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DETECTION OF ENDOLYMPHATIC HYDROPS
IN RECURRENT IDIOPATHIC BPPV USING MRI
(in 41 young patients)
G.Dumas; A.Attye; I.Troprès; J.Petrossi;
S.Schmerber; A.Krainik
ENT Department CHU Grenoble (France)
Université Joseph Fourier, Grenoble Institute of
Neurosciences UMR-S836 France
Department of Neuro-Radiology and MRI. CHU Grenoble
(France)
XXXXI Conventus Societas Latina. Torino - July 6th 2016
INTRODUCTION
ENDOLYMPHATIC HYDROPS (EH)-MRI
• Menière’s disease (MD) (MRI : Suzuki 2011; Naganawa
2010;2012)
• Recurrent Vestibulopathy (RV) (MRI: Kato M. 2013; Attyé
A. 2015)
-Naganawa S. et al.Visualization of endolymphatic hydrops in Menière’s diseasewith single dose intraveinous
gadolinium- based contrast media using heavily T2-weighted 3D-FLAIR.Magn Reson Med Sci. 2010;9:237-42
-Kato M. et al. Endolymphatic hydrops revealed by magnetic resonance imaging in patients with atypical Menière’s
disease. Acta Otolaryngol. 2013; 133(2):123-9
-Attyé A.; Dumas G. et al. Recurrent peripheral vestibulopathy: is MRI useful for the diagnosis of endolymphatic
hydrops in clinical practice? Eur. Radiol. DOI 10.1007/s00330-015-3712-5
OBJECTIVES
• Main
MRI Hydrops identification
- in Primary Idiopathic recurrent BPPV in
young patients ?
• Secondary
Pathophysiological relationship Hydrops/BPPV
POPULATION
(n=201 patients; 25 controls)
BPPV ir:
N=41
BPPVa:
N=28
RV:N=64
Controls:N=25
CONTROL
Mean AGE Gender
Ratio
F/M
55
13/12
57.9
44/24
Recurrent
47.8
Vestibulopathy
(RV)
Associated BPPV 55.8
(aPBBV)
57.5
41/23
Meniere's
diease (MD)
MD:N=68
Case/Control Retrospective Study
22/6
31/10
Exclusion criteria
• Excluded
• All other radiological or neurological causes
• Sudden hearing loss and isolated not recurrent BPPV in older
patients, post traumatic BPPV or Lindsay Hemmenway syndrome
Methodology
Gadolinium IV Injection
single dose
MRI 3 Tesla
FLAIR
More than 700 patients explored by this technique in Grenoble during these 4 last years
(A.Attyé)
Methodology
NORMAL DATA- NORMAL SUBJECT
7
Methodology: Endolymphatic Hydrops (EH) Grading
Cochlear Hydrops
Vestibular Hydrops
cochleo-vestibular
Hydrops
Cochlear Hydrops is not specific of pathological condition (observed in 12% of controls)
Only Saccule EH or cochleo-saccular EH are specific of pathologic conditions
8
VESTIBULAR Hydrops
Comparaison with normal Subject
(Ratio between Endolymphatic space /
Vestibular space >50%)
M&Ms))
Attyé, Troprès,
ESMRMB 2013
Saccule+++
Asymmetry
Normal Subject
Naganawa, Magn Reson Med 2012
[email protected]
RecurrentVestibul
opathy
Clinique Universitaire de Neuroradiologie et d’IRM
Unilateral Recurrent
Idiopathic BPPV
n=41
Unilat. Clinical
Symptoms
Unilatéral
MRI Hydrops
Bilatéral
MRI Hydrops
MRI Hydrops
Ipsilatéral to
symptoms side
Discordant
MRI/clinic lesion
side
40
(1 cas bilat)
15
6
21
0
Kappa 0,71
INCAPACITATING RECURRENT BILATERAL POSTERIOR CANAL BPPV
Evolution 4 years (Mme I. Yamina 56 ans)
(BILATERAL SACCULUS HYDROPS)
• Disabling chronic Recurrent
Bilat BPPV progressing
