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  • Title: [Optimization of delivering minimum Gd-DTPA at the posterior upper point on tympanic medial wall and hT2W-3D-FLAIR sequence for detecting endolymphatic hydrops].
    Author: Zou J, Wang Z, Chen YK, Zhang GP, Lu JP, Zheng HL.
    Journal: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2018 Dec 07; 53(12):931-938. PubMed ID: 30585006.
    Abstract:
    Objective: To optimize delivery of gadolinium-diethylenetriamine pentaacetic acid(Gd-DTPA) at the posterior upper point on tympanic medial wall and heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery (hT2W-3D-FLAIR) sequence, and to implement the technique of detecting endolymphatic hydrops using gadolinium-enhancement MRI. Methods: Thirteen patients with periphery vertigo, who visited Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Changhai Hospital during June and December of 2017, were enrolled in the study.0.10-0.20 ml of Gd-DTPA in various dilutions (10, 20, and 40-fold) were delivered at the posterior upper point on tympanic medial wall using a soft-tipped tympanic suction and drug-spraying needle through an artificially perforated tympanic membrane. Inner ear MRI was performed at 8, 24 h after Gd-DTPA administration using a 3T MR machine in combination with a 20-channel Tim 4G head/neck coil and the sequence of hT2W-3D-FLAIR to detect the gadolinium-enhancement signal within the inner ear and possible endolymphatic hydrops. The scanning time was either 8 min 35 s or 15 min 11 s. Results: Efficient inner ear uptake of Gd-DTPA was detected and induced high signal to noise ratio of MRI in patients receiving targeted delivery of 0.15-0.20 ml of 10-fold diluted contrast agent at the posterior upper point on tympanic medial wall. At 8 h after delivery, significant uptake was detected in the scala tympani and vestibuli of hook region and basal turn of the cochlea, and perilymhatic compartment of the vestibule. At 24 h after delivery, the distribution of Gd-DTPA became homogenous in each turn of the cochlea and perilymphatic compartment of the vestibule. However, obvious individual variance existed in the inner ear uptake when 0.10 ml of 40-fold diluted Gd-DTPA was delivered. Efficient inner ear uptake and high quality images that generated in patients receiving 0.10, 0.15, and 0.20 ml of 20-fold Gd-DTPA demonstrated endolymphatic hydrops with minor individual variance. There was insignificant difference in the enhancement signal of inner ear between 0.15 and 0.10 ml groups when Gd-DTPA was diluted at 20-fold except for the signal of semicircular canal of 0.15 ml group (190.00±53.95 vs 165.50±42.13, t=2.61, P<0.05). There was insignificant difference in the image quality between 8 min 35 s and 15 min 11 s canning time. Various degrees of endolymphatic hydrops were detected in 7 cochleae and 11 vestibule, and both simultaneous cochlear and vestibular endolymphatic hydrops were detected in 4 ears. Cochlear endolymphatic hydrops was detected in all the 3 patients with definite Meniere's disease, and 2 of them had combined cochlear and vestibular endolymphatic hydrops. Endolymphatic hydrops was not detected in patients with possible Meniere's disease nor with symptoms of superior semicircular canal dehiscence. Conclusion: Targeted delivery of 0.10 ml with 20-fold diluted Gd-DTPA (total dosage of 5 μmol) at the posterior upper point on tympanic medial wall in combination with 8 min 35 s scanning time hT2W-3D-FLAIR sequence for inner ear MRI in a 3T MR machine is a clinically practical method to detect endolymphatic hydrops, and reduce the requirement for MRI hardware. 目的： 探讨优化用于检测内淋巴积水的钆增强MRI技术。 方法： 2017年6—12月，就诊于解放军海军军医大学第一附属医院耳鼻咽喉头颈外科的13例外周性眩晕患者纳入研究。用软头鼓室吸引喷药针将0.10～0.20 ml不同稀释度(10、20、40倍)的钆喷酸葡胺(gadolinium-diethylenetriamine pentaacetic acid，Gd-DTPA)注射液经预先形成的鼓膜穿孔注射到鼓室内侧壁后上部；分别于8、24 h后用3T Skyra磁共振仪和20通道Tim 4G头/颈线圈行内耳MRI，用重T2加权三维液体衰减反转恢复(heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery，hT2W-3D-FLAIR)序列检测内耳钆增强信号及可能存在的内淋巴积水病变，与每板层数60和104对应的扫描时间分别为8 min 35 s和15 min 11 s。观察不同药物剂量、稀释度及扫描时间对检测内淋巴积水的影响。用SPSS 21.0软件进行统计分析。 结果： 向患者鼓室内侧壁后上部靶向投放0.15～0.20 ml、10倍稀释的Gd-DTPA，内耳可产生有效的摄取，MRI的信噪比很高。8 h后耳蜗钩端、第一回的鼓阶与前庭阶以及前庭外淋巴腔有显著摄取，所有内淋巴腔均无摄取；24 h后耳蜗各回及前庭外淋巴腔的信号均匀。对于0.10 ml、40倍稀释的Gd-DTPA，内耳摄取存在较大个体差异。投放体积0.10、0.15、0.20 ml、20倍稀释的Gd-DTPA，内耳均产生了有效的摄取，显示内淋巴积水图像清晰，个体差异很小；其中投放0.15 ml者与0.10 ml者的内耳信号强度，除了0.15 ml组半规管的灰度值在8 h与24 h之间差异有统计学意义(190.00±53.95比165.50±42.13，t＝2.61，P<0.05)外，其他差异均无统计学意义。采用8 min 35 s扫描时间与15 min 11 s扫描时间的图像质量无明显差异。7耳存在不同程度的耳蜗积水，11耳存在不同程度的前庭积水，同时出现耳蜗和前庭积水者4耳；3例临床确诊梅尼埃病者均有耳蜗积水，其中2例合并前庭积水；2例疑似梅尼埃病者和1例疑似上半规管裂综合征者未见内淋巴积水。 结论： 经鼓室内侧壁后上部靶向投放0.10 ml、20倍稀释的Gd-DTPA(双耳总剂量5 μmol)，结合8 min 35 s的hT2W-3D-FLAIR序列进行内耳3T MRI，是一种临床行之有效的检测内淋巴积水的方法。.
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