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Abstract：
OBJECTIVE: Conventionally, MRI aids in differentiating acute unilateral peripheral vestibulopathy/vestibular neuritis (AUPV/VN) from mimickers. Meanwhile, the diagnostic utility of MRIs dedicated to the inner ear remains to be elucidated for diagnosing AUPV/VN.
METHODS: We prospectively recruited 53 patients with AUPV/VN (mean age ± SD = 60 ± 15 years, 29 men). Initial MRIs were performed with a standard protocol, and an additional axial 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence was obtained 4 h after intravenous injection of gadoterate meglumine. Abnormal enhancement was defined as a signal intensity that exceeded the mean + 2SD value on the healthy side. The findings of neurotologic evaluation and MRIs were compared.
RESULTS: Overall, the inter-rater agreement for gadolinium enhancement was 0.886 (Cohen\'s kappa coefficient). Enhancement was observed in 26 patients (49%), most frequently in the vestibule (n = 20), followed by the anterior (n = 12), horizontal (HC, n = 8), posterior canal (n = 5), and superior (n = 3) and inferior (n = 1) vestibular nerves. In multivariable logistic regression analysis, the enhancement was associated with decreased HC gain in video head-impulse tests (p = 0.036), increased interaural difference in ocular vestibular-evoked myogenic potentials (p = 0.001), and a longer onset-to-MRI time span (p = 0.024). The sensitivity and specificity were 92.3% and 81.5%, respectively, with an area under the curve of 0.90 for predicting gadolinium enhancement.
CONCLUSIONS: Robust gadolinium enhancement was observed on 4-hour-delayed 3D-FLAIR images in nearly half of the patients with AUPV/VN, with a good correlation with the results of neurotologic evaluation. The positivity may be determined by the extent of vestibular deficit, timing of imaging acquisition, and possibly by the underlying etiology causing AUPV/VN. MRIs may aid in delineating the involved structures in AUPV/VN.
METHODS: We prospectively recruited 53 patients with AUPV/VN (mean age ± SD = 60 ± 15 years, 29 men). Initial MRIs were performed with a standard protocol, and an additional axial 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence was obtained 4 h after intravenous injection of gadoterate meglumine. Abnormal enhancement was defined as a signal intensity that exceeded the mean + 2SD value on the healthy side. The findings of neurotologic evaluation and MRIs were compared.
RESULTS: Overall, the inter-rater agreement for gadolinium enhancement was 0.886 (Cohen\'s kappa coefficient). Enhancement was observed in 26 patients (49%), most frequently in the vestibule (n = 20), followed by the anterior (n = 12), horizontal (HC, n = 8), posterior canal (n = 5), and superior (n = 3) and inferior (n = 1) vestibular nerves. In multivariable logistic regression analysis, the enhancement was associated with decreased HC gain in video head-impulse tests (p = 0.036), increased interaural difference in ocular vestibular-evoked myogenic potentials (p = 0.001), and a longer onset-to-MRI time span (p = 0.024). The sensitivity and specificity were 92.3% and 81.5%, respectively, with an area under the curve of 0.90 for predicting gadolinium enhancement.
CONCLUSIONS: Robust gadolinium enhancement was observed on 4-hour-delayed 3D-FLAIR images in nearly half of the patients with AUPV/VN, with a good correlation with the results of neurotologic evaluation. The positivity may be determined by the extent of vestibular deficit, timing of imaging acquisition, and possibly by the underlying etiology causing AUPV/VN. MRIs may aid in delineating the involved structures in AUPV/VN.
摘要：
目标：通常，MRI有助于区分急性单侧外周前庭病/前庭神经炎（AUPV/VN）与模拟者。同时,专用于内耳的MRI在诊断AUPV/VN方面的应用尚待阐明.
方法：我们前瞻性招募了53例AUPV/VN患者（平均年龄±SD=60±15岁，29人）。初始MRI采用标准协议进行，静脉注射gadoterate葡甲胺后4小时，获得了额外的轴向3D流体衰减反转恢复（3D-FLAIR）序列。异常增强被定义为超过健康侧的平均值+2SD值的信号强度。比较了神经学评估和MRI的结果。
结果：总体而言，钆增强的评分者间一致为0.886(科恩的卡帕系数)。在26例患者（49％）中观察到增强，最常见的前庭(n=20)，其次是前(n=12)，水平(HC,n=8),后管（n=5），和上（n=3）和下（n=1）前庭神经。在多变量逻辑回归分析中，增强与视频头部脉冲测试中HC增益降低相关(p=0.036)，眼前庭诱发的肌源性电位的耳间差异增加（p=0.001），和较长的开始到MRI的时间跨度（p=0.024）。敏感性和特异性分别为92.3%和81.5%,分别,曲线下的面积为0.90，用于预测钆的增强。
结论：在近一半的AUPV/VN患者中，在4小时延迟的3D-FLAIR图像上观察到稳健的钆增强，与神经评估结果有很好的相关性。阳性可能由前庭缺陷的程度决定，成像采集的定时，并可能由潜在的病因引起AUPV/VN。MRI可能有助于描绘AUPV/VN中涉及的结构。
方法：我们前瞻性招募了53例AUPV/VN患者（平均年龄±SD=60±15岁，29人）。初始MRI采用标准协议进行，静脉注射gadoterate葡甲胺后4小时，获得了额外的轴向3D流体衰减反转恢复（3D-FLAIR）序列。异常增强被定义为超过健康侧的平均值+2SD值的信号强度。比较了神经学评估和MRI的结果。
结果：总体而言，钆增强的评分者间一致为0.886(科恩的卡帕系数)。在26例患者（49％）中观察到增强，最常见的前庭(n=20)，其次是前(n=12)，水平(HC,n=8),后管（n=5），和上（n=3）和下（n=1）前庭神经。在多变量逻辑回归分析中，增强与视频头部脉冲测试中HC增益降低相关(p=0.036)，眼前庭诱发的肌源性电位的耳间差异增加（p=0.001），和较长的开始到MRI的时间跨度（p=0.024）。敏感性和特异性分别为92.3%和81.5%,分别,曲线下的面积为0.90，用于预测钆的增强。
结论：在近一半的AUPV/VN患者中，在4小时延迟的3D-FLAIR图像上观察到稳健的钆增强，与神经评估结果有很好的相关性。阳性可能由前庭缺陷的程度决定，成像采集的定时，并可能由潜在的病因引起AUPV/VN。MRI可能有助于描绘AUPV/VN中涉及的结构。