since 4 years
• Audiogram : normal
• Manœuvres failure
• Gaceck surgery on the right
side (2012)
• Parnes technique
(Posterior Canal exclusion)
on the left side (2013)
(App. Th. Richard Vitton)
MRI before Surgery
SUMMARY (n=201)
No Hydrops
Hydrops
100%
EH is significantly more
often observed MD/RV
(p< 0.01) (χ²=9.886,df=1)
MD/irBPPV (p<0.05)
(t- test)
55%
46%
90%
88%
50%
MRI Hydrops
observed in
3/25 Controls
=12%
(cochlear EH)
0%
irBPPV
RV
MD
aBPPV
Kappa 0,71
Idiopathic Recurrent BPPV (irBPPV); Recurrent Vestibulopathy (RV); Menière’s disease
(MD);associted BPPV (aBPPV)
Hydrops Grading :Cochlear and /or
Vestibular (n=201)
100%
50%
Mixt Hydrops
Vestibular Hydrops
Cochlear Hydrops
0%
EH location: MD group (2± 0.85)/RV Group (1.48±0.68) (t-test,p<0.01)
MD group grading >irVPPB grading (t-test,p<0.01)
Kappa 0,71
irBPPV and HYDROPS n=41
HYDROPS in irBPPV
20
18
16
14
12
10
8
6
4
2
0
18
44%
18; 44%
23; 56%
14
34%
5
12%
4
10%
H Absent
H Présent
aBPPV and HYDROPS (n=28)
HYDROPS IN ABPPV
HYDROPS and aBPPV
H Absent
6
15%
46%
3
2
15%
Absent
23%
H Présent
2
15%
Cochlée Cochléo sacculaire Saccule
85%
DISCUSSION
Hydrops then BPPV
BPPV then Hydrops
Homeostasis
–Calcium-
BPPVCANALOLITHIASIS
Hydrops
« Traumatic »
CANALOLITHIASIS
HYDROPS
The Puddle
• TheoryHydrops
Yamane H et al. Assessment of Menière’s disease from a radiological aspect-saccular otoconia as a cause of Menière’s disease? Acta
Otolaryngologica.2012;132:1054
Bôhmer A. Hydrostatic presure inthe inner ear fluid compartments and its effects on inner ear function. Acta Otolaryngol Suppl 1993; 507:3-24 théorie du poddle
Hughes CA; Proctor L. Laryngoscope 1997; 107(5):607-13
Barber SR. BPPV commonly occurs following repair of SSCD. Laryngoscope 2015. ( Lithiases après chirurgie du canal sup DCA)
Phillips JS Otolaryngol head neck surg. 2009
HYDROPS & OTOCONIES
Ductus Reuniens & Endolymphatic Sinus
Endolymphatic Canal
Yamane, Acta Oto-Laryngol, 2012 and 2015
17
Hydrops/MRI :
CONCLUSIONS
•
MRI :reveals EH in irBPPV. (Specific Sacculus EH in 21% of cases) (Total=55%)
–
–
Need for future electrophysiological corrélations to validate (OAE: positionnal phase
swift, multi fréquential Admittancemétry, Ecochg). Ongoing study (R.Quatre).
Need for anatomic temporal bone correlations
•
•
•
•
EH in irBPPV: Frequency and grading < MD.
aBPPV is observed in 29% of MD (EH in 88% of aBPPV: id MD)
In aBPPV most often BPPV follows MD
Possible BPPV after labyrinth surgery (SSCD or Endolymphatic Sac Surgery)
•
Hypothesis : Hydrops is a common cue to different recurrent vestibular
peripheral pathologies
It is more likely that irBPPV follows EH than the opposit
•
•
Hydrops/MRI :
CONCLUSIONS
IRM :HE repère ds VPPBir
–
•
.
Nécessité de futures corrélations avec électrophysiologie pour validation (OAE
décalage de phase positionnelle, Admittancemétrie multi fréquentielle, Ecochg).
Etude en cours (R.Quatre).
MdM VR et VPPB: HE souvent bilatéral alors que manifestations cliniques sont
habituellement unilatérales
•
•
HE et VPPBir: Fréquence et grading VPPB récidivant < MdM.
