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Visualization of the saccule and utricle with non-contrast-enhanced FLAIR sequences

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3D-fluid attenuation inversion recovery (FLAIR) collected 4 h after intravenous gadolinium injection can delineate the perilymphatic space (PLS) from the endolymphatic space (ELS) to capture endolymphatic hydrops, the pathological counterpart of Ménière’s disease. We aimed to optimize visualization of such inner ear internal anatomy using 3D-FLAIR without injection.


3D-FLAIR signal from different fluid compartments such as PLS and ELS was first simulated. Then, twenty-two healthy subjects were scanned at 3.0-T MRI with non-injected 3D-FLAIR using variable T2 preparations (T2Preps) (OFF, 200, 400, and 600 ms) and variable inversion times (TIs) (from 224 to 5000 ms) and different resolutions (1.0 × 1.0 × 1.5, 0.6 × 0.6 × 0.8, and 0.6 × 0.6 × 0.6 mm3). The relative contrast between PLS and ELS and the visibility of the saccule and utricle were assessed. Additionally, non-injected 3D-FLAIR with the optimal setting was tested in a Ménière patient and compared with gadolinium-injected 3D-FLAIR.


The PLS and ELS were differentiated when T2Prep was used but not without. The relative contrast was larger with T2Prep at 400 ms than at 200 or 600 ms (0.72 ± 0.22 vs. 0.44 ± 0.11, p = 0.019; and 0.72 ± 0.22 vs. 0.46 ± 0.28, p = 0.034, respectively). The saccule and utricle were best delineated in 87. % cases with T2Prep = 400 and TI = 2100 ms at the highest resolution. Visualization of the saccule and utricle in the optimized non-injected 3D-FLAIR was similar to conventional injected 3D-FLAIR in a patient.


Combining a specific T2Prep and TI in non-injected 3D-FLAIR could separate PLS and ELS and even the saccule and utricle, paving the way toward future application to diagnose Ménière’s disease.

Key Points

MRI can capture the internal anatomy of inner ear without injection of contrast media.

Specific parameters consisting of a T2 preparation of 400 ms and an inversion time of 2100 ms must be used to visualize the saccule and utricle on non-injected 3D-FLAIR.

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Endolymphatic hydrops


Endolymphatic space


Fluid attenuation inversion recovery


Gadolinium-based contrast agent


Ménière’s disease


Perilymphatic space


Relative contrast


T2 preparation


Inversion time


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TT takes full responsibility for the content of the manuscript, including the data analysis. LH, XB, VD, and TT contributed to conception and design. HF, LH, LD, TY, and XB contributed to patient selection and execution of the imaging. LZ, BZ, BT, and VP supported technical points for the sequence. HF, LH, and TT contributed to sample analysis and manuscript preparation.


The study was supported by public grants from the French Agence Nationale de la Recherche within the context of the Investments for the Future Program, referenced ANR-10-LABX-57 and named “TRAIL” (Translational Research and Advanced Imaging Laboratory).

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Correspondence to Thomas Tourdias.

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The scientific guarantor of this publication is Thomas Tourdias.

Conflict of interest

LZ is an employee of Canon Medical Systems China. BZ is an employee of Canon Medical Systems Europe. VP and BT are employees of Canon Medical Systems Corporation. They provided MR technical support for this study under a Canon collaboration agreement. They did not receive payment for participating in the study and had no personal motivation for the study outcome. The other authors of this manuscript have no conflicts of interest.

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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Institutional Review Board approval was obtained.


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Xavier Barreau and Thomas Tourdias share senior authorship.

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Fukutomi, H., Hamitouche, L., Yamamoto, T. et al. Visualization of the saccule and utricle with non-contrast-enhanced FLAIR sequences. Eur Radiol 32, 3532–3540 (2022).

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