目的：近年来，内耳内淋巴显像技术发展迅速，这种检查的给药方法不仅可以局部给药，亦可通过静脉给药；各个研究机构报告了多种内耳内淋巴积水的评价标准。目前，关于内耳内淋巴显像的研究越来越深入，多个临床机构报告了梅尼埃病患者内耳内淋巴显像与临床检查的相关性研究，如梅尼埃病患者内耳内淋巴显像积水程度与耳蜗电图（electrocochleography,ecochg）、前庭诱发肌源性电位（vestibular-evoked myogenic potential,vemp）、冷热实验及甘油实验等检查的相关性，但国际上尚无不同梅尼埃病发作时期与内耳内淋巴间隙显像的相关性研究。本研究旨在通过经咽鼓管中耳腔导入造影剂钆行内耳3d-flair mri扫描的方法，对梅尼埃病患者组受试者进行研究，并讨论梅尼埃病患者组内耳内淋巴间隙显像与临床特征（上次眩晕发作结束距mri扫描时间）的相关性。

方法：梅尼埃病患者26例，其中三例为双侧梅尼埃病患者，共29侧患耳。根据患者的临床特征，将受试者分为a组和b组。其中，a组为mri扫描时无眩晕发作且距上次眩晕发作结束＞14天的患者，a组共有12例受试者共14侧患耳；b组为扫描时处于眩晕发作期或距上次眩晕发作结束≤14天的患者，b组共有14例受试者共15侧患耳。在鼻内窥镜引导下，将稀释八倍的钆喷酸葡胺注射液通过咽鼓管注入患耳中耳腔，给药一天后运用3t核磁共振机行3d-flair mri扫描，得到内耳内淋巴间隙的显影，并对耳蜗和前庭内耳内淋巴间隙、总淋巴间隙分别进行测量，并计算得到耳蜗和前庭内耳内淋巴间隙与总淋巴间隙的比值。本次研究采用anova方差分析进行统计学研究。

结果：26例梅尼埃病患者共29侧患耳经咽鼓管中耳腔给药成功。其中26侧患耳前庭及耳蜗内耳内淋巴间隙均得到显影。在b6，b12，b14三位患者的3d-flair mri扫描图像中，其耳蜗和半规管外淋巴间隙均得到增强显影，而前庭未得到显影。a组rv均值为0.37，标准差为 0.06；rc均值为0.15，标准差为 0.04。b组rv均值为0.52，标准差为 0.26；rc均值为0.18，标准差为 0.06。对于rv变量来说，b组与a组样本数据存在显著差异（p＜0.05），b组rv均数明显大于a组rv值均数。对于rc变量来说，b组与a组样本数据差异不显著（p＞0.05）。据我们团队之前提出的梅尼埃病影像学诊断标准，其中a组患者耳蜗内淋巴积水阳性率为7.1%，前庭内淋巴积水阳性率为42.9%；b组患者耳蜗内淋巴积水阳性率为13.3%，前庭内淋巴积水阳性率为66.7%。b组中，4位梅尼埃病发作期患者（b3，b5，b6,b14）耳蜗内淋巴积水阳性率为50%，前庭内淋巴积水阳性率为100%。b组前庭内淋巴积水阳性率高于a组。

结论：梅尼埃病患者的临床特征（上次眩晕发作结束距扫描的时间）与mri扫描诊断阳性率相关，发作期距扫描时间近或处于发作期患者mri检查阳性率高。前庭内淋巴积水影像学诊断标准应补充为：前庭内淋巴间隙与总淋巴间隙的比值≥39%即可诊断为前庭内淋巴积水，患耳耳蜗、半规管显影而前庭不显影即可诊断为极重度前庭内淋巴积水。

objective: in recent years, endolymphatic imaging has been progressing rapidly. the administration methods are various, which contain local administration intravenous administration. many institutions reported different evaluative stards for endolymphatic hydrops. now, researches on endolymphatic imaging are more more advanced. much more clinical institutions published their study about relationships of endolymphatic imaging clinical examinations, such as electrocochleography(ecochg）,vestibular-evoked myogenic potential(vemp), caloric test glycerol test. however, there is no relevant study about different periods of meniere’s disease endolymphatic imaging. this research aimed to study the relationship of endolymphatic imaging clinical manifestations (duration of last attack period to mri scan) of meniere’s patients.

method: 26 meniere’s patients 29 affected ears in total were enrolled in this research. according to clinical manifestations, when performing mri scan, patients who were not in attack period the duration of last attach period to mri scan was longer than 14 days were divided to group a; patients who were in attack period or the duration of last attach period to mri scan was shorter than or equal to 14 days were divided to group b. administrate gadolinium to mid-ear affected by md  through eustachian tube, then perform 3d-flair mri scan afer one day. after measurement calculation, compare rv rc (area of endolymphatic space divided by total lymphatic space in vestibule cochlea, respectively) of the two groups. anova test was utilized in this research.

results: 29 affected ears of 26 patients were administrated successfully. the endolymphatic spaces were distinct from perilymphatic spaces in vestibule cochlea in 26 ears. in the images of b6, b12, b14, the cochlea semicircular canals were enhanced, but the vestibules were not enhanced. for group a ,the average of rv was 0.37, the stard deviation was 0.06; the average of rc was 0.15, the stard deviation was 0.04. as to group b ,the average of rv was 0.52, the stard deviation was 0.26; the average of rc was 0.18, the stard deviation was 0.06. according to anova test, rv of the two group had significant difference（p＜0.05）, rc had no significant difference（p＞0.05）. the positive rc rv in group a were 7.1% 42.9% respectively. the positive rc rv in group b were 13.3% 66.7%, respectively. as to 4 patients who were during attack period in group b, the positive rc rv were 50% 100%, respectively. the positive rv of group b was higher than that of group a.

conclusion: the clinical manifestations (duration of last attack period to mri scan) of meniere’s patients had relationship with positive rate of mri scan. the possibility of positive rv was higher when the duration of attack period to mri scan was shorter. the diagnosis stard for endolymphatic hydrops in vestibule should be revised as following: ratio of endolymphatic space in vestibule( area of endolymphatic space devided by that of total lymphatic space) ≥39% indicates endolymphatic hydrops in vestibule; when the perilymphatic spaces of cochlea semicircular canals are enhanced, but the perilymphatic space of vestibule is not enhanced, it indicates extremely endolymphatic hydrops in vestibule.