Is endolymphatic hydrops, as detected in MRI, a truly cochleocentric finding?

IntroductionThe most common histopathological finding in Ménière’s disease (MD) is endolymphatic hydrops (EH), which involves the dilation of the membranous labyrinth. The direct relationship between EH and MD is debated, although EH plays a crucial role in auditory and vestibular functional tests. MRI sequences such as 3D-FLAIR and 3D-real-IR are used to study EH, with the latter being more effective. This study aimed to examine whether the severity of EH detected by MRI is always more pronounced in the cochlea than in the vestibule, indicating a cochleocentric progression of the condition.MethodsA retrospective longitudinal study was conducted at a tertiary care medical center from 2019 to 2023, involving patients diagnosed with unilateral Ménière’s disease. All patients underwent MRI hydrops assessments (3D-REAL-IR sequences) using 3 Tesla magnets and gadobutrol contrast agent. EH was graded qualitatively and quantitatively for both ears using scales for cochlear endolymphatic hydrops (cEH) and vestibular endolymphatic hydrops (vEH). Volumetric measurements of the vestibule and endolymph were performed, and the vestibular endolymphatic ratio (vELR) was calculated. The degree of perilymphatic enhancement (PE) and endolymphatic herniation was also assessed. Patient data, including demographics, disease features, comorbidities, hearing loss, and vestibular function, were collected from medical records. Statistical analysis involved various tests to compare groups and evaluate correlations, using a significance level of p