Abstract：Objective This study aims to examine vestibular aqueduct visualized in the gadolinium-enhanced MRI of the inner ear and explore the clinical significance of visualization. Methods The MRI of the inner ear before and after intratympanic gadolinium injection and the clinical data of 691 patients (including 300 males and 391 females, aged 9-82 years, 531 bilateral and 160 unilateral) who underwent MRI gadolinium angiography (tympani puncture) in the inner ear due to vertigo or sudden deafness in the Department of Imaging of the First Affiliated Hospital of Fujian Medical University was analyzed retrospectively. The main clinical manifestations included vertigo (n=483), sudden deafness (n=125), dizziness (n=42), tinnitus (n=39), and normal (n=2). The MR images were assessed by two experienced radiologists: (1)Compared with the images performed before gadolinium injection, the increased signal in the gadolinium-enhanced images of the vestibular aqueduct area was considered visualization. (2)The presence of endolymphatic hydrops was evaluated by visual scoring system. The incidence of vestibular aqueduct visualization in all patients in the gadolinium-enhanced magnetic resonance images was summarized. Chi-square test was used to analyze whether the incidence was different in patients between vertigo and non-vertigo, sudden deafness and non-sudden deafness, or membranous labyrinth with or without hydrops in the inner ear. Contingency correlation coefficient was used to analyze the correlation between vestibular aqueduct visualization and endolymphatic hydrops.Results In all MR images of the inner ear after intratympanic gadolinium injection, endolymphatic hydrops were seen in 26.8% (327/1 222). The visualization rate of the vestibular aqueduct was 7.4% (90/1 222). The visualization rates were 6.0%(56/938) in vertigo ear and 12.0%(34/284) in non-vertigo ear, and the difference was statistically significant(χ2=11.509, P＜0.01). The visualization was observed in 10.2%(19/186)of ears with sudden deafness and 6.9%(71/1 036)of ears without sudden deafness, with no significant difference(χ2=2.612, P＞0.05). The visualization was found in 4.0%(6/149)of tinnitus ears and 7.9%(85/1 073) of non-tinnitus ears, with no statistically significant difference(χ2=2.880, P＞0.05). About 30.1%(282/938) vertigo-affected ears and 15.8%(45/284) non-vertigo ears showed endolymphatic hydrops, and the difference was statistically significant(χ2=22.488, P＜0.01). The visualization was found in 3.1%(10/327)of ears with endolymphatic hydrops and 8.9%(80/895)of ears without endolymphatic hydrops, and the difference was statistically significant(χ2=12.139, P＜0.01). A negative correlation was found between visualization of vestibular aqueduct and endolymphatic hydrops(r=-0.099, P＜0.01). Conclusions In the gadolinium-contrast MR images of the inner ear after intratympanic injection, gadolinium contrast agent can enter the vestibular aqueduct, and the incidence of visualization is about 7.4%. The vestibular aqueduct can be visualized in the MRI gadolinium images of the inner ear because osseous vestibular aqueduct contains perilymphatic space. The vestibular aqueduct is not visualized in the gadolinium-contrast MR images of the inner ear in patients with endolymphatic hydrops, suggesting that some changes about vestibular aqueduct may be an important part of the pathogenesis of Ménierè's disease or vertigo.
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Lai Yanmei, Liu Ying, Fang Zheming, Cao Dairong. Observation and clinical significance of visualization in gadolinium-contrast MRI of vestibular aqueduct. Chinese Journal of Anatomy and Clinics, 2020, 25(6): 628-633.
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2020, Vol. 25 
