The impact of 3D real-IR delayed post gadolinium MRI parameterisation on the diagnostic performance and optimal
Steve Connor1,2,3, Irumee Pai4,5, Philip Touska6
1School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK. steve.connor@kcl.ac.uk.
Objectives:
To compare the performance and optimal combination of MRI descriptors used for the diagnosis of Ménière's disease (MD) between a real-IR sequence with "zero-point" endolymph (ZPE), and an optimised real-IR sequence with negative signal endolymph (NSE).
Materials And Methods:
This retrospective single-centre cross-sectional study evaluated delayed post-gadolinium ZPE and NSE real-IR MRI in consecutive patients with Ménièriform symptoms (8/2020-10/2023). Two observers assessed 14 MRI descriptors. "Definite MD" (2015 criteria) and "all MD" ears (wider clinical criteria) were compared to controls. Cohen's kappa and risk ratios (RR) were evaluated for each descriptor. Forward stepwise logistic regression established which combination of descriptors best predicted MD.
Results:
The study included 132 patients (57 men; mean age 57.7 ± 13.6), with 87 "all MD" (56 "definite") and 39 control ears. The NSE sequence demonstrated increased perilymph SNR, and improved both diagnostic performance and reliability for 9/14 descriptors. However, ZPE demonstrated superior diagnostic performance for the best descriptor of "saccule absent, large as or confluent with the utricle" (RR 6.571, ZPE; 6.300, NSE) and that of "asymmetric perilymphatic enhancement" (RR 3.628, ZPE; 2.903, NSE). Both sequences combined these two descriptors in the optimal predictive model for "definite MD", with "grade 2 cochlear hydrops" also significant for NSE. ZPE and NSE descriptor combinations both correctly classified 95.8% of ears. The ZPE descriptor combination performed better for "all MD" (ZPE, AUC-ROC 0.914; NSE, AUC-ROC 0.893).
Conclusion:
Parameter optimisation with NSE Real-IR influenced the optimal selection of MRI descriptors but did not improve their diagnostic performance in definite MD.
Key Points:
Question Delayed post-gadolinium ZPE (FLAIR) and NSE (REAL-IR) sequences are widely applied for diagnosing MD, but their relative benefits remain unclear. Findings Optimised NSE sequences improve perilymphatic depiction and influence the selection of the optimal MRI descriptors, but do not improve diagnostic performance. Clinical relevance Radiologists may continue to apply either ZPE or NSE sequences since they offer similar diagnostic abilities, but the choice of the sequence will influence which MRI features should be evaluated to support the diagnosis of MD.
Insights
Optimised negative signal endolymph (NSE) MRI sequences improve perilymphatic depiction for Ménière's disease (MD) diagnosis, but diagnostic performance remains similar to zero-point endolymph (ZPE) sequences.
Area of Science:
- Radiology
- Neuroimaging
- Otolaryngology
Background:
- Ménière's disease (MD) diagnosis relies on imaging, with delayed post-gadolinium real-inversion recovery (real-IR) MRI sequences like zero-point endolymph (ZPE) and negative signal endolymph (NSE) being commonly used.
- The relative diagnostic performance and optimal descriptor combinations for ZPE and NSE sequences in MD diagnosis require further clarification.
Purpose of the Study:
- To compare the diagnostic performance and optimal MRI descriptor combinations of ZPE and NSE real-IR sequences for Ménière's disease (MD).
- To evaluate the impact of parameter optimization in NSE sequences on diagnostic accuracy for MD.
Main Methods:
- Retrospective analysis of delayed post-gadolinium ZPE and NSE real-IR MRI in patients with Ménièriform symptoms.
- Two observers assessed 14 MRI descriptors, comparing "definite MD" and "all MD" ears against controls using Cohen's kappa and risk ratios.
- Forward stepwise logistic regression identified optimal descriptor combinations for MD prediction.
Main Results:
- NSE sequences improved perilymph signal-to-noise ratio (SNR) and diagnostic reliability for 9 out of 14 descriptors.
- ZPE demonstrated superior performance for "saccule absent" and "asymmetric perilymphatic enhancement" descriptors.
- Both ZPE and NSE descriptor combinations achieved 95.8% correct classification for "definite MD", with ZPE performing better for "all MD" (AUC-ROC 0.914 vs 0.893).
Conclusions:
- Optimized NSE real-IR sequences influence the selection of MRI descriptors but do not enhance diagnostic performance for definite MD compared to ZPE.
- Radiologists can utilize either ZPE or NSE sequences, as both offer comparable diagnostic abilities for MD.
- The choice of MRI sequence dictates the specific features to evaluate for supporting the diagnosis of MD.
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