Unenhanced subtraction MRI for endolymphatic hydrops using 3D-FLAIR at two inversion times

Unenhanced subtraction MRI using 3D-FLAIR at two inversion times yielded higher SNR than enhanced sequences (p<0.001) and excellent agreement for endolymphatic hydrops grading in 202 patients, offering a contrast-free approach.

• In healthy volunteers, endolymph and perilymph signal intensities diverged with increasing inversion time on unenhanced 3D-FLAIR, demonstrating inherent contrast.
• Unenhanced subtraction images had lower image quality score but higher SNR (p<0.001) and intermediate contrast-to-noise ratio compared to enhanced sequences.
• Excellent inter-sequence agreement for EH grading was achieved using any two of the three image sets (unenhanced subtraction, enhanced 3D-FLAIR, 3D-real IR).

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