7-Tesla sodium magnetic resonance imaging of the inner ears in unilateral Ménière’s disease and endolymphatic hydrops: an exploratory study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Whilst delayed post-gadolinium MRI has led to a shift in the diagnostic paradigm of Meniere’s Disease (MD), there remains a strong desire to develop a non-contrast enhanced MRI technique to detect and monitor MD. The endolymphatic space (ES) undergoes hydropic expansion in Ménière’s Disease (MD) and the concentration of sodium ions in the endolymph is at least 10 times lower than that in the perilymph. It was hypothesised that the lower sodium (23Na) concentration in the endolymph relative to the surrounding perilymph would result in a differential reduction in 23Na-MRI signal in inner ears with endolymphatic hydrops (EH). This proof of principle study explored the feasibility of 7-Tesla (7T) 23Na-MRI to lateralise EH ears in unilateral MD.
Methods
In this prospective study, 7T 23Na-MRI was performed in participants with both unilateral definite MD and severe vestibulo-cochlear EH on a delayed post-gadolinium real inversion recovery sequence. Two blinded independent observers qualitatively graded the visibility and anatomical compatibility of inner ear 23Na MRI signal intensity (NaSI), before and after registering to 3D T2-weighted (T2w) MRI and determined the certainty of EH laterality. The internal auditory meatus (IAM), cochlea and vestibule were segmented using 3D Slicer and NaSI was quantified. Inner ear median NaSI were scaled to the adjacent IAM median NaSI and compared between the two ears.
Results
In 4 unilateral MD participants (mean age 60.3 years, 2 men), both observers correctly predicted EH laterality in 1/4 before and 3/4 participants after fusion to 3D T2w MRI. There was no incorrect lateralisation of EH by either observer, either before or after registration and fusion. In the 3 participants correctly lateralised, quantitative analysis revealed the median inner ear NaSI scaled to the ipsilateral IAM was 1.2–2.8 times higher in the normal cochlea and 1.9–2.9 times higher in the vestibule, compared to the EH ear. Intraclass correlation coefficient for inner ear median NaSI was 0.70.
Conclusion
This exploratory study revealed the potential for severe EH to be qualitatively and quantitatively lateralised with 7T 23Na MRI in patients with unilateral definite MD.
Trial registration
NCT04370366; registered 29/4/20.
Whilst delayed post-gadolinium MRI has led to a shift in the diagnostic paradigm of Meniere’s Disease (MD), there remains a strong desire to develop a non-contrast enhanced MRI technique to detect and monitor MD. The endolymphatic space (ES) undergoes hydropic expansion in Ménière’s Disease (MD) and the concentration of sodium ions in the endolymph is at least 10 times lower than that in the perilymph. It was hypothesised that the lower sodium (23Na) concentration in the endolymph relative to the surrounding perilymph would result in a differential reduction in 23Na-MRI signal in inner ears with endolymphatic hydrops (EH). This proof of principle study explored the feasibility of 7-Tesla (7T) 23Na-MRI to lateralise EH ears in unilateral MD.
Methods
In this prospective study, 7T 23Na-MRI was performed in participants with both unilateral definite MD and severe vestibulo-cochlear EH on a delayed post-gadolinium real inversion recovery sequence. Two blinded independent observers qualitatively graded the visibility and anatomical compatibility of inner ear 23Na MRI signal intensity (NaSI), before and after registering to 3D T2-weighted (T2w) MRI and determined the certainty of EH laterality. The internal auditory meatus (IAM), cochlea and vestibule were segmented using 3D Slicer and NaSI was quantified. Inner ear median NaSI were scaled to the adjacent IAM median NaSI and compared between the two ears.
Results
In 4 unilateral MD participants (mean age 60.3 years, 2 men), both observers correctly predicted EH laterality in 1/4 before and 3/4 participants after fusion to 3D T2w MRI. There was no incorrect lateralisation of EH by either observer, either before or after registration and fusion. In the 3 participants correctly lateralised, quantitative analysis revealed the median inner ear NaSI scaled to the ipsilateral IAM was 1.2–2.8 times higher in the normal cochlea and 1.9–2.9 times higher in the vestibule, compared to the EH ear. Intraclass correlation coefficient for inner ear median NaSI was 0.70.
Conclusion
This exploratory study revealed the potential for severe EH to be qualitatively and quantitatively lateralised with 7T 23Na MRI in patients with unilateral definite MD.
Trial registration
NCT04370366; registered 29/4/20.
Date Issued
2025-11-11
Date Acceptance
2025-10-07
Citation
BMC Medical Imaging, 2025, 25
ISSN
1471-2342
Publisher
BMC
Journal / Book Title
BMC Medical Imaging
Volume
25
Copyright Statement
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41219717
PII: 10.1186/s12880-025-01986-6
Subjects
Endolymphatic hydrops
Magnetic resonance imaging
Meniere’s disease
Sodium
Ultra-high-field MRI
Humans
Meniere Disease
Endolymphatic Hydrops
Magnetic Resonance Imaging
Male
Female
Middle Aged
Prospective Studies
Ear, Inner
Aged
Adult
Feasibility Studies
Sodium
Publication Status
Published
Coverage Spatial
England
Article Number
454
Date Publish Online
2025-11-11