感音難聴とめまい: 病態はどこまで分かったか —内耳MRI画像の進歩
従来, 難聴やめまいのMRI (Magnetic Resonance Imaging) 診断では聴神経腫瘍の有無や奇形, 椎骨脳底動脈循環不全, 脳腫瘍, 多発性硬化症などが診断される程度であり, 内耳のリンパ環境の変化については, 迷路炎によるリンパ腔の形態的変化や著明な内耳出血がない限り検出が困難であった. 近年, 3Tの登場とマルチチャンネルコイルによる信号雑音比の向上, 新しいパルスシークエンスソフトの開発による高速化などのMR技術の顕著な進歩が複合して, 内耳リンパ環境の変化を鋭敏に捉えることのできる3D-FLAIR (fluid attenuated inversion recov...
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| Published in | 日本耳鼻咽喉科学会会報 Vol. 113; no. 10; pp. 783 - 789 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本耳鼻咽喉科学会
2010
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0030-6622 1883-0854 |
| DOI | 10.3950/jibiinkoka.113.783 |
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| Abstract | 従来, 難聴やめまいのMRI (Magnetic Resonance Imaging) 診断では聴神経腫瘍の有無や奇形, 椎骨脳底動脈循環不全, 脳腫瘍, 多発性硬化症などが診断される程度であり, 内耳のリンパ環境の変化については, 迷路炎によるリンパ腔の形態的変化や著明な内耳出血がない限り検出が困難であった. 近年, 3Tの登場とマルチチャンネルコイルによる信号雑音比の向上, 新しいパルスシークエンスソフトの開発による高速化などのMR技術の顕著な進歩が複合して, 内耳リンパ環境の変化を鋭敏に捉えることのできる3D-FLAIR (fluid attenuated inversion recovery) が臨床応用可能となり, 従来は画像的な異常を検出できなかった突発性難聴やハント症候群, ムンプス難聴などの多くの患者で異常所見を検出し得るようになった. さらに3D-FLAIRを鼓室内ガドリニウム造影剤投与と組み合わせることによって, 内リンパ水腫を検出することが可能となった. しかし, 本法はガドリニウム造影剤の適応外使用であり, 侵襲性もあるので, 次のステップとして静脈注射での内リンパ腔描出を目指した. まず血液迷路関門の透過性が亢進していると思われる突発性難聴症例を対象に通常量静脈投与4時間後には迷路外リンパ腔が増強され, 前庭において内リンパ腔の認識が造影欠損として可能であることを示した. メニエール病については国内で認可されている最大量である2倍量のガドリニウム造影剤の静脈投与4時間後の3D-FLAIRで蝸牛, 前庭において内リンパ水腫を描出することに成功した. しかし, 静脈投与4時間後撮影は鼓室内ガドリニウム造影剤投与に比べて造影剤の外リンパ移行が不十分なことも多く, さらに薄い濃度の造影剤を検出する方法を検討している. このようにさまざまな内耳MRI研究は, 感音性難聴とめまいにおける画像を使った客観的医療の導入のきっかけとなることを目指して進化している. |
|---|---|
| AbstractList | 従来, 難聴やめまいのMRI (Magnetic Resonance Imaging) 診断では聴神経腫瘍の有無や奇形, 椎骨脳底動脈循環不全, 脳腫瘍, 多発性硬化症などが診断される程度であり, 内耳のリンパ環境の変化については, 迷路炎によるリンパ腔の形態的変化や著明な内耳出血がない限り検出が困難であった. 近年, 3Tの登場とマルチチャンネルコイルによる信号雑音比の向上, 新しいパルスシークエンスソフトの開発による高速化などのMR技術の顕著な進歩が複合して, 内耳リンパ環境の変化を鋭敏に捉えることのできる3D-FLAIR (fluid attenuated inversion recovery) が臨床応用可能となり, 従来は画像的な異常を検出できなかった突発性難聴やハント症候群, ムンプス難聴などの多くの患者で異常所見を検出し得るようになった. さらに3D-FLAIRを鼓室内ガドリニウム造影剤投与と組み合わせることによって, 内リンパ水腫を検出することが可能となった. しかし, 本法はガドリニウム造影剤の適応外使用であり, 侵襲性もあるので, 次のステップとして静脈注射での内リンパ腔描出を目指した. まず血液迷路関門の透過性が亢進していると思われる突発性難聴症例を対象に通常量静脈投与4時間後には迷路外リンパ腔が増強され, 前庭において内リンパ腔の認識が造影欠損として可能であることを示した. メニエール病については国内で認可されている最大量である2倍量のガドリニウム造影剤の静脈投与4時間後の3D-FLAIRで蝸牛, 前庭において内リンパ水腫を描出することに成功した. しかし, 静脈投与4時間後撮影は鼓室内ガドリニウム造影剤投与に比べて造影剤の外リンパ移行が不十分なことも多く, さらに薄い濃度の造影剤を検出する方法を検討している. このようにさまざまな内耳MRI研究は, 感音性難聴とめまいにおける画像を使った客観的医療の導入のきっかけとなることを目指して進化している. |
| Author | 長縄, 慎二 中島, 務 |
| Author_xml | – sequence: 1 fullname: 長縄, 慎二 organization: 名古屋大学医学部放射線科 – sequence: 1 fullname: 中島, 務 organization: 名古屋大学医学部耳鼻咽喉科 |
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| Copyright | 2010 一般社団法人 日本耳鼻咽喉科学会 |
