Name: in vivo morphometric analysis of human cranial nerves using magnetic resonance imaging in meni&#232;re's disease ears and normal hearing ears
Uploaded: 2018-02-21T15:00:00
Description: Watch this Scientific Journal Video about In Vivo Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in MeniÃƒÂ¨re's Disease Ears and Normal Hearing Ears at JoVE.com

Robert G&#252;rkov received fundings from the German Ministry of Research and Education BMBF, Grant No. 01 EO 0901.

All the procedures were approved by the local ethical committee (Institutional review board of the University of Munich/LMU Munich Protocol No. 093-09). All patients gave their informed consent to the performed procedures.
1. Clinical Examination
<ol>
	<li>Identify patients suffering from suspected MD in cooperation with the Department for Ear, Nose and Throat (ENT).
	<ol>
		<li>Perform clinical evaluation; vertigo, tinnitus/ringing of the ear, and hearing loss (possibly fluctuating) need to...

<ol>
	<li>Gurkov, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vivo+visualized+endolymphatic+hydrops+and+inner+ear+functions+in+patients+with+electrocochleographically+confirmed+Meniere's+disease.">In vivo visualized endolymphatic hydrops and inner ear functions in patients with electrocochleographically confirmed Meniere's disease.</a> Otol Neurotol. 33 (6), 1040-1045 (2012).</li><li>Gurkov, R., Flatz, W., Louza, J., Strupp, M., Krause, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vivo+visualization+of+endolyphatic+hydrops+in+patients+with+Meniere's+disease:+correlation+with+audiovestibular+function.">In vivo visualization of endolyphatic hydrops in patients with Meniere's disease: correlation with audiovestibular function.</a> Eur Arch Otorhinolaryngol. 268 (12), 1743-1748 (2011).</li><li>Gurkov, R., Pyyko, I., Zou, J., Kentala, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+is+Meniere's+disease?+A+contemporary+re-evaluation+of+endolymphatic+hydrops.">What is Meniere's disease? A contemporary re-evaluation of endolymphatic hydrops.</a> J Neurol. 263, 71-81 (2016).</li><li>Plontke, S. K., Gurkov, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Meniere's+Disease.">Meniere's Disease.</a> Laryngorhinootologie. 94 (8), 530-554 (2015).</li><li>Klockars, T., Kentala, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Inheritance+of+Meniere's+disease+in+the+Finnish+population.">Inheritance of Meniere's disease in the Finnish population.</a> Arch Otolaryngol Head Neck Surg. 133 (1), 73-77 (2007).</li><li>Greco, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Meniere's+disease+might+be+an+autoimmune+condition.">Meniere's disease might be an autoimmune condition.</a> Autoimmun Rev. 11 (10), 731-738 (2012).</li><li>Ozdogmus, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Connections+between+the+facial,+vestibular+and+cochlear+nerve+bundles+within+the+internal+auditory+canal.">Connections between the facial, vestibular and cochlear nerve bundles within the internal auditory canal.</a> J Anat. 205 (1), 65-75 (2004).</li><li>Nakamichi, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishing+normal+diameter+range+of+the+cochlear+and+facial+nerves+with+3D-CISS+at+3T.">Establishing normal diameter range of the cochlear and facial nerves with 3D-CISS at 3T.</a> Magn Reson Med Sci. 12 (4), 241-247 (2013).</li><li>Kang, W. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normative+diameters+and+effects+of+aging+on+the+cochlear+and+facial+nerves+in+normal-hearing+Korean+ears+using+3.0-tesla+magnetic+resonance+imaging.">Normative diameters and effects of aging on the cochlear and facial nerves in normal-hearing Korean ears using 3.0-tesla magnetic resonance imaging.</a> Laryngoscope. 122 (5), 1109-1114 (2012).</li><li>Jaryszak, E. M., Patel, N. A., Camp, M., Mancuso, A. A., Antonelli, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cochlear+nerve+diameter+in+normal+hearing+ears+using+high-resolution+magnetic+resonance+imaging.">Cochlear nerve diameter in normal hearing ears using high-resolution magnetic resonance imaging.</a> Laryngoscope. 119 (10), 2042-2045 (2009).</li><li>Henneberger, A., Ertl-Wagner, B., Reiser, M., Gurkov, R., Flatz, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morphometric+evaluation+of+facial+and+vestibulocochlear+nerves+using+magnetic+resonance+imaging:+comparison+of+Meniere's+disease+ears+with+normal+hearing+ears.">Morphometric evaluation of facial and vestibulocochlear nerves using magnetic resonance imaging: comparison of Meniere's disease ears with normal hearing ears.</a> Eur Arch Otorhinolaryngol. 274 (8), 3029-3039 (2017).</li><li>Zwergal, A., Brandt, T., Magnusson, M., Kennard, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=DIZZYNET:+the+European+network+for+vertigo+and+balance+research.">DIZZYNET: the European network for vertigo and balance research.</a> J Neurol. 263, 1 (2016).</li><li>Zwergal, A., Brandt, T., Magnusson, M., Kennard, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=DIZZYNET--a+European+network+initiative+for+vertigo+and+balance+research:+visions+and+aims.">DIZZYNET--a European network initiative for vertigo and balance research: visions and aims.</a> J Neurol. 263, 2-9 (2016).</li><li>Grill, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=DizzyReg:+the+prospective+patient+registry+of+the+German+Center+for+Vertigo+and+Balance+Disorders.">DizzyReg: the prospective patient registry of the German Center for Vertigo and Balance Disorders.</a> J Neurol. , (2017).</li><li>Semaan, M. T., Alagramam, K. N., Megerian, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+basic+science+of+Meniere's+disease+and+endolymphatic+hydrops.">The basic science of Meniere's disease and endolymphatic hydrops.</a> Curr Opin Otolaryngol Head Neck Surg. 13 (5), 301-307 (2005).</li><li>Hayashi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Usefulness+of+the+advanced+neuroimaging+protocol+based+on+plain+and+gadolinium-enhanced+constructive+interference+in+steady+state+images+for+gamma+knife+radiosurgery+and+planning+microsurgical+procedures+for+skull+base+tumors.">Usefulness of the advanced neuroimaging protocol based on plain and gadolinium-enhanced constructive interference in steady state images for gamma knife radiosurgery and planning microsurgical procedures for skull base tumors.</a> Acta Neurochir Suppl. 116, 167-178 (2013).</li></ol>