Après chirurgie du sac endolymphatique (blocage sac)
–
–
•
•
Possible VPPB (canal Hor.) après BSE (technique de Saliba)
Décrit également par Barber SR (2015) après chirurgie des DCA
Hypothèse : Hydrops est une manifestation commune à différentes
pathologies récurrentes périphériques vestibulaires
Il est plus vraisemblable que le VPPB soit secondaire à HE que l’inverse
OBJECTIFS
• Principal
IRM Hydrops identification
- VPPB récidivant Idiopathique du sujet
jeune?
• Secondaire
Relations Physiopathologiques Hydrops/VPPB?
HYDROPS CONSTATE en
IRM AU COURS de VPPB
RECIDIVANTS
G. Dumas; A. Attye; A. Coffre; R. Quatre; S. Schmerber
Service ORL- Neuroradiologie CHU Grenoble
SIRV 3-4 Juin 2016
POPULATION
(n=176 patients;25 controls)
riBPPV:
N=19
Mean AGE Gender Ratio
F/M
Control:N=25
CONTROL
aBPPV:
N=25
55
13/12
57.9
44/24
47.8
41/23
Associated BPPV
(aPBBV)
55.8
20/5
Recurrent Idiopathic
BPPV (riBPPV)
57.5
14/5
Meniere's diease (MD)
Recurrent
Vestibulopathy (RV)
RV:N=64
MD:N=68
Inclusion criteria
• Unilat. Menière ‘s Disease. Definite (AAO-HNS GL,1995) (n=68)
• Recurrent Peripheral Vestibulopathy (Leliever 1981)
(n=64)
• Isolated recurrent rotatory vertigos (unilat Tinnitus)
• Isolated not neurological récurrent unsteadiness
(n=39)
(n=25)
• Idiopathic BPPV (started in young patient)were included(n=19)
(Hallpike; Mc Clure)
• Excluded
• All other radiological or neurological causes
• Sudden hearing loss and isolated not recurrent BPPV in older
patients, post traumatic BPPV or Lindsay Hemmenway syndroma
Critères Exclusion
• Toutes autres causes radiologiques ou
neurologiques
• Surdité Brusque ou VPPB isolé non recurrent
du sujet âgé,
VPPB post traumatique ou
Lindsay Hemmenway syndrome
DISCUSSION
• MRI E. Hydrops is observed in irBPPV (55%)
• Spécific Saccular EH in 21% ; not spécific cochlear in 34% cas
• Modifications pressionnelles ou homéostasie (concentration calcique)
• Patho-physiologic Relations between Menière –Récurrent Vestibulopathy - BPPV
(Proctor;Hughes 1997)(Yamane 2012)
•
Bilatéral Hydrops : in 28% BPPV and in 31 % of MD
• 22% bilateral MD: Barath K, Schuknecht B., 2014 (MRI) (53cases)
• 35% MD (Temporal bone anatomic study):Ming Yee Lin; Merchant (2010) (17 cases)
• No anatomic description of hydrops in BPPV up to date (elderly patients.
DISCUSSION
•
Menière & BPPV : frequently associated (18% our séries)
• 0.6 % (Karlberg 2000)
•
•
•
5.5% (Gross)
31% (Hughes 1997)
44% (Proctor)
•
In common population :(Murdin L. 2015)(Verrigan MA 2013)
• Vertigà prévalence = 3-10%
• MD Prévalence =0.12-0.5% (0.27% UK Tyrell 2014; 0.19% USA Harris 2010)
• BPPV annual Incidence l = 0.06-0.6% (prévalence 9% in young patients for Verrigan)
•
Hydrops is observed in 90% MD and 55% (21% spécific)BPPV ( intercritic periods):
• (suggest a threshold for symptoms in a sort of « chronic pathology »)
• Barath K.( 2014) : Hydrops in 90% MD (n=53)
• Naganawa (2013): observes a significant or moderate cochlear or vestibular EH in all patients 100% (n=20)
•
Normal Subjects. : EH is observed in 12% of cases (cochlear)
HYDROPS & OTOCONIES vestibule aqueduct
Control Subjects : Chondrocytes with
nucleus
Michaels, Acta Oto-Laryngol, 2009
Patients: Chondrocytes
hypertrophy and minéralization
27
METHODS and PROCEDURE
• 1) MRI Scan 4 hours after intravenous gadoteric acid injection –
FLAIR imaging ( TR: 8000ms, TE: 316ms T1: 2400ms) with
subtraction process
• 2) Semi quantitative visual analysis:
• 3) E.H.Gradation based on the number and localization of EH
• 4) Control subjects approved by institutional review bord (IRB
6705/15-CHUG-02)
• 5) Two radiologists performed blind, semi quantitative
evaluation of MRI Scan
• 6) Statistical Study: used Student’s t’test.
