Despite various criteria applied over the years to diagnose Ménière’s disease since the concept of endolymphatic hydrops was first observed in postmortem examinations of patients in 1938, the diagnosis still remains mainly clinical. To visualise endolymphatic hydrops in MRI imaging, if established and widely available, would indeed be a helpful tool. In this publication, the authors have presented a meta-analysis of 11 suitably selected studies out of 30 results to assess the clinical implications of delayed-acquisition post-gadolinium MRI in identifying endolymphatic hydrops for diagnosis of Ménière’s disease. The parameters assessed in this systematic review were the eligibility criteria, type of scan and sequences used, the dose and route of administration of gadolinium, the number of hours after gadolinium administration that the MRI was acquired, the items of interest seen on the scans and whether the assessment was blinded or not. The MRI technique mostly applied was fluid-attenuated inversion recovery (FLAIR) rather than 3D-real inversion recovery (3D-real IR). The time allowed in most cases was 3.5 to 4.5 hours. The route of administration was intravenous because intratympanic administration requires 24 hours for acquisition. The risk of bias varied from low to high and, in some studies, unclear. Radiological assessment was focused on the vestibule and cochlea by most, vestibule only by some and on cochlea only by none. All studies used some type of quantitative assessment in grading the hydrops. The protocols used appeared grossly uniform. While noting this as a useful advancement in the MRI technique in identifying Ménière’s disease, the authors call for further validation before this can be widely used, and availability of a 3T MRI scanner remains an issue.
Gadolinium enhanced MRI and the diagnosis of Ménière’s disease
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