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| References | 31) Yamamoto M, Teranishi M, Naganawa S, et al: Relationship between the Degree of Endolymphatic Hydrops and Electrocochleography. Audiol Neurootol 2009; 15: 254-260. 1) Casselman JW, Kuhweide R, Ampe W, et al: Pathology of the membranous labyrinth: comparison of T1-and T2-weighted and gadolinium-enhanced spin-echo and 3DFT-CISS imaging. AJNR Am J Neuroradiol 1993; 14: 59-69. 34) Tagaya M, Teranishi M, Naganawa S, et al: 3 Tesla magnetic resonance imaging obtained 4 hours after intravenous gadolinium injection in patients with sudden deafness. Acta Otolaryngol 2010; 130: 665-669. 4) Koizuka I, Seo Y, Murakami M, et al: Micro-magnetic resonance imaging of the inner ear in the guinea pig. NMR Biomed 1997; 10: 31-34. 22) Naganawa S, Satake H, Iwano S, et al: Communication between cochlear perilymph and cerebrospinal fluid through the cochlear modiolus visualized after intratympanic administration of Gd-DTPA. Radiat Med 2008; 26: 597-602. 37) Colletti V, Mandala M, Carner M, et al: Evidence of Gadolinium Distribution from the Endolymphatic Sac to the Endolymphatic Compartments of the Human Inner Ear. Audiol Neurootol 2010; 15: 353-363. 21) Naganawa S, Nakashima T: Cutting edge of inner ear MRI. Acta Otolaryngol Suppl 2009; 560: 15-21. 33) Yoshioka M, Naganawa S, Sone M, et al: Individual differences in the permeability of the round window: evaluating the movement of intratympanic gadolinium into the inner ear. Otol Neurotol 2009; 30: 645-648. 28) Miyagawa M, Fukuoka H, Tsukada K, et al: Endolymphatic hydrops and therapeutic effects are visualized in ‘atypical’ Meniere's disease. Acta Otolaryngol 2009 ; 129: 1326-1329. 29) Nakashima T, Naganawa S, Pyykko I, et al: Grading of endolymphatic hydrops using magnetic resonance imaging. Acta Otolaryngol Suppl 2009; 560: 5-8. 20) Nakashima T, Naganawa S, Sugiura M, et al: Visualization of endolymphatic hydrops in patients with Meniere's disease. Laryngoscope 2007; 117: 415-420. 24) Naganawa S, Satake H, Kawamura M, et al: Separate visualization of endolymphatic space, perilymphatic space and bone by a single pulse sequence; 3D-inversion recovery imaging utilizing real reconstruction after intratympanic Gd-DTPA administration at 3 Tesla. Eur Radiol 2008; 18: 920-924. 27) Fukuoka H, Tsukada K, Miyagawa M, et al: Semi-quantitative evaluation of endolymphatic hydrops by bilateral intratympanic gadolinium-based contrast agent (GBCA) administration with MRI for Meniere's disease. Acta Otolaryngol 2009; 10: 1-7. 2) Iwayama E, Naganawa S, Ito T, et al: High-resolution MR cisternography of the cerebellopontine angle: 2D versus 3D fast spin-echo sequences. AJNR Am J Neuroradiol 1999; 20: 889-895. 8) Naganawa S, Koshikawa T, Nakamura T, et al: Comparison of flow artifacts between 2D-FLAIR and 3D-FLAIR sequences at 3T. Eur Radiol 2004; 14: 1901-1908. 13) Sugiura M, Naganawa S, Teranishi M, et al: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings in patients with sudden sensorineural hearing loss. Laryngoscope 2006; 116: 1451-1454. 23) Kawai H, Naganawa S, Ishihara S, et al: MR imaging of the cochlear modiolus after intratympanic administration of Gd-DTPA. Magn Reson Med Sci 2010; 9: 23-29. 14) Sugiura M, Naganawa S, Sone M, et al: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings in a patient with cochlear otosclerosis. Auris Nasus Larynx 2008; 35: 269-272. 