Clinical application of MIIRMR as a salvage method in gadolinium-enhanced MRI after intra-tympanic injection

Area of Science:

• Radiology
• Neuroimaging
• Otolaryngology

Background:

• Endolymphatic hydrops (EH) is a condition affecting the inner ear.
• Three-dimensional fluid-attenuated inversion-recovery (3D-FLAIR) and 3D-real inversion-recovery (3D-real IR) are current imaging techniques for EH detection.
• Medium inversion-time inversion-recovery imaging with magnitude reconstruction (MIIRMR) may offer improved sensitivity for EH detection.

Purpose of the Study:

• To evaluate the success rate of inner ear visualization using 3D-FLAIR and 3D-real IR.
• To determine the endolymphatic hydrops (EH) detection rates of these sequences.
• To assess if salvage MIIRMR can improve EH detection rates and diagnostic performance for Meniere's disease (MD).

Main Methods:

• Fifty-one patients with vestibular syndrome underwent intra-tympanic gadolinium injection.
• 3D-FLAIR and 3D-real IR imaging were performed 24 hours post-injection.
• MIIRMR was used as a salvage sequence when 3D-FLAIR failed, and diagnostic performance for MD was analyzed.

Main Results:

• 3D-FLAIR and 3D-real IR achieved success rates of 88.90% and 72.55%, respectively.
• MIIRMR increased overall success and EH detection rates by 11.10% and 6.86%, respectively.
• For Meniere's disease, the combined sequence (MIIRMR + 3D-FLAIR + 3D-real IR) showed 92.11% sensitivity and 79.68% specificity.

Conclusions:

• MIIRMR is effective in improving imaging success and EH detection rates when 3D-FLAIR is insufficient.
• The combination of MIIRMR, 3D-FLAIR, and 3D-real IR offers superior diagnostic value for Meniere's disease compared to conventional sequences alone.