PMC9288196_01
Magnetic resonance images of a 60-year-old female (patient #1) with right-sided clinically defined Meniere's disease. According to the Barath classification, the example case of the normal cochlea classified as grade 0 cochlear hydrops (CH). A) Delayed-postcontrast three-dimensional fluidattenuated inversion recovery (3D-FLAIR) T2 axial image of both ears at the level of cochlear modiolus (marked with a dotted arrow). A non-enhancing cochlear duct is invisible in the enhanced scala vestibuli and scala tympani (marked with an arrowhead) - no signs of CH, the inter-scalar septum visible between the cochlear turns (marked with a thick arrow). B) Three-dimensional fast-inflow steady-state acquisition (3D-FIESTA) axial image of both ears demonstrates the normal anatomy of the inner ear structures at the cochlear modiolus level (marked with a dotted arrow). Osseus spiral lamina (marked with a thin arrow) separates scala vestibuli (marked with an arrowhead) from scala tympani (marked with a small arrowhead)
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F1
These images were interpreted as normal, meaning grade 0 CH and grade 0 VH in the Barath scale (Figure 1).
Magnetic resonance images of a 60-year-old female (patient #1) with right-sided clinically defined Meniere's disease. According to the Barath and Bernaerts classification, the example case of a normal vestibule classified as grade 0 vestibular hydrops. Delayed-postcontrast 3D-FLAIR T2 axial image of both ears below the level of modiolum (inferior part of the vestibule). The saccule (marked with a small arrowhead) and utricle (marked with an arrowhead) are well visualized. The saccule is smaller than the utricle, and endolymphatic structures encompass less than 50% of the vestibular area
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F2
Moreover, the saccule was smaller than the utricle, which was also graded 0 VH on the Bernaerts scale (Figure 2).
PMC9288196_02
Magnetic resonance image of a 34-year-old female (patient #2) with right-sided clinically defined Meniere's disease. According to the Barath classification, it is an example case of grade 1 cochlear hydrops. Delayed-postcontrast 3D-FLAIR T2 axial image of both ears at the level of the cochlear modiolus. On the right side, a non-enhancing cochlear duct is visible as small dark nodules (marked with arrowheads) in the enhancing scala vestibuli; on the left side, normal left inner ear anatomy is presented for comparison
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F3
It was classified as grade 1 CH (Figure 3).
Magnetic resonance image of a 34-year-old female (patient #2) with right-sided clinically defined Meniere's disease. Delayed-postcontrast 3D-FLAIR T2 axial image of both ears at the level of the basal turn of the cochlea. The more robust enhancement of the basal cochlear turn on the affected right side (marked with an arrow) compared with normal perilymphatic enhancement on the left side
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F4
In addition, the more robust enhancement of the basal turn of the cochlea was present on the affected side (Figure 4).
PMC9288196_03
Magnetic resonance image of a 53-year-old female (patient #3) with right-sided clinically defined Meniere's disease. According to the Barath classification, it is an example case of grade 2 cochlear hydrops. Delayed-postcontrast 3D-FLAIR T2 axial image of both ears at the level of the cochlear modiolus. On the right side, a non-enhancing widened cochlear duct (marked with arrows) completely obstructs scala vestibuli, enhancing scala tympani (marked with arrowheads) resembling stripes
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F5
The enlarged scala media completely obstructed the scala vestibuli corresponding to grade 2 CH in Barath classifications; in addition, the more pronounced enhancement of the cochlea was observed (Figure 5).
PMC9288196_04
Magnetic resonance image of a 36-year-old male (patient #4) with right-sided clinically defined Meniere's disease. According to the Bernaerts classification, it is an example case of grade 1 (extra-low) vestibular hydrops. On the Barath scale, it is grade 0, presenting no signs of VH. Delayedpostcontrast 3D-FLAIR T2 axial image of both ears below the mid-modiolar level (inferior part of the vestibule). The right saccule (small arrowhead) is slightly bigger than the utricle (marked with an arrowhead), but the vestibular structures are still separated. Compared with a left unaffected side, the saccule (marked with a thin arrow) is smaller than the utricle (marked with a thick arrow)
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F6
According to the Barath criteria, this finding is considered normal grade 0 VH, but in the grading system proposed by Bernaerts, it was regarded as abnormal grade 1 VH (Figure 6).
PMC9288196_05
Magnetic resonance image of a 59-year-old female (patient #5) with right-sided clinically defined Meniere's disease. The example case of the mild vestibular hydrops - grade 2 in the Bernaerts scale and grade 1 in the Barath grading system. Delayed-postcontrast 3D-FLAIR T2 axial image of both ears below the mid-modiolar level (inferior part of the vestibule). On the right side, the saccule and utricle are enlarged and fused (arrowhead), but the enhancing rim of the vestibule's perilymphatic space is still visible (marked with arrows)
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F7
It corresponded with grade 1 VH in the Barath scale and grade 2 in Bernaerts modification (Figure 7).
PMC9288196_06
Magnetic resonance images of a 45-year-old male (patient #6) with right-sided clinically defined Meniere's disease. The example case of grade 2 vestibular hydrops according to the Barath classification and grade 3 in the Bernaerts scale. A) Delayed-postcontrast 3D-FLAIR T2 axial image of both ears below the mid-modiolar level (inferior part of the vestibule). No enhancing perilymphatic vestibular space is seen on the right. It is entirely encompassed by the widened, confluent endolymphatic saccule and utricle (marked with arrowhead). The endolymphatic hydrops herniation into the lateral semi-circular canal's posterior crus is visible (marked with an arrow). On the left side, the non-affected ear, the lateral semi-circular canal is preserved (marked with a dotted arrow). B) 3D-FIESTA axial image of both ears. Normal anatomy of the fluid-filled inner ear structures is visualized. The vestibule is marked with a thick arrow, posterior crus of the lateral semi-circular canal is marked with a thin arrow
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F8
In the sixth example (patient #6), a 45-year-old male with right-sided MD, the dilated confluent saccule and utricle pushed away the perilymphatic space, and no surrounding contrast structure was seen around them (Figure 8A). The widening of endolymphatic vestibular structures was so significant that they herniate into the posterior crus of the lateral semi-circular canal (Figure 8B).
PMC9288196_07
Magnetic resonance images of a 68-year-old male (patient #7) with right-sided clinically defined Meniere's disease. According to the Barath and Bernaerts classification, no signs of cochlear or vestibular endolymphatic hydrops are visible, classified as grade 0 in both scales. Delayed-postcontrast 3D-FLAIR T2 axial image of both ears at the mid-modiolar level revealed a more robust perilymphatic enhancement of cochlea on the affected (right) side (marked with an arrow)
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F9
Still, a robust PE of the cochlea was observed on the affected (right) side (Figure 9).