Diagnostic Accuracy of Quantitative, Qualitative and Semi-Quantitative Delayed Post Gadolinium MR Imaging Criteria in Meniere's Disease

Abstract Clinical Relevance The recent detection of endolymphatic hydrops (EH); the pathological hallmark of MD; on the delayed post gadolinium MR hydropic sequences has resulted shift in the diagnostic paradigm. Researchers defined various MRI qualitative, quantitative, and semi-quantitative criteria and grading scales for endolymphatic hydrops however, the best performance and combination of MRI criteria in distinguish MD affected ears is little explored. Establishing the most reliable and highly performing MRI features will improve the ability of the radiologist to diagnose Meniere’s Disease. Objectives To evaluate the diagnostic performance of MRI criteria used for the detection of Menière’s Disease (MD) ears on delayed post-gadolinium MRI. To determine which combination of descriptors should be optimally applied to establish the diagnosis. Materials and Methods This retrospective case-control study evaluated consecutive delayed post-gadolinium MRI of patients with Menièriform symptoms. 7 quantitative and semi-quantitative MR criteria of MD and qualitative perilymphatic enhancement (PLE) in the cochlea were evaluated within the study cohort. Definite MD ears according to the 2015 Barany Society criteria were compared to control ears. Sensitivity and Specificty were calculated for each descriptor to determined which combination of MRI descriptors would best predict MD ears, and the area under the ROC curve for this model was measured. Results 50 patients (30 female, 20 males; age mean 50 ±13 years) with 30 definite MD and 15 control ears were evaluated. Of the defining MRI criteria, the grade 2 cochlear hydrops, the grade 2 vestibular hydrops, saccule as large as utricle and cochlear perilymphatic enhancement were associated with the presence of MD ears (p < 0.05). The highest sensitivity was achieved by severe vestibular hydrops and “saccule, as large as the utricle”. Conclusion The best predictors of MD are the quantitative detection of severe vestibular hydrops together with the Semiquantitative detection of enlarged or confluent saccules which add value to the diagnosis.