We have demonstrated a feasible and accessible method of evaluation of morphometric changes of cranial nerves, as they may occur in several pathophysiological situations, here in MD compared to normal hearing controls.
Modifications and Troubleshooting:
Similar measurements to the ones reported here for the 7th and 8th cranial nerves can be performed using the employed 3D-CISS-sequence scans for all other cranial nerves at diff...

Magnetic resonance imaging (MRI) plays a major role in visualizing and analyzing anatomy as well as physiological and pathological processes in the human body. Since clinical and electrophysiological diagnosis of Meni&#232;re&#39;s Disease (MD) can be challenging, using additional information derived from MRI is more than helpful1,2,3,4. An in vivo method was developed to analyze endolymphatic hydrops in MD and morphometric changes of cranial nerves using MRI. With this combined approach, diagnosis of definite MD was confirmed, and morphometric changes of cranial nerves were studied at different levels throughout the course of the nerves. Etiology of MD is still unclear5,6,7. It was proposed that neural cell loss could be involved in MD, but this has yet to be confirmed.
Suitable cranial nerves for morphometric analysis in MD are the 7th and 8th nerve with its branches, which were analyzed in this study. Only a few studies can be found analyzing morphometric aspects of these nerves using MRI8,9,10. The study by Henneberger et al. analyzed morphometric changes of the 7th and 8th cranial nerve in MD ears compared to normal hearing ears11.
The method presented here enables in vivo visualization and morphometric analysis of the 7th and 8th cranial nerves throughout their course from the brain to the temporal bone. Using this method, we have shown that there are significant differences between the patient group of MD patients and healthy ears. We propose the described method for use in several situations/diseases whenever potential morphometric changes of cranial nerves are of interest. Whether this method will be established in clinical diagnostic workups remains to be evaluated by future studies. Real alternatives to the described method for in vivo evaluation of morphometric changes of cranial nerves are not available, and while computed tomography (CT) has its strengths such as wide availability, speed, and depiction of bony changes, it also exhibits too low tissue contrasts to visualize subtle changes in cranial nerves within the neurocranium and temporal bone. Post mortem analysis of cranial nerve changes in MD patients remains to be studied. With special imaging and evaluation techniques as described here, it is possible to analyze morphometric changes of cranial nerves in MD patients and healthy controls using MRI. Routine MRI workup of the brain often does not include high resolution, strongly T2-weighted imaging techniques, which are mandatory for the evaluation of morphometric changes of cranial nerves 7 and 8.
The developed method may have further diagnostic impact on evaluating different levels of severity in MD, as well as play a role in the evaluation of vertigo, hearing deficits, and tinnitus. Specialized centers for diagnostic and therapeutic workup of vertigo play a major role in today&#39;s health care systems and our method could provide specialists with a possible tool for their diagnostic workup12,13,14. Vertigo is a complex symptom occurring in several diseases, requiring a thorough interdisciplinary cooperation between different specialties, as demonstrated in specialized centers for diagnostic and therapeutic workup of vertigo12,13,14.
To our knowledge, there is no method available in the literature for in vivo morphometric analysis of cranial nerves in MD and healthy controls.

