Role of Hydrops MRI in the differentiation between Menière's Disease and Vestibular Migraine: a prospective study

Anja Bernaerts^1*Morgana Sluydts²Vincent Liégeois¹Catherine Blaivie²Floris L. Wuyts^2,3Joost van Dinther²Andrzej J ZAROWSKI²Filip Deckers¹Bert De Foer¹

• ¹ZAS Augustinus Hospital, Department of Radiology, Antwerp, Belgium
• ²European Institute for Otorhinolaryngology, Head & Neck Surgery, Antwerp, Antwerp, Belgium
• ³Lab for Equilibrium Investigations and Aerospace, Faculty of Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium

We investigated the value of delayed post-gadolinium (Gd) three-dimensional (3D) sampling perfection with application of optimized contrast using different flip angle evolution (SPACE) fluid-attenuated inversion recovery (FLAIR) sequence to differentiate between Menière's disease (MD) and vestibular migraine (VM) in a prospective study. Methods: A total of 31 patients -15 with MD (10 definite MD, 5 probable MD) and 16 with VM (9 definite VM, 7 probable VM) were prospectively enrolled from January 2019 till December 2022. The female/male distribution in the MD group was 7/8 and in the VM group 14/2. All patients underwent a 3D SPACE-FLAIR and a 3D SPACE-T2 sequence, 4 hours after intravenous injection of a single dose of Gadobutrol (1.0 mmol/ml). Cochlear endolymphatic hydrops (CEH) and vestibular endolymphatic hydrops (VEH) as well as asymmetrical perilymphatic enhancement (PLE) were assessed. Results: None of the VM patients had signs of CEH, VEH or an enhanced PLE. In contrast, only 2 patients of the MD group had normal CEH, 1 patient had normal VEH and 6 had equal PLE on both ears. The logistic regression analysis using both VEH and CEH correctly predicted both diagnoses of MD in 100% and VM in 100%. Using only CEH, VEH or PLE as a criterion misclassified respectively 2,1 and 6 patients as VM. That is why the logistic regression of the combination of CEH and VEH is more powerful.The combination of CEH, VEH allows for 100% correct identification of VM and MD. This enables the differential diagnosis of MD/VM, in the appropriate clinical setting. Clinical relevance statement: This study proves that hydrops MRI can differentiate MD from VM accurately. Therefore, MR hydrops can obviate the need of trial medication in case of clinical ambiguous findings.