OBJECTIVES: Endolymphatic hydrops (EH) can be studied in patients by MRI. With 
the semi-quantitative grading system, previous imaging studies showed 
discrepancies in the occurrence and grading of EH in patients with Meniere's 
disease (MD). Here, we compared the inversion of the saccule to utricle area 
ratio (SURI) with the semi-quantitative method of grading conventionally used to 
diagnose MD.
METHODS: Imaging was carried out on a 3-T MRI scanner. We performed 3D-FLAIR 
sequences 4 h after a single intravenous dose of contrast agent. Two 
radiologists independently studied the morphology of the inner ear structures in 
the healthy subjects and MD patients. Each subject was then graded on the basis 
of the EH semi-quantitative analysis and on saccular morphology using axial and 
sagittal reference slices in the vestibule plane.
RESULTS: Thirty healthy subjects and 30 MD patients had MRI scans. Using the 
semi-quantitative method, we found no significant difference in the number of 
subjects with EH between the two groups. SURI was found in 15 out of 30 MD 
patients and in none of the 30 healthy subjects. In three MD patients the 
saccule was not visible.
CONCLUSION: SURI is currently the most specific criterion for imaging diagnosis 
of MD.
KEY POINTS: • Half of MD patients presented with inversion of the saccule to 
utricle ratio. • Saccular analysis is crucial when assessing patients with 
Meniere's disease. • In some patients, the saccule is not visible, suggestive of 
intra-labyrinthine fistulae.