Cochlear Lymph Fluid Signal Increase in Patients with Otosclerosis after Intravenous Administration of Gadodiamide

PURPOSE Increased cochlear lymph fluid signals on three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) images obtained several minutes after intravenous administration of a single dose of gadolinium-based contrast agent (IV-SD-GBCA) in a patient with severe retrofenestral type otosclerosis had been reported. This increase was thought to represent breakdown of the blood-labyrinthine barrier. The purpose of this study was to evaluate cochlear lymph signal on heavily T2-weighted 3D-FLAIR (HF) images obtained 4 hours after IV-SD-GBCA in patients with otosclerosis, Ménière's disease, and healthy subjects. MATERIALS AND METHODS Twenty-two ears from 12 patients with otosclerotic plaques determined by computed tomography (CT), 16 ears from 8 healthy volunteers, and 10 ears from 9 Ménière's disease patients with significant endolymphatic hydrops on magnetic resonance (MR) images were retrospectively analyzed. Images were obtained 4 hours after IV-SD-GBCA. Patients and healthy volunteers underwent MR cisternography (MRC) for anatomical reference of the fluid space and HF at 3T. The region of interest (ROI) was manually drawn on MRC images around the scala tympani in the basal cochlear turn. The reference ROI was set in the cerebellum. ROIs were copied onto HF images and the signal intensity ratio (SIR) of cochlear perilymph to cerebellum was measured. Differences in the SIR on HF images among the three groups were tested by one-way analysis of variance (ANOVA). RESULTS The mean SIR was 24.0 ± 10.1 in otosclerosis patients, 7.9 ± 1.5 in volunteers, and 11.6 ± 3.9 in Ménière's disease patients. The mean SIR was significantly higher in the otosclerosis group than in the other groups (P < 0.001). In the otosclerosis group, there was a significant difference in the SIR between the retrofenestral type and the fenestral type (P = 0.033). CONCLUSIONS In patients with otosclerosis, the SIR was higher than in Ménière's disease patients or in healthy volunteers. The SIR was higher in the retrofenestral type than in the fenestral type.