Contrast-Enhanced MRI in Patients with Cochleovestibular Syndrome

Objective . To review and analyze state of the art contrast-enhanced magnetic resonance imaging (MRI) for diagnosing the causes of cochleovestibular syndrome, with a particular focus on visualizing endolymphatic hydrops and differential diagnosis of the main pathologies. Materials and Methods . An analysis of MRI techniques was conducted. Protocols for examinations involving intravenous and intratympanic contrast medium administration, as well as the use of high-field machines (3 Tesla) and specialized pulse sequences for visualizing inner ear structures, were examined. Particular attention was paid to imaging protocols, including delayed contrast enhancement, for identifying endolymphatic hydrops, a key pathomorphological substrate of Ménière's disease. Results . Key MRI signs of the main diseases manifesting as cochleovestibular syndrome are demonstrated: Meniere's disease, intralabyrinthine schwannoma, labyrinthitis, and endolymphatic sac tumor. A technique for visualizing and grading endolymphatic hydrops is described in detail. Two contrast-enhancing methods are compared, identifying their advantages and limitations. Conclusion . Contrast-enhanced MRI, especially with delayed enhancement, is a highly informative and safe method for diagnosing the causes of cochleovestibular syndrome. MRI not only allows for the exclusion of tumors but also visualization of endolymphatic hydrops, which is crucial for diagnosing Ménière's disease. Standardized protocols and a multidisciplinary approach are essential for improving the accuracy and reproducibility of results.