Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study
In-vivo non-invasive verification of endolymphatic hydrops (ELH) by means of intravenous delayed gadolinium (Gd) enhanced magnetic resonance imaging of the inner ear (iMRI) is rapidly developing into a standard clinical tool to investigate peripheral vestibulo-cochlear syndromes. In this context, me...
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Frontiers Media S.A.
2021-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.647296/full |
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| author | Rainer Boegle Rainer Boegle Rainer Boegle Johannes Gerb Johannes Gerb Emilie Kierig Emilie Kierig Sandra Becker-Bense Sandra Becker-Bense Birgit Ertl-Wagner Birgit Ertl-Wagner Marianne Dieterich Marianne Dieterich Marianne Dieterich Marianne Dieterich Valerie Kirsch Valerie Kirsch Valerie Kirsch |
| author_facet | Rainer Boegle Rainer Boegle Rainer Boegle Johannes Gerb Johannes Gerb Emilie Kierig Emilie Kierig Sandra Becker-Bense Sandra Becker-Bense Birgit Ertl-Wagner Birgit Ertl-Wagner Marianne Dieterich Marianne Dieterich Marianne Dieterich Marianne Dieterich Valerie Kirsch Valerie Kirsch Valerie Kirsch |
| author_sort | Rainer Boegle |
| collection | DOAJ |
| description | In-vivo non-invasive verification of endolymphatic hydrops (ELH) by means of intravenous delayed gadolinium (Gd) enhanced magnetic resonance imaging of the inner ear (iMRI) is rapidly developing into a standard clinical tool to investigate peripheral vestibulo-cochlear syndromes. In this context, methodological comparative studies providing standardization and comparability between labs seem even more important, but so far very few are available. One hundred eight participants [75 patients with Meniere's disease (MD; 55.2 ± 14.9 years) and 33 vestibular healthy controls (HC; 46.4 ± 15.6 years)] were examined. The aim was to understand (i) how variations in acquisition protocols influence endolymphatic space (ELS) MR-signals; (ii) how ELS quantification methods correlate to each other or clinical data; and finally, (iii) how ELS extent influences MR-signals. Diagnostics included neuro-otological assessment, video-oculography during caloric stimulation, head-impulse test, audiometry, and iMRI. Data analysis provided semi-quantitative (SQ) visual grading and automatic algorithmic quantitative segmentation of ELS area [2D, mm2] and volume [3D, mm3] using deep learning-based segmentation and volumetric local thresholding. Within the range of 0.1–0.2 mmol/kg Gd dosage and a 4 h ± 30 min time delay, SQ grading and 2D- or 3D-quantifications were independent of signal intensity (SI) and signal-to-noise ratio (SNR; FWE corrected, p < 0.05). The ELS quantification methods used were highly reproducible across raters or thresholds and correlated strongly (0.3–0.8). However, 3D-quantifications showed the least variability. Asymmetry indices and normalized ELH proved the most useful for predicting quantitative clinical data. ELH size influenced SI (cochlear basal turn p < 0.001), but not SNR. SI could not predict the presence of ELH. In conclusion, (1) Gd dosage of 0.1–0.2 mmol/kg after 4 h ± 30 min time delay suffices for ELS quantification. (2) A consensus is needed on a clinical SQ grading classification including a standardized level of evaluation reconstructed to anatomical fixpoints. (3) 3D-quantification methods of the ELS are best suited for correlations with clinical variables and should include both ears and ELS values reported relative or normalized to size. (4) The presence of ELH increases signal intensity in the basal cochlear turn weakly, but cannot predict the presence of ELH. |
| first_indexed | 2024-12-21T21:24:47Z |
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| institution | Directory Open Access Journal |
| issn | 1664-2295 |
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| last_indexed | 2024-12-21T21:24:47Z |
| publishDate | 2021-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-64de95e07ef04aaf9ade38c970a5884b2022-12-21T18:49:48ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-04-011210.3389/fneur.2021.647296647296Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative StudyRainer Boegle0Rainer Boegle1Rainer Boegle2Johannes Gerb3Johannes Gerb4Emilie Kierig5Emilie Kierig6Sandra Becker-Bense7Sandra Becker-Bense8Birgit Ertl-Wagner9Birgit Ertl-Wagner10Marianne Dieterich11Marianne Dieterich12Marianne Dieterich13Marianne Dieterich14Valerie Kirsch15Valerie Kirsch16Valerie