19) Zou J, Pyykko I, Bjelke B, et al: Communication between the perilymphatic scalae and spiral ligament visualized by in vivo MRI. Audiol Neurootol 2005; 10: 145-152. 6) Lane JI, Witte RJ, Bolster B, et al: State of the art: 3T imaging of the membranous labyrinth. AJNR Am J Neuroradiol 2008; 29: 1436-1440. 5) Ito T, Naganawa S, Fukatsu H, et al: High-resolution MR images of inner ear internal anatomy using a local gradient coil at 1.5 Tesla: correlation with histological specimen. Radiat Med 1999; 17: 343-347. 3) Naganawa S, Ito T, Fukatsu H, et al: MR imaging of the inner ear: comparison of a three-dimensional fast spin-echo sequence with use of a dedicated quadrature-surface coil with a gadolinium-enhanced spoiled gradient-recalled sequence. Radiology 1998; 208: 679-685. 10) Sone M, Mizuno T, Sugiura M, et al: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging investigation of inner ear disturbances in cases of middle ear cholesteatoma with labyrinthine fistula. Otol Neurotol 2007; 28: 1029-1033. 38) Naganawa S, Ishihara S, Iwano S, et al: Detection of presumed hemorrhage in the ampullar endolymph of the semicircular canal: a case report. Magn Reson Med Sci 2009; 8: 187-191. 39) Kakigi A, Nishimura M, Takeda T, et al: Effects of gadolinium injected into the middle ear on the stria vascularis. Acta Otolaryngol 2008; 128: 841-845. 12) Sugiura M, Naganawa S, Nakata S, et al: 3D-FLAIR MRI findings in a patient with Ramsay Hunt syndrome. Acta Otolaryngol 2007; 127: 547-549. 36) Khurana A, Runge VM, Narayanan M, et al: Nephrogenic systemic fibrosis: a review of 6 cases temporally related to gadodiamide injection (omniscan). Invest Radiol 2007; 42: 139-145. 35) Nakashima T, Naganawa S, Teranishi M, et al: Endolymphatic hydrops revealed by intravenous gadolinium injection in patients with Meniere's disease. Acta Otolaryngol 2009; 14: 1-6. 17) Niyazov DM, Andrews JC, Strelioff D, et al: Diagnosis of endolymphatic hydrops in vivo with magnetic resonance imaging. Otol Neurotol 2001; 22: 813-817. 30) Sone M, Naganawa S, Teranishi M, et al: Changes in endolymphatic hydrops in a patient with Meniere's disease observed using magnetic resonance imaging. Auris Nasus Larynx 2010; 37: 220-222. 7) Naganawa S, Komada T, Fukatsu H, et al: Observation of contrast enhancement in the cochlear fluid space of healthy subjects using a 3D-FLAIR sequence at 3 Tesla. Eur Radiol 2006; 16: 733-737. 18) Naganawa S, Koshikawa T, Nakamura T, et al: High-resolution T1-weighted 3D real IR imaging of the temporal bone using triple-dose contrast material. Eur Radiol 2003; 13: 2650-2658. 11) Nakata S, Mizuno T, Naganawa S, et al: 3D-FLAIR MRI in facial nerve paralysis with and without audio-vestibular disorder. Acta Otolaryngol 2010; 130: 632-636. 15) Naganawa S, Asai H, Ishigaki T, et al: MR imaging of the vestibular aqueduct in normal volunteers and patients with Meniere's disease—a preliminary report. Nippon Igaku Hoshasen Gakkai Zasshi 1991; 51: 213-218. 25) Naganawa S, Ishihara S, Iwano S, et al: Three-dimensional (3D) visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPA: optimization of a 3D-real inversion-recovery turbo spin-echo (TSE) sequence and application of a 32-channel head coil at 3T. J Magn Reson Imaging 2010; 31: 210-214. 