Attyé A.; Dumas G. et al. Recurrent peripheral vestibulopathy: is MRI useful in clinical practice?.
Eur.Radiol.2015
Hydrops COCHLEAIRE
Comparaison avec Sujet normal
Attyé,
Troprès,
ESMRMB
2013
Sujet Normal
Maladie de Menière (dilatation nodulaire)
Unilateral Recurrent Idiopathic BPPV
n=19
Clinical
unilateral
Symptoms
19
MRI Hydrops MRI Hydrops
unilatéral
bilatéral
6
3
MRI
Discordance
Hydrops
on side
Homolatéral
lesion
to the
MRI/clinic
symptomatic
side
9
0
Recurrent Right BPPV- Woman 45 years old
: Initially of the Posterior; then of the latéral
S.C. Canal.
VNG TEST POS. Mc CLURE
SUPINE ROLL TEST
Head toward Right Head toward Left
Supine Roll Test
MRI 3T Gado
Recurrent Peripheral Vestibulopathy
n=64
Side of
Clinical
Symptoms
(Tinnitus)
43
MRI Hydrops MRI Hydrops Normal MRI
unilatéral
bilatéral
21
10 (16%)
33(51%)
Discordant
side results
MRI/Tinnitus
15(23%)
Recurrent Vestibulopathy.
Two cases with Left Tinnitus. Normal
Audiogram
Case 1: Recurrent vertigo + Left Tinnitus
Negative Result
Case 2: Recurrent « otolithic symptoms »
Positive Result
Atypical Recurrent Vestibulopathy:
unsteadiness
Seldom Left Tinnitus. Normal Audiogram
Recurrent majoration of unsteadiness + Seldom Left Tinnitus Recurrent « otolithic symptoms » unsteadiness-imbalance
Left Cochlear Hydrops + Main Left Saccular Hydrops
Unilatéral Meniere’s disease
n=68
Unilateral
Sensoryneural
Hearing loss
68
MRI Hydrops MRI Hydrops
unilatéral
bilatéral
40
21 (31%)
Normal MRI
Discordant
side results
MRI/Hearing
Loss
(Side error)
7
9 (13%)
Significant correlation between MRI EH side and side of the hearing loss
(χ²=37.61,df=1,p<0.001)
Results in Normal subjects
• Criteria for hydrops found in 3/25 subjects=12%
Hydrops Percentage in each
population (n=176)
No Hydrops
EH significantly
more frequent in
MD/RV (p< 0.01)
(χ²=9.886,df=1)
MD/irBPPV (p<0.05)
(t- test)
100%
47%
46%
Hydrops
90%
88%
50%
0%
Idiopathic Recurrent BPPV (irBPPV); Recurrent Vestibulopathy (RV); Menière’s disease
(MD);associted BPPV (aBPPV)
Cochlear and /or Vestibular
Hydrops grading (n=176)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Mixt Hydrops
Vestibular Hydrops
Cochlear Hydrops
Average number of EH localizations: MD group (2± 0.85)/RV Group(1.48±0.68) (t-test,p<0.01)
Bilateral endolymphatic Hydrops
(n=176)
16%
16%
31%
25%
100%
50%
0%
irBPPV: 16%; Recurrent Vestibulopathy (RV):16%; Menière’s disease (MD):31%; VR ou
MdM + VPPB (aBPPV):16%
STATISTICAL ANALYSIS
Inter rater agreement between 2 Radiologists
( Cohen’s Kappa coefficient )
( Dr. Quesada C.I.C Grenoble)
Result of the concordance between 2 observers
•
Kappa= 0.71
MRI Hydrops Evolution in MD
before and after instrumental or
surgical treatment:N=19
Titolo del grafico
9
8
7
6
5
4
3
2
1
0
Intratympanic
Gentamicin (IG)
no hydrops
Endolymphatic Sac
Surgery (ESS)
improuved
Vestibular Neurectomy
(VN)
identical
impaired
IG=Intratympanic Gentamicin(n=9)- ESS=Endolymphatic Sac Surgery(n=7)-
MRI Hydrops Follow Up before and
after ESS
(ESS= endolymphatic sac surgery)
PRE ESS
POST ESS
DISCUSSION
• Hydrops can be observed in BPPV (47%):
physiopathological relationship have already been
suggested Menière – Recurrent Vestibulopathy-BPPV
(Proctor;Hughes 1997)
• Menière and BPPV are frequently associated (27%):
BPPV is associated with Menière (MD)in 0.6 %
(Karlberg) to 30% (Hughes).
