The value of post-contrast delayed three-dimensional fluid-attenuated inversion recovery MRI in the diagnosis of unilateral vestibulopathy manifesting as episodic vestibular syndrome

Q: What imaging findings were evaluated on post-contrast delayed 3D-FLAIR MRI?

The study assessed endolymphatic hydrops (EH) and perilymphatic enhancement (PE), and classified patients as MRI-negative, EH, PE, or EH + PE based on the observed MRI patterns.

Q: How common were MRI-positive findings in patients with UVP and episodic vestibular syndrome?

Among 134 patients, 48.51% (65/134) had MRI-positive findings, with EH, PE, and EH + PE observed in 21.64%, 17.16%, and 9.7% respectively.

Q: Which factors predicted abnormal MRI findings?

Independent determinants for positive MRI findings included canal paresis (CP) value, pure-tone average (PTA), and atherosclerotic vascular risk factors.

Sep 30, 2026

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Post-contrast delayed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MRI is increasingly used to localize lesions and infer mechanisms in unilateral vestibulopathy (UVP) presenting as episodic vestibular syndrome. This study evaluated 134 UVP patients with episodic vestibular syndrome using cochleovestibular function tests and MRI assessment of endolymphatic hydrops and perilymphatic enhancement. Nearly half showed MRI-positive findings, and abnormal MRI correlated with worse auditory and vestibular test parameters, enabling identification of independent predictive determinants including canal paresis, pure-tone average, and vascular risk factors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Background

Objectives

Methods

Participants and assessments

MRI grouping

Results

Conclusions

Original Article The value of post-contrast delayed three-dimensional fluidattenuated inversion recovery MRI in the diagnosis of unilateral vestibulopathy manifesting as episodic vestibular syndrome Xiaoyuan Qi1,2, Siru Xue3, Ziming Zhu3, Hongning Jia2, Jianping Wang2, Fan Wu2, Xinyue Yan2, Bentao Yang4, Xu Yang3, Ping Gu1 1Vertigo Department, The First Hospital of Hebei Medical University, Hebei Hospital, Xuanwu Hospital of Capital Medical University, Shijiazhuang, China; 2Second Department of Vertigo, Cangzhou Central Hospital, Cangzhou, China; 3Department of Neurology, Peking University First Hospital, Beijing, China; 4Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China Contributions: (I) Conception and design: P Gu, X Yang, B Yang; (II) Administrative support: X Qi, P Gu, X Yang; (III) Provision of study materials or patients: X Qi, S Xue, Z Zhu, H Jia, J Wang, F Wu, X Yan; (IV) Collection and assembly of data: X Qi, S Xue, Z Zhu, H Jia, J Wang, F Wu, X Yan; (V) Data analysis and interpretation: X Qi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Prof. Bentao Yang, Doctorate Degree. Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang, Dongcheng District, Beijing 100730, China. Email: [cjr.yangbentao@vip.163.com](cjr.yangbentao@vip.163.com); Prof. Xu Yang, Master’s Degree. Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, [China. Email: yangxu2011@163.com](China. Email: yangxu2011@163.com); Prof. Ping Gu, Doctorate Degree. Vertigo Department, The First Hospital of Hebei Medical University, Hebei Hospital, Xuanwu Hospital of Capital Medical University, No. 89 Donggang Road, Shijiazhuang 050023, China. Email: [gpwh2000@hebmu.edu.cn](gpwh2000@hebmu.edu.cn). Background: Unilateral vestibulopathy (UVP) manifesting as episodic vestibular syndrome (EVS) is quite common in clinical practice. In recent years, post-contrast delayed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) has drawn increasing attention from clinicians owing to its effects in identifying the lesion site and speculating the possible mechanisms of UVP. This study aimed to investigate 3D-FLAIR MRI findings in patients with UVP manifesting as EVS, analyze their correlations with cochleovestibular function test results, determine the predictive factors for abnormal MRI findings in such patients, and explore the possible pathogenesis. Methods: A total of 134 patients with UVP presenting as EVS were included. Cochleovestibular function tests, including pure tone audiometry, caloric test, and video head impulse test (vHIT) were conducted. All patients underwent 3D-FLAIR MRI for evaluating endolymphatic hydrops (EH) and perilymphatic enhancement (PE) . According to the MRI findings, patients were divided into MRI-negative (−), EH, PE, and EH + PE groups. The relationships between MRI findings and parameters of cochleovestibular function tests were analyzed. The predictive factors for abnormal MRI findings were determined. Results: Among the 134 patients with UVP included, 48.51%(65/134) had MRI-positive findings. The presence of EH, PE, and simultaneous presence of EH and PE were found in 21.64%(29/134), 17.16%(23/134), and 9.7%(13/13/4) of the patients, respectively. Compared with the MRI− group, the puretone average (PTA) was significantly higher in the EH (P=0.014) and EH + PE groups (P<0.05) . The PE group had significantly higher canal paresis (CP) values than that in the MRI− (P<0.001), EH (P=0.003), and EH + PE groups (P<0.05), and significantly lower vHIT gain values than that in the MRI− (P=0.001), EH (P=0.001), and EH + PE groups (P<0.05) . The proportion of patients with abnormal vHIT results was significantly higher in the PE group than that in the MRI− (P=0.001) and EH

FAQs

What imaging findings were evaluated on post-contrast delayed 3D-FLAIR MRI?

The study assessed endolymphatic hydrops (EH) and perilymphatic enhancement (PE), and classified patients as MRI-negative, EH, PE, or EH + PE based on the observed MRI patterns.

How common were MRI-positive findings in patients with UVP and episodic vestibular syndrome?

Among 134 patients, 48.51% (65/134) had MRI-positive findings, with EH, PE, and EH + PE observed in 21.64%, 17.16%, and 9.7% respectively.

Which factors predicted abnormal MRI findings?

Independent determinants for positive MRI findings included canal paresis (CP) value, pure-tone average (PTA), and atherosclerotic vascular risk factors.

Sep 30, 2026

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