The Utility of Contrast-Enhanced 3D-Real Inversion Recovery Magnetic Resonance Imaging in the Diagnosis of Endolymphatic Hydrops-A Retrospective Study of a Newly Implemented Clinical Service at a Tertiary Center.

Background: Over the last decade, delayed gadolinium-enhanced magnetic resonance imaging (MRI) of the inner ear has become increasingly used as an objective marker for the diagnosis of endolymphatic hydrops (EH) in Ménière's disease (MD). This study evaluates the utility of this imaging technique in the first 100 patients scanned at our tertiary center. Methods: A retrospective study was conducted in the Department of Otology and Neuro-otology at University College London Hospitals between October 2020 and May 2022. Patients were classified into 4 groups: "definite MD," "probable MD," isolated cochlear symptoms, and MD-vestibular migraine (VM) overlap syndrome. The local imaging protocol consisted of an intravenous gadolinium (IV-Gd) injection followed by T2 SPACE and 3D-real inversion recovery magnetic resonance imaging (MRI) of the inner ears after 4 hours. Results: The first 100 patients scanned were included. All patients with "definite MD" and MD-VM overlap syndrome had evidence of radiological EH on MRI. About 38% of patients in the "probable MD" group and 25% of patients in the isolated cochlear hydrops group had radiological EH. For the "definite MD" group, 98% of positive scans correlated with disease laterality; this was 87% in the "probable MD" group. Duration of disease >4 years and more severe hearing loss were found to be statistically significant factors for the detection of EH. Conclusion: Our study demonstrates that EH is much more likely to be detected in patients with a clinical diagnosis of "definite MD" or MD-VM overlap syndrome, and also correlates with the increasing duration and severity of symptoms. Further studies using standardized imaging protocols would be helpful in comparing outcomes.