26) Liu F, Huang WN, Song HT, et al: Endolymphatic visualization in patients with Meniere's disease. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2008; 30: 651-654. 32) Katayama N, Yamamoto M, Teranishi M, et al: Relationship between endolymphatic hydrops and vestibular-evoked myogenic potential. Acta Otolaryngol 2010; 130: 917-923. 9) Yoshida T, Sugiura M, Naganawa S, et al: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings and prognosis in sudden sensorineural hearing loss. Laryngoscope 2008; 118: 1433-1437. 16) Tanioka H, Zusho H, Machida T, et al: High-resolution MR imaging of the inner ear: findings in Meniere's disease. Eur J Radiol 1992; 15: 83-88. |
| References_xml | – reference: 34) Tagaya M, Teranishi M, Naganawa S, et al: 3 Tesla magnetic resonance imaging obtained 4 hours after intravenous gadolinium injection in patients with sudden deafness. Acta Otolaryngol 2010; 130: 665-669. – reference: 10) Sone M, Mizuno T, Sugiura M, et al: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging investigation of inner ear disturbances in cases of middle ear cholesteatoma with labyrinthine fistula. Otol Neurotol 2007; 28: 1029-1033. – reference: 27) Fukuoka H, Tsukada K, Miyagawa M, et al: Semi-quantitative evaluation of endolymphatic hydrops by bilateral intratympanic gadolinium-based contrast agent (GBCA) administration with MRI for Meniere's disease. Acta Otolaryngol 2009; 10: 1-7. – reference: 39) Kakigi A, Nishimura M, Takeda T, et al: Effects of gadolinium injected into the middle ear on the stria vascularis. Acta Otolaryngol 2008; 128: 841-845. – reference: 36) Khurana A, Runge VM, Narayanan M, et al: Nephrogenic systemic fibrosis: a review of 6 cases temporally related to gadodiamide injection (omniscan). Invest Radiol 2007; 42: 139-145. – reference: 1) Casselman JW, Kuhweide R, Ampe W, et al: Pathology of the membranous labyrinth: comparison of T1-and T2-weighted and gadolinium-enhanced spin-echo and 3DFT-CISS imaging. AJNR Am J Neuroradiol 1993; 14: 59-69. – reference: 3) Naganawa S, Ito T, Fukatsu H, et al: MR imaging of the inner ear: comparison of a three-dimensional fast spin-echo sequence with use of a dedicated quadrature-surface coil with a gadolinium-enhanced spoiled gradient-recalled sequence. Radiology 1998; 208: 679-685. – reference: 30) Sone M, Naganawa S, Teranishi M, et al: Changes in endolymphatic hydrops in a patient with Meniere's disease observed using magnetic resonance imaging. Auris Nasus Larynx 2010; 37: 220-222. – reference: 38) Naganawa S, Ishihara S, Iwano S, et al: Detection of presumed hemorrhage in the ampullar endolymph of the semicircular canal: a case report. Magn Reson Med Sci 2009; 8: 187-191. – reference: 18) Naganawa S, Koshikawa T, Nakamura T, et al: High-resolution T1-weighted 3D real IR imaging of the temporal bone using triple-dose contrast material. Eur Radiol 2003; 13: 2650-2658. – reference: 4) Koizuka I, Seo Y, Murakami