内耳钆造影技术在疾病诊疗中的研究进展

Research Progress on Gadolinium-Enhanced Inner Ear MRI in Disease Diagnosis and Treatment

摘要: 内耳钆造影技术是通过静脉或鼓室途径注入钆对比剂，利用高分辨率磁共振成像(MRI)实现内耳淋巴液可视化的一种影像学方法，近年来在内耳相关疾病的诊疗中取得显著进展。该技术可有效区分内耳迷路中的外淋巴液与内淋巴液，为梅尼埃病、突发性耳聋、迟发性膜迷路积水及免疫性耳病等疾病的病理生理机制研究提供了关键依据。在梅尼埃病中，钆造影可量化内淋巴积水(EH)的程度、部位及动态变化，显著提高了该病的早期诊断率与分期准确性。此外，基于三维真实重建反转恢复(3D-real IR)或三维液体衰减反转恢复(3D-FLAIR)序列的成像方案，结合半定量或自动化图像分析系统，进一步提升了内耳结构显像的可靠性与可重复性。近年来，该技术亦逐步应用于手术前评估、疗效监测及个体化治疗策略制定，展现出良好的临床前景。然而，其标准化操作流程、图像判读统一标准及长期预后关联性研究仍有待进一步深化。

Abstract: The gadolinium-enhanced inner ear MRI, which entails the administration of gadolinium-based contrast agents either intravenously or via the tympanic cavity, leverages high-resolution magnetic resonance imaging (MRI) to enable the visualization of inner ear lymphatic fluids. In recent years, this imaging modality has witnessed substantial advancements in the diagnosis and management of inner ear-related disorders. Notably, it facilitates the precise differentiation between perilymph and endolymph within the inner ear labyrinth, thereby furnishing critical insights into the pathophysiological mechanisms underlying conditions such as Meniere’s disease, sudden sensorineural hearing loss, delayed endolymphatic hydrops, and immune-mediated otological diseases. In the context of Meniere’s disease, gadolinium contrast allows for the quantification of the extent, localization, and dynamic evolution of endolymphatic hydrops (EH), markedly enhancing the early diagnostic rate and staging accuracy of the disease. Furthermore, the integration of three-dimensional real inversion recovery (3D-real IR) or three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences with semi-quantitative or automated image analysis systems has further improved the reliability and reproducibility of inner ear structural imaging. In recent years, this technique has also been increasingly applied in preoperative evaluation, therapeutic efficacy monitoring, and the formulation of individualized treatment strategies, showcasing promising clinical potential. Nevertheless, areas such as standardized operating protocols, unified image interpretation criteria, and studies exploring correlations with long-term prognosis remain to be further refined and validated.