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The round window sign: a sensitive sign to detect perilymphatic fistulae on delayed postcontrast 3D-FLAIR sequence

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Abstract

Objectives

The aim of this study is to assess the diagnostic performance of a new MR sign, named the round window sign (RWS), to diagnose perilymphatic fistula (PLF) in a population of patients with chronic cochleo-vestibular symptoms, classified as definite or probable Menière’s disease (MD).

Methods

A total of 164 patients (mean age 52 ± 35 years) with chronic cochleo-vestibular symptoms underwent MRI, between 4 and 5 h after intravenous gadoteric acid injection (Dotarem®, 0.1 mmol/kg). MRI exploration was carried out on a 3-T Achieva® TX scanner. We analyzed the presence of the RWS, defined as a nodular FLAIR high signal in the round window (RW) and the presence of associated saccular hydrops. When this RWS was present, a temporal bone CT scan was performed and the RW was analyzed.

Results

Of the 164 patients with definite MD (85 patients) or probable MD (79 patients), we found the RWS in 18 (11%), and 17/18 were classified into the group of probable MD. All these 18 patients showed other MR sequences considered as normal, including heavily weighted T2 imaging. Among these 18 patients, the temporal bone CT examination presented a filling of the RW in 13 patients (72%) and no filling of the RW in 5 patients (28%). Seven patients were surgically managed confirming in vivo the PLF diagnosis. The RWS was associated with the presence of a saccular hydrops in 4 cases.

Conclusion

Delayed postcontrast 3D-FLAIR may reveal perilymphatic fistulae in patients with probable Menière’s disease using the round window sign.

Key Points

• MRI with delayed acquisition can detect perilymphatic fistulae with perfect sensitivity, based on the presence of the round window sign.

• This visual sign is only visible on a 3D-FLAIR sequence.

• 3D-FLAIR sequence with delayed acquisition is more sensitive than temporal bone CT scan examination in detecting PLF.

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Abbreviations

3D:

Three-dimensional

BLB:

Blood-labyrinth barrier

CSF:

Cerebrospinal fluid

DMD:

Definite Menière’s disease

EH:

Endolymphatic hydrops

FLAIR:

Fluid attenuation inversion recovery

MD:

Menière’s disease

PLF:

Perilymphatic fistula

PMD:

Probable Menière’s disease

RW:

Round window

RWS:

Round window sign

SURI:

Saccule to utricle area ratio inversion

TSE:

Turbo spin echo

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Imaging Department, Head and Neck Unit, Huriez Hospital, CHU Lille, 59037, Lille, France

    Frédérique Dubrulle, Victor Chaton & Hedi Farah

  2. Otology and Oto-neurosurgery Department, Salengro Hospital, CHU Lille, 59037, Lille, France

    Michael Risoud, Quentin Charley & Christophe Vincent

Authors
  1. Frédérique Dubrulle
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  2. Victor Chaton
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  3. Michael Risoud
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  4. Hedi Farah
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  5. Quentin Charley
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  6. Christophe Vincent
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Corresponding author

Correspondence to Frédérique Dubrulle.

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Guarantor

The scientific guarantor of this publication is Dr. Frederique Dubrulle.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Dubrulle, F., Chaton, V., Risoud, M. et al. The round window sign: a sensitive sign to detect perilymphatic fistulae on delayed postcontrast 3D-FLAIR sequence. Eur Radiol 30, 6303–6310 (2020). https://doi.org/10.1007/s00330-020-06924-4

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  • DOI: https://doi.org/10.1007/s00330-020-06924-4

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