BPPV occurs in 5.5% (Gross) to 44% of MD (Proctor)
•
Calzada A.P.2012: Hydrops brings dammages to Otolithic membrane and delivers floating particles or debris
•
Buckingham R.A.(1999); Otsuka.K (2010): liberatory maneuvers mobilize débris and provoque one occlusion of endolymphatic canal (Secondary or consequent Hydrops)
•
Yamane H. 2012: Menière (62 cas)CT Scan 3D obstruction by otoconies of canal reuniens (cochlea)37%; saccule canal 51%
-Hughes CA; Proctor L.Benign Paroxysmal Positional Vertigo .Laryngoscope 1997;107:607-13.
-Boniver R. .(1977 JF ORL; 1998 Acta Otolaryngol Belg.;2008 Int. Tinnit.J)
-Yamane H.et al.Assessment of Menière’s disease from radiological aspect-saccule otoconia as a cause of Menière’s disease? Acta
Otolaryngologica.2012;132(10):1054-60
DISCUSSION
• Hydrops is observed (even in intercritical periods)
in 90% MD cases and is bilateral in 31% of MD
and in 16% of RV(A.Attye, G.Dumas 2014)
• Barath K, Schuknecht B. (2014).in M.D.(53cases)
MRI 3T: 22% of bilateral Hydrops
• Ming-Yee Lin; Merchant S.N. (2010): Temporal
bones E.E.I. Massachusetts: 17 Unilat. Menière: 6
(35%) bilatéral hydrops (Asymptomatic controlat
endolymphatic saccular hydrops preceding the
clinical bilatéralisation )
CONCLUSIONS
• In MD and RV: Hydrops is a chronic often bilatéral phenomenon
with usually a unilateral clinical manifestation (possibly related to
a critical threshold necessary to bring out a clinical expression) ?
• Hydrops revealed by MRI is more fréquent and graded in MD than
in RV and than in i.recurrent BPPV.
• Hydrops identified by MRI in atypical unsteadiness brings new
arguments to the concept of new clinical entities such as récurrent
paroxystic not neurologic unsteadiness associated with tinnitus.
• Hypothesis : Hydrops is a common cue to different recurrent
peripheral vestibular disorders
CONCLUSIONS
• Post surgical (endolymphatic sac surgery) MRI controls in MD
showed only at best an improvement of Endolymphatic Hydrops
but no definite radical dramatic extinction disapearance.
• Detection of Hydrops/MRI: a reliable, accurate and repeatable
Méthod. Diagnostic efficiency.
• Validation needs further confrontation with électrophysiologic
Hydrops markers (positional OAE phase shift, multifréquential
impédancemétry , Ecochg).
Conflicts of Interest
The authors signal no conflict of interest.
