Gadolinium-enhanced delayed MRI of inner ear: A valuable diagnostic tool for Ménière's disease and delayed endolymphatic hydrops: A retrospective cohort study

Objective The diagnosis of Ménière's disease (MD) and delayed endolymphatic hydrops (DEH) is challenging due to overlapping symptoms. This study aimed to retrospectively evaluate the diagnostic performance of gadolinium-enhanced delayed inner ear magnetic resonance imaging (MRI) for visualizing endolymphatic hydrops (EH) in patients with MD and DEH. Methods This retrospective study included 191 patients with unilateral MD ( n = 164) or DEH ( n = 27), stratified into definite MD (DMD, n = 129), probable MD (PMD, n = 35), and DEH subgroups. All patients underwent intratympanic administration of gadolinium followed by 3.0-T MRI using 3D-FLAIR and 3D-real-IR sequences. Clinical data, including pure-tone audiometry (PTA), speech recognition score (SRS), electrocochleography (ECochG), and caloric testing, were analyzed to assess correlations between EH and auditory–vestibular function. Results EH was detected in 85.2% (23/27) of clinically diagnosed DEH patients. Detection rates were 96.1% in DMD cases and 28.6% in PMD cases. There was no significant difference in cochlear or vestibular EH between the DMD and DEH groups. However, the DMD group exhibited a significantly higher incidence and severity of EH than the PMD group ( P < 0.05). In DMD patients, the degree of EH was positively correlated with PTA, clinical stage, and disease course ( P < 0.05), and negatively correlated with SRS ( P < 0.05). The degree of vestibular EH was also positively correlated with caloric test abnormalities (Spearman's ρ = 0.350, P < 0.001). Conclusion Gadolinium-enhanced delayed MRI of the inner ear provides objective evidence of EH and improves the diagnostic accuracy for MD and DEH. Its incorporation into standardized diagnostic protocols may further enhance clinical decision-making.