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	<tbody>
		<tr height="189">
			<td height="189" style="height:189px;width:216px;">MR-scanner, e.g. Siemens Magnetom Verio, or appropriate MR-scans in DICOM format, e.g. 3D-CISS</td>
			<td style="width:71px;">Siemens Healthcare GmbH, Erlangen, Germany, or MR scans by any other vendor</td>
			<td align="right" style="width:119px;">1</td>
			<td style="width:167px;">Instead of the MR scanner, appropriately acquired MR-scans can be used for morphometric analysis</td>
		</tr>
		<tr height="105">
			<td height="105" style="height:105px;width:216px;">Osirix or any other DICOM-Viewer with appropriate evaluation tools</td>
			<td style="width:71px;">Pixmeo SARL, Geneva, Switzerland</td>
			<td align="right" style="width:119px;">2</td>
			<td>Software for viewing and evaluating DICOM images</td>
		</tr>
		<tr height="105">
			<td height="105" style="height:105px;width:216px;">MedCalc or any other statistical analysis software, e.g. SPSS&#160;</td>
			<td style="width:71px;">MedCalc Software bvba, Ostend, Belgium</td>
			<td align="right" style="width:119px;">3</td>
			<td>Software for statistical analysis</td>
		</tr>
		<tr height="105">
			<td height="105" style="height:105px;width:216px;">Computer running Windows or MacOSX/macOS</td>
			<td style="width:71px;">e.g. Lenovo, Apple or anything selfmade</td>
			<td align="right" style="width:119px;">4</td>
			<td>Hardware on which the above software can be employed</td>
		</tr>
	</tbody>
</table>

in vivo morphometric analysis of human cranial nerves using magnetic resonance imaging in meni&#232;re's disease ears and normal hearing ears

Analysis of neural structures in Meni&#232;re's Disease (MD) is of importance, since a loss of such structures has previously been proposed for this patient group but has yet to be confirmed. This protocol describes a method of in vivo evaluation of neural changes especially well suitable for cranial nerve analysis using magnetic resonance imaging (MRI). MD-patients and normal hearing persons were examined in a 3-T MR-scanner using a scan protocol including strongly T2-weighted 3D gradient-echo-sequence (3D-CISS). In the patient group, MD was additionally confirmed using MRI-based assessment of endolymphatic hydrops. Morphometric analysis was performed using a freeware DICOM viewer. Evaluation of cranial nerves included measurements of cross-sectional areas (CSAs) of the nerves at different levels as well as orthogonal diametric measurements.

Statistical analysis was performed using statistical analysis software, and two-sided independent samples t-test was applied. Image evaluation was performed by two readers. A significant difference between the mean values of the patient group (n = 21) and healthy control group (n = 39) can be found for measurements of the CSA of the facial nerve, CN, SVN, and IVN (Table 2). CSA measurements in the patient group showed significantly larger CSA values (<strong clas...

Watch this Scientific Journal Video about In Vivo Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in MeniÃƒÂ¨re's Disease Ears and Normal Hearing Ears at JoVE.com

In Vivo Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in MeniÃƒÆ’Ã†'Ãƒâ€šÃ‚Â¨re's Disease Ears and Normal Hearing Ears

To evaluate morphological changes of cranial nerves such as loss of neural structures or swelling of cranial nerves in Meni&#232;re&#39;s Disease (MD) or in healthy persons in vivo, a protocol of evaluation has been developed using magnetic resonance imaging (MRI). Additional MRI-based confirmation of MD was performed.

In Vivo Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in Meni&#232;re's Disease Ears and Normal Hearing Ears

Analysis of neural structures in Meni&#232;re's Disease (MD) is of importance, since a loss of such structures has previously been proposed for this ...

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