DETECTION OF ENDOLYMPHATIC HYDROPS
IN RECURRENT PERIPHERAL VERTIGOS
USING MRI IN 176 PATIENTS
G.Dumas; A.Attye; I.Troprès; J.Petrossi; M.Roustit;
A.Karkas; S.Schmerber; A.Krainik
ENT Department CHU Grenoble (France)
Université Joseph Fourier, Grenoble Institute of
Neurosciences UMR-S836 France
Department of Neuro-Radiology and MRI. CHU Grenoble
(France)
Politzer society . Niigata. June 30th-July 4th 2015
CONCLUSIONS
•
•
•
•
•
•
•
Detection of Hydrops/MRI: a reliable, accurate and repeatable Méthod. Diagnostic
efficiency
Need of validation by further confrontation with électrophysiologic Hydrops markers
(OEAP et phase, multifréquential impédancemétry , Ecochg)
In MD and RV: Hydrops is a chronic often bilatéral phenomenon with usually a
unilateral clinical manifestation (possibly related to notion of a critical threshold to
bring a clinical expression) ?
Hydrops revealed by MRI is more fréquent in MD than in RV and than in i.recurrent
BPPV.
Hypothesis : Hydrops may be related with i.r. BPPV in young patients
MRI and Hydrops bring new arguments to the concept of new clinical entities such as
récurrent paroxystic not neurologic unsteadiness associated with tinnitus.
Post surgical (endolymphatic sac surgery) MRI controls in MD showed only at best an
improvement of Endolymphatic Hydrops but no definite radical dramatic extinction
(deletion) disparition.
• Travail préliminaire rétrospectif
• Démarrage travail prospectif: inclusion de
plus de sujets nx financement sujets
témoins volontaires CPPRB comité
d’éthique
CPP
contrat de protection des personnes
• Financement par PHRC régional
• DRCI financement des travaux et surcouts
: ARC promotion assurance…
Population.N=176 patients
(Included since 2012)
VPPB idiopathique
sujet jeune
7 10
Vertiges récurrents
Ménière
44
47
VPPB + vertiges
récurrents ou
+Ménière
TEMOINS
n= 10 (6 H; 4 F)
Age moyen = 46, 2 (2170)
• 9 patients Menière ont été contrôlés en
IRM pré et post traitement instrumental
ou chirurgical
• 16 Menière ont eu IRM post
thérapeutique seule
MENIÈRE: AAO HNS Guidelines 1995
• M. Certain: confirmation Histopathologique ( ou IRM?):
• M. Défini :
•
•
•
•
2 ou plus épisodes de vertiges spontanés de 20 mn ou plus;
Au moins 1 épisode hypoacousie concomitant documenté
Acouphène ou plénitude oreille atteinte
Autres pathologies exclues
• M. Probable:
•
•
•
•
1 épisode de vertige défini spontané
1épisode de déficit auditif documenté en au moins une occasion
Acouphènes ou plénitude de l’oreille du côté atteint
Autres causes exclues
• M. Possible:
• Vertige récurrent épisodique type Menière isolé sans tr. Auditif docum.
OU
• Surdité neurosensorielle fluctuante ou fixée avec déséquilibre mais
sans épisodes définis
• Autres causes exclues
TECHNIQUE EXAMEN
MMMETHODSSéquence FLAIR-VISTA (IRM
3T), Délai 4 H post GMado (Antenne tête 32
canaux, TR: 8000 ms, TE: 316 ms,
TI:
2400 ms, Voxel: 0.8 mm isotropique, durée:
8’56).
