HEAD AND NECK
In vivo imaging of saccular hydrops in humans reflects sensorineural
hearing loss rather than Meniere’s disease symptoms
Received: 3 October 2017 /Revised: 7 December 2017 /Accepted: 20 December 2017 /Published online: 21 March 2018
European Society of Radiology 2018
Objectives A case-controlled imaging study demonstrated that saccular hydrops was specific to Meniere’s disease (MD), but
only present in a subset of patients. Here, we compared patients with definite MD, vertigo and sensorineural hearing loss (SNHL)
to elucidate the relationship between saccular hydrops and extent of SNHL.
Methods In this prospective study, we performed 3D-FLAIR sequences between 4.5 and 5.5 h after contrast media injection in
patients with MD (n=20), SNHL (n=20), vertigo (n=20) and 30 healthy subjects. Two radiologists independently graded saccular
hydrops. ROC analysis was performed to determine the hearing loss threshold to differentiate patients with saccular hydrops.
Results Saccular hydrops was found in 11 of 20 MD patients, 10 of 20 SNHL patients and in none of the vertigo patients and
healthy subjects. In SNHL patients, 45 dB was the threshold above which there was a significant association with saccular
hydrops, with sensitivity of 100 % and specificity of 90 %. In MD patients, 40 dB was the threshold above which there was a
significant association with saccular hydrops, with sensitivity of 100 % and specificity of 44 %.
Conclusions Our results indicate saccular hydrops as a feature of worse than moderate SNHL rather than MD itself.
• MRI helps clinicians to assess patients with isolated low-tone sensorineural hearing loss.
• Saccular hydrops correlates with sensorineural hearing loss at levels above 40 dB.
• Vertigo patients without sensorineural hearing loss do not have saccular hydrops.
• Saccular hydrops is described in patients without clinical diagnosis of Meniere’sdisease.
Keywords Inner ear
Magnetic resonance imaging
ESS Endolymphatic sac surgery
MD Meniere’s disease
SNHL Sensorineural hearing loss
SURI Saccule to Utricle Ratio Inversion
Meniere’s disease (MD) clinical diagnosis relies on fluctuat-
ing sensorineural hearing loss (SNHL) accompanied by aural
pressure, tinnitus and episodic vertigo. Since the first report of
Altmann , pathological studies of temporal bones have con-
cluded that problems in the production and absorption of inner
ear endolymph can lead to MD. Later, Kimura  investigated
the first animal model in guinea pigs and showed that block-
age of the endolymphatic sac and duct causes obstruction of
Alexandre Krainik and Sébastien Schmerber contributed equally to this
manuscript as last authors
* Arnaud Attyé
Department of Neuroradiology and MRI, Grenoble Alpes University
Hospital – SFR RMN Neurosciences, Grenoble, France
IRMaGe, University Grenoble Alpes, F-38000 Grenoble, France
Neuroradiology and MR Unit, CS 10217- Grenoble University
Hospital, F-38043 Grenoble cedex 9, France
Department of Radiology, Rouen University Hospital, Rouen, France
Unité innovation technologique, Centre d’Investigation Clinique,
CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France
IRMaGe, Inserm US 17, CNRS UMS 3552, Grenoble, France
Department of Otology, Grenoble Alpes University Hospital,
European Radiology (2018) 28:2916–2922