M, et al: Micro-magnetic resonance imaging of the inner ear in the guinea pig. NMR Biomed 1997; 10: 31-34. – reference: 25) Naganawa S, Ishihara S, Iwano S, et al: Three-dimensional (3D) visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPA: optimization of a 3D-real inversion-recovery turbo spin-echo (TSE) sequence and application of a 32-channel head coil at 3T. J Magn Reson Imaging 2010; 31: 210-214. – reference: 32) Katayama N, Yamamoto M, Teranishi M, et al: Relationship between endolymphatic hydrops and vestibular-evoked myogenic potential. Acta Otolaryngol 2010; 130: 917-923. – reference: 33) Yoshioka M, Naganawa S, Sone M, et al: Individual differences in the permeability of the round window: evaluating the movement of intratympanic gadolinium into the inner ear. Otol Neurotol 2009; 30: 645-648. – reference: 14) Sugiura M, Naganawa S, Sone M, et al: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings in a patient with cochlear otosclerosis. Auris Nasus Larynx 2008; 35: 269-272. – reference: 19) Zou J, Pyykko I, Bjelke B, et al: Communication between the perilymphatic scalae and spiral ligament visualized by in vivo MRI. Audiol Neurootol 2005; 10: 145-152. – reference: 13) Sugiura M, Naganawa S, Teranishi M, et al: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings in patients with sudden sensorineural hearing loss. Laryngoscope 2006; 116: 1451-1454. – reference: 28) Miyagawa M, Fukuoka H, Tsukada K, et al: Endolymphatic hydrops and therapeutic effects are visualized in ‘atypical’ Meniere's disease. Acta Otolaryngol 2009 ; 129: 1326-1329. – reference: 9) Yoshida T, Sugiura M, Naganawa S, et al: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings and prognosis in sudden sensorineural hearing loss. Laryngoscope 2008; 118: 1433-1437. – reference: 23) Kawai H, Naganawa S, Ishihara S, et al: MR imaging of the cochlear modiolus after intratympanic administration of Gd-DTPA. Magn Reson Med Sci 2010; 9: 23-29. – reference: 6) Lane JI, Witte RJ, Bolster B, et al: State of the art: 3T imaging of the membranous labyrinth. AJNR Am J Neuroradiol 2008; 29: 1436-1440. – reference: 31) Yamamoto M, Teranishi M, Naganawa S, et al: Relationship between the Degree of Endolymphatic Hydrops and Electrocochleography. Audiol Neurootol 2009; 15: 254-260. – reference: 8) Naganawa S, Koshikawa T, Nakamura T, et al: Comparison of flow artifacts between 2D-FLAIR and 3D-FLAIR sequences at 3T. Eur Radiol 2004; 14: 1901-1908. – reference: 20) Nakashima T, Naganawa S, Sugiura M, et al: Visualization of endolymphatic hydrops in patients with Meniere's disease. Laryngoscope 2007; 117: 415-420. – reference: 37) Colletti V, Mandala M, Carner M, et al: Evidence of Gadolinium Distribution from the Endolymphatic Sac to the Endolymphatic Compartments of the Human Inner Ear. Audiol Neurootol 2010; 15: 353-363. – reference: 12) Sugiura M, Naganawa S, Nakata S, et al: 3D-FLAIR MRI findings in a patient with Ramsay Hunt syndrome. Acta Otolaryngol 2007; 127: 547-549. – reference: 16) Tanioka H, Zusho H, Machida T, et al: High-resolution