Radiology (J.L., L.S., N.H., T.X., L.W., R.G.)
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L. Li
bMedical Service (L.L.), Shandong Provincial ENT Hospital, Shandong University, Jinan, China
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G. Song
cDepartment of Radiology (G.S.), Shandong Province Qianfoshan Hospital, Jinan, China
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H. Xu
dDepartment of Radiology (H.X., R.G., C.L.)
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T. Xu
aFrom the Departments of Radiology (J.L., L.S., N.H., T.X., L.W., R.G.)
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Y. Cheng
fSiemens Healthineers Digital Technology (Shanghai) Co. Ltd (Y.C.), Shanghai, China
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L. Xiao
gMR Scientific Marketing (L.X.), Diagnostic Imaging, Siemens Healthineers Ltd, Shanghai, China
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L. Wang
aFrom the Departments of Radiology (J.L., L.S., N.H., T.X., L.W., R.G.)
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R. Gong
aFrom the Departments of Radiology (J.L., L.S., N.H., T.X., L.W., R.G.)
dDepartment of Radiology (H.X., R.G., C.L.)
eGong Ruozhen Innovation Studio (R.G.), Shandong Provincial Hospital, Shandong University, Jinan, China
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C. Li
dDepartment of Radiology (H.X., R.G., C.L.)
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  • FIG 1.
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    FIG 1.

    The images of different scores for the separate visualization of the cochlear and vestibular endolymph in patients with MD. A, E, and F, 3D TSE real IR images. The perilymph is slightly enhanced (arrowheads). B, C, D, and G, ZOOMit SPACE real IR images. The perilymph is markedly enhanced (arrowheads). A, Score 1 for the cochlea. It is impossible to recognize the cochlear duct (endolymph, arrows and question marks). B, Score 2 for the cochlea. The cochlear duct (endolymph, arrow) was recognized only in the basal turn of the cochlea. C, Score 3 for the cochlea. The cochlear duct (endolymph, arrows) was recognized in the basal and middle turns of the cochlea. D, Score 4 for the cochlea. The cochlear duct (endolymph, arrows) was recognized in the basal, middle, and apical turns of the cochlea. E, Score 2 for the vestibule. A small part of the boundary for the utricle (arrow) was clearly displayed (≤ one-half of vestibular endolymph), and the edge could be clearly delineated, while the rest of the boundary was blurred (saccule, arrow and question mark). F, Score 3 for the vestibule. Most of the boundary of the saccule and the whole utricle (arrows) was clearly displayed (> one-half and <1 of vestibular endolymph), and the edge could be clearly delineated. G, Score 4 for the vestibule. The boundary of the saccule and utricle (endolymph, arrows) was clearly displayed (the whole vestibular endolymph).

  • FIG 2.
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    FIG 2.

    ZOOMit SPACE real IR images of different degrees of cochlear and vestibular EH in patients with MD. A, Normal cochlea (none). The scala media is minimally visible (solid arrow). B, Cochlear EH (I). The scala media becomes indirectly visible (solid arrows) as a nodular black cutout of the scala vestibuli, which was partially obstructed. C, Cochlear EH (II) and vestibular EH (III). The scala vestibuli is fully obliterated owing to the distended scala media (solid arrows). There is major or full obliteration of the bony vestibule; occasionally, only a few vestibular perilymphatic spaces near the cochlea remained (arrowhead). D, Normal vestibule. The saccule (solid arrow) and utricle (dotted arrow) are visibly separated and take less than one-half of the area of the vestibule. E, Vestibular EH (I). The saccule (solid arrow), normally smaller than the utricle, has become equal or larger than the utricle but is not yet confluent with the utricle (dotted arrow). F, Vestibular EH (II). There is a confluence of the saccule and utricle (solid arrow), with a continuous peripheral rim enhancement of the perilymphatic space (arrowheads).

  • FIG 3.
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    FIG 3.

