内耳钆造影MRI成像的研究现状与展望

Current Status and Future Perspectives of Inner Ear Gadolinium-Enhanced MRI

摘要:

内耳位置深在、解剖结构复杂，其疾病的诊断长期面临挑战。内耳钆造影磁共振成像技术通过静脉、鼓室或咽鼓管途径将造影剂引入外淋巴间隙并进行特定序列扫描，实现了内淋巴积水（endolymphatic hydrops，EH）的可视化评估; 同时，外淋巴强化程度及延迟动力学还可反映血-迷路屏障（blood-labyrinth barrier，BLB）功能状态，这为内耳疾病的诊断与鉴别提供了重要的影像学依据。本文系统综述了该技术的成像原理、给药途径、EH评估方法及其在梅尼埃病 (Meniere''s disease，MD)、突发性耳聋 (sudden sensorineural hearing loss，SSNHL)、前庭性偏头痛 (vestibular migraine，VM)、迟发性膜迷路积水、前庭神经炎、听神经瘤和耳硬化症等常见内耳疾病中的临床应用，并对评估标准统一化、低场强设备应用及人工智能辅助量化等未来发展方向进行了展望, 以期为临床推广与后续研究提供参考。

Abstract:

The deep and complex anatomy of the inner ear has long challenged its clinical diagnosis. Gadolinium-enhanced MRI of the inner ear enables the visualization of endolymphatic hydrops (EH) by means of contrast agent distribution within the perilymphatic space by intravenous, intratympanic, or eustachian tube routes and the use of optimized imaging sequences. In addition, the degree and delayed kinetics of perilymphatic enhancement can reflect the functional status of the blood-labyrinth barrier (BLB), providing critical imaging evidence for the diagnosis and differentiation of inner ear disorders. This article reviews gadolinium-enhanced inner ear MRI, covering its imaging mechanisms, delivery routes, EH assessment protocols, and clinical applications in common inner ear disorders, including Meniere''s disease (MD), sudden sensorineural hearing loss (SSNHL), vestibular migraine (VM), delayed endolymphatic hydrops, vestibular neuritis, vestibular schwannoma, and otosclerosis. It also explores crucial future directions, including the standardization of evaluation criteria, the expansion of imaging to low-field-strength MRI, and the introduction of artificial intelligence-based quantification to enhance clinical utility and guide further research.