1. Analyse visuelle semi-quantitative
(diamètre transv. saccule >1/2 espace global
vestibule )
(pour d’autres (Naganawa) >1/3)
2. Dilatation nodulaire canal cochléaire
(morphologique)
Nakashima, Acta Oto Laryngologica
2. Analyse sur des volumes: non fait
2009
Morita, The Laryngoscope 2009
Naganawa,
Magn Reson Med 2013 avec une population témoin
3. Comparaison
[email protected]
Clinique
Universitaire de Neuroradiologie et d’IRM
M&C
•
Quand peut-on parler d’hydrops?Hydrops
cochléaire
Comparaison à une population témoinAttyé, Troprès,
ESMRMB 2013
Sujet témoin
Surdité de perception et
acouphènes droits
Naganawa, Magn Reson Med 2012
[email protected]
Clinique
Universitaire de Neuroradiologie et d’IRM
Hydrops Percentage in each
population (n=176)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
50%
72%
90%
92%
Hydrops
Pas d'hydrops
MRI Hydrops Evolution in MD
before and after intrumental or
surgical treatment :
100%
90%
2
80%
2
70%
60%
Colonne1
50%
Dispariton de l'hydrops
40%
Hydrops diminué
3
Hydrops inchangé
30%
Hydrops augmenté
20%
10%
1
1
0%
LC
DES
LC= Labyrinthectomie Chimique(n=6)- DSE= Décompression sac
DISCUSSION
• Appréciation semi quantitative de l’Hydrops
(Kappa corr. Examin.0,7)
• Quel cadre nosologique ? (parenté
physiopathologique)
Menière - Vertige Récurrent-VPPB
(Proctor;Hughes 1997)
• Fréquente Association Menière et VPPB (30%)
VPPB associé à Menière ds 0.6 (Karlberg) à 30%
(Hughes). Occurrence de VPPB au cours de
Menière ds 5.5 (Gross) à 44% (Proctor)
• VPPB et syndrome de prépondérence
directionnelle . Boniver R.(1977 JF ORL; 1998 Acta
Otolaryngol Belg.;2008 Int. Tinnit.J)
-Hughes CA; Proctor L.Benign Paroxysmal Positional Vertigo .Laryngoscope
1997;107:607-13.
CONCLUSIONS
•
•
•
•
•
•
Méthode d’imagerie fiable et reproductible, rentabilité
diagnostique
Technique à valider : nécessite une confirmation
électrophysiologique de l’Hydrops (OEAP et phase,
impédancemétrie multifréquentielle, Ecochg)
Hydrops: état chronique (souvent bilatéral) qui ne s’exprime
cliniquement (unilat.)qu’a partir d’un seuil ds la Maladie de
Menière et Vertiges Récurrents?
Images Hydrops plus fréquentes ds Menière et Vertiges
récurrents que ds VPPB récidivants
Hypothèse : Hydrops dans les VPPB récidivants idiopathiques
du sujet jeune
Apport radiologique IRM au concept de nouvelles entités
instabilités récurrentes paroxystiques non neurologiques avec
acouphènes.
STATISTICAL ANALYSIS
( Dr. Quesada C.I.C Grenoble)
Cohen ‘s KAPPA Test of concordence
Result of the concordance
between observators (2 Radiologists)
0.0 - 0.20 slight
0.21- 0.40 fair
0.41- 0.60 Moderate
•
0.61- 0.80 Substantial
Robust
0.81 – 1 Almost perfect
Kappa= 0.71
METHODS and PROCEDURE
• 1) MRI Scan 4 hours after intravenous gadoteric acid injection –
FLAIR imaging ( TR: 8000ms, TE: 316ms T1: 2400ms) with
subtraction process
• 2) Semi quantitative visual analysis:
• Saccule+utricle transversal diameter >1/2 bone vestibular space
• Cochlear morphology: nodular dilatation aspect
• 3) E.H.Gradation based on the number and localization of EH
• 4) Control subjects approved by institutional review bord (IRB
6705/15-CHUG-02)
• 5) Two radiologists performed blind, semi quantitative
evaluation of MRI Scan
• 6) Statistical Study: used Student’s t’test.
Attyé A.; Dumas G. et al. Recurrent peripheral vestibulopathy: is MRI useful in clinical practice?.
Eur.Radiol.2015
COCHLEAR Hydrops
Comparison with normal Subjects
Attyé,
Troprès,
ESMRMB
2013
Normal Subject
Menière’s disease (nodular dilatation)
Bilateral Endolymphatic
Hydrops (n=201)
28%
16%
31%
25%
100%
50%
0%
irBPPV: 16%; Récurrent Vestibulopathy (RV):16%; Menière (MD):31%; RV or MD +
BPPV (aBPPV):16%
Kappa 0,71
irVPPB et HYDROPS n=41
Présence Hydrops ds irVPPB
Hydrops et irVPPB
18
44%
18; 44%
14
23; 56%
34%
5
12%
4
10%
H Absent
H Présent
aVPPB et HYDROPS (n=28)
PRESENCE HYDROPS DANS AVPPB
HYDROPS ET aVPPB
H Absent
H Présent
6
15%
46%
2
3
2
15%
23%
15%
Absent
CochléeCochléo sacculaireSaccule
85%