    A, ROI image of zs-3D real IR at the level of the lower cochlear basal turn. Circle 1 of 1 mm2 indicates the ROI for the perilymph in the scala tympani in the basal turn of the cochlea. B, Zs-3D real IR image at the middle level of the vestibule. Circle 1 of 1 mm2 indicates the ROI for the endolymph in the utricle. C, The zs-3D real IR image at the level of the left middle cerebellar peduncle. Circle 1 of 10 mm2 indicates the ROI for SI in the left middle cerebellar peduncle. D, The zs-3D real IR image at the level of the artifact-free air area of the ipsilateral external auditory canal. Circle 1 of 6 mm2 indicates the ROI for the SD in the artifact-free air area of the ipsilateral external ear.

  • FIG 4.
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    FIG 4.

    Differences in the CNRs (A), SNRs (B), and SIRs (C) of the affected and asymptomatic sides are found between the 2 sequences (P < . 001).

Tables

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    Table 1:

    Pulse sequence parameters

    ParameterZOOMit SPACE Real IRTSE Real IR
    TR (ms)80005300
    TE (ms)491191
    TI (ms)22501850
    Turbo factor19233
    BW (Hz/pixel)305213
    Voxel (mm)0.6 × 0.6 × 1.00.6 × 0.6 × 0.6
    Average41
    iPAT22
    Scan time15 min 12 sec16 min 47 sec
    Flip angle modeConstant180
    FOV (mm)160 × 80220 × 220
    Matrix size256 × 128384 × 384
    Reconstruction modeRealReal
    • Note:—BW indicates bandwidth; iPAT, integrated parallel acquisition techniques.

    • View popup
    Table 2:

    Scores for separate visualization of endolymphatic space in the cochlea and vestibule by 2 pulse sequences in 50 patients with MD

    VisualizationSequenceScore
    Affected side4321
     Cochlea3D ZOOMit SPACE real IR371300
    3D TSE real IR172832
     Vestibule3D ZOOMit SPACE real IR40910
    3D TSE real IR272210
    Asymptomatic side
     Cochlea3D ZOOMit SPACE real IR34520
    3D TSE real IR128183
     Vestibule3D ZOOMit SPACE real IR49100
    3D TSE real IR272300
    • View popup
    Table 3:

    Number and percentage distribution of cochlear and vestibular EH grading by 2 pulse sequences in 50 patients with MD

    3D ZOOMit SPACE Real IR3D TSE Real IRWilcoxon Signed-Rank Test
    (No.) (%)(No.) (%)Z ValueP Value
    Affected side
     No cochlear EH7 (14.0)a15 (30.0)–2.83.005
     Cochlear EH (I)12 (24.0)a4 (8.0)
     Cochlear EH (II)31 (62.0)31 (62.0)
     No vestibular EH3 (6.0)3 (6.0)0.001.000
     Vestibular EH (I)13 (26.0)13 (26.0)
     Vestibular EH (II)18 (36.0)18 (36.0)
     Vestibular EH (III)16 (32.0)16 (32.0)
    Asymptomatic side
     No cochlear EH46 (92.0)48 (96.0)–1.41.157
     Cochlear EH (I)3 (6.0)1 (2.0)
     Cochlear EH (II)1 (2.0)1 (2.0)
     No vestibular EH48 (96.0)48 (96.0)0.001.000
     Vestibular EH (I)0 (0.0)0 (0.0)
     Vestibular EH (II)2 (4.0)2 (4.0)
     Vestibular EH (III)0 (0.0)0 (0.0)
    • ↵a Compared with the 3D TSE real IR sequence, P < .017.

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J. Li, L. Sun, N. Hu, L. Li, G. Song, H. Xu, T. Xu, Y. Cheng, L. Xiao, L. Wang, R. Gong, C. Li
A Novel MR Imaging Sequence of 3D-ZOOMit Real Inversion-Recovery Imaging Improves Endolymphatic Hydrops Detection in Patients with Ménière Disease
American Journal of Neuroradiology Apr 2023, DOI: 10.3174/ajnr.A7842

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A Novel MR Imaging Sequence of 3D-ZOOMit Real Inversion-Recovery Imaging Improves Endolymphatic Hydrops Detection in Patients with Ménière Disease
J. Li, L. Sun, N. Hu, L. Li, G. Song, H. Xu, T. Xu, Y. Cheng, L. Xiao, L. Wang, R. Gong, C. Li
American Journal of Neuroradiology Apr 2023, DOI: 10.3174/ajnr.A7842
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