MR imaging of the inner ear: findings in Meniere's disease. Eur J Radiol 1992; 15: 83-88. – reference: 21) Naganawa S, Nakashima T: Cutting edge of inner ear MRI. Acta Otolaryngol Suppl 2009; 560: 15-21. – reference: 2) Iwayama E, Naganawa S, Ito T, et al: High-resolution MR cisternography of the cerebellopontine angle: 2D versus 3D fast spin-echo sequences. AJNR Am J Neuroradiol 1999; 20: 889-895. – reference: 5) Ito T, Naganawa S, Fukatsu H, et al: High-resolution MR images of inner ear internal anatomy using a local gradient coil at 1.5 Tesla: correlation with histological specimen. Radiat Med 1999; 17: 343-347. – reference: 29) Nakashima T, Naganawa S, Pyykko I, et al: Grading of endolymphatic hydrops using magnetic resonance imaging. Acta Otolaryngol Suppl 2009; 560: 5-8. – reference: 22) Naganawa S, Satake H, Iwano S, et al: Communication between cochlear perilymph and cerebrospinal fluid through the cochlear modiolus visualized after intratympanic administration of Gd-DTPA. Radiat Med 2008; 26: 597-602. – reference: 17) Niyazov DM, Andrews JC, Strelioff D, et al: Diagnosis of endolymphatic hydrops in vivo with magnetic resonance imaging. Otol Neurotol 2001; 22: 813-817. – reference: 15) Naganawa S, Asai H, Ishigaki T, et al: MR imaging of the vestibular aqueduct in normal volunteers and patients with Meniere's disease—a preliminary report. Nippon Igaku Hoshasen Gakkai Zasshi 1991; 51: 213-218. – reference: 26) Liu F, Huang WN, Song HT, et al: Endolymphatic visualization in patients with Meniere's disease. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2008; 30: 651-654. – reference: 7) Naganawa S, Komada T, Fukatsu H, et al: Observation of contrast enhancement in the cochlear fluid space of healthy subjects using a 3D-FLAIR sequence at 3 Tesla. Eur Radiol 2006; 16: 733-737. – reference: 11) Nakata S, Mizuno T, Naganawa S, et al: 3D-FLAIR MRI in facial nerve paralysis with and without audio-vestibular disorder. Acta Otolaryngol 2010; 130: 632-636. – reference: 35) Nakashima T, Naganawa S, Teranishi M, et al: Endolymphatic hydrops revealed by intravenous gadolinium injection in patients with Meniere's disease. Acta Otolaryngol 2009; 14: 1-6. – reference: 24) Naganawa S, Satake H, Kawamura M, et al: Separate visualization of endolymphatic space, perilymphatic space and bone by a single pulse sequence; 3D-inversion recovery imaging utilizing real reconstruction after intratympanic Gd-DTPA administration at 3 Tesla. Eur Radiol 2008; 18: 920-924. |
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| Snippet | 従来, 難聴やめまいのMRI (Magnetic Resonance Imaging) 診断では聴神経腫瘍の有無や奇形, 椎骨脳底動脈循環不全, 脳腫瘍, 多発性硬化症などが診断される程度であり, 内耳のリンパ環境の変化については, 迷路炎によるリンパ腔の形態的変化や著明な内耳出血がない限り検出が困難であった.... |
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| SubjectTerms | FLAIR (fluid attenuated inversion recovery) MRI ガドリニウム造影剤 内リンパ水腫 高磁場 |
| Title | 感音難聴とめまい: 病態はどこまで分かったか —内耳MRI画像の進歩 |
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| ispartofPNX | 日本耳鼻咽喉科学会会報, 2010, Vol.113(10), pp.783-789 |
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