Kirsch17Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyGerman Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyGraduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyGerman Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyGerman Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyGerman Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Radiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, CanadaDepartment of Radiology, University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyGerman Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyGraduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, GermanyMunich Cluster for Systems Neurology (SyNergy), Munich, GermanyDepartment of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyGerman Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, GermanyGraduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, GermanyIn-vivo non-invasive verification of endolymphatic hydrops (ELH) by means of intravenous delayed gadolinium (Gd) enhanced magnetic resonance imaging of the inner ear (iMRI) is rapidly developing into a standard clinical tool to investigate peripheral vestibulo-cochlear syndromes. In this context, methodological comparative studies providing standardization and comparability between labs seem even more important, but so far very few are available. One hundred eight participants [75 patients with Meniere's disease (MD; 55.2 ± 14.9 years) and 33 vestibular healthy controls (HC; 46.4 ± 15.6 years)] were examined. The aim was to understand (i) how variations in acquisition protocols influence endolymphatic space (ELS) MR-signals; (ii) how ELS quantification methods correlate to each other or clinical data; and finally, (iii) how ELS extent influences MR-signals. Diagnostics included neuro-otological assessment, video-oculography during caloric stimulation, head-impulse test, audiometry, and iMRI. Data analysis provided semi-quantitative (SQ) visual grading and automatic algorithmic quantitative segmentation of ELS area [2D, mm2] and volume [3D, mm3] using deep learning-based segmentation and volumetric local thresholding. Within the range of 0.1–0.2 mmol/kg Gd dosage and a 4 h ± 30 min time delay, SQ grading and 2D- or 3D-quantifications were independent of signal intensity (SI) and signal-to-noise ratio (SNR; FWE corrected, p < 0.05). The ELS quantification methods used were highly reproducible across raters or thresholds and correlated strongly (0.3–0.8). However, 3D-quantifications showed the least variability. Asymmetry indices and normalized ELH proved the most useful for predicting quantitative clinical data. ELH size influenced SI (cochlear basal turn p < 0.001), but not SNR. SI could not predict the presence of ELH. In conclusion, (1) Gd dosage of 0.1–0.2 mmol/kg after 4 h ± 30 min time delay suffices for ELS quantification. (2) A consensus is needed on a clinical SQ grading classification including a standardized level of evaluation reconstructed to anatomical fixpoints. (3) 3D-quantification methods of the ELS are best suited for correlations with clinical variables and should include both ears and ELS values reported relative or normalized to size. (4) The presence of ELH increases signal intensity in the basal cochlear turn weakly, but cannot predict the presence of ELH.https://www.frontiersin.org/articles/10.3389/fneur.2021.647296/fullendolymphatic hydropsendolymphatic spaceinner ear imaginggadolinium based contrast agentintravenousconvolutional neural network |
| spellingShingle | Rainer Boegle Rainer Boegle Rainer Boegle Johannes Gerb Johannes Gerb Emilie Kierig Emilie Kierig Sandra Becker-Bense Sandra Becker-Bense Birgit Ertl-Wagner Birgit Ertl-Wagner Marianne Dieterich Marianne Dieterich Marianne Dieterich Marianne Dieterich Valerie Kirsch Valerie Kirsch Valerie Kirsch Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study Frontiers in Neurology endolymphatic hydrops endolymphatic space inner ear imaging gadolinium based contrast agent intravenous convolutional neural network |
| title | Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study |
| title_full | Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study |
| title_fullStr | Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study |
| title_full_unstemmed | Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study |
| title_short | Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study |
| title_sort | intravenous delayed gadolinium enhanced mr imaging of the endolymphatic space a methodological comparative study |
| topic | endolymphatic hydrops endolymphatic space inner ear imaging gadolinium based contrast agent intravenous convolutional neural network |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.647296/full |
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