{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T22:59:45Z","timestamp":1776380385384,"version":"3.51.2"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T00:00:00Z","timestamp":1720483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Hybrid of reversed image of positive endolymph signal and negative image of perilymph signal (HYDROPS) in delayed gadolinium\u2010enhanced magnetic resonance imaging (MRI) typically depicts normal inner ear as \u201cwhite\u2010tone\u201d and endolymphatic hydrops as \u201cblack\u2010transparent\u201d appearances, whereas ears with auditory and vestibular disorders are occasionally depicted as \u201cgray\u2010tone.\u201d This study aimed to investigate the pathological basis of sudden sensorineural hearing loss (SSNHL) patients with \u201cgray\u2010tone\u201d appearances on HYDROPS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Delayed gadolinium\u2010enhanced MRI examinations were conducted on 29 subjects with unilateral SSNHL. We mainly analyzed positive perilymph image (PPI) and positive endolymph image (PEI), which were components HYDROPS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>On PPI, signal intensity (SI) values extracted from the cochlear and vestibular region of interest (ROI) were higher in the SSNHL ears with dizziness\/vertigo symptom at the first visit compared to the healthy ear. Additionally, the PPI\/PEI enhancement pattern in the vestibule was associated with a high prevalence of hearing and vestibular deteriorations at the first visit and poor hearing improvement after treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Enhancement on PPI\/PEI may result from leakage of gadolinium into the inner ear following breakdown of the blood\u2010labyrinth barrier, with high SI being correlated with the amount of leakage. Particularly, a significant leakage into the endolymphatic space, defined as PPI+\/PEI+, indicates severe inner ear pathology. Ultimately, we emphasize that the \u201cgray\u2010tone\u201d appearance in the inner ear on HYDROPS comprises enhancements on both PPI and PEI and propose a new classification for evaluating SSNHL Peri\u2010 and Endolymphatic image Enhancement pattern in Delayed gadolinium\u2010enhanced MRI (SPEED).<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lio2.1295","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T10:55:04Z","timestamp":1720522504000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Gray\u2010tone appearances on 4\u2010hour delayed gadolinium\u2010enhanced magnetic resonance imaging indicate severe inner ear pathology and symptoms in sudden sensorineural hearing loss"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2682-4329","authenticated-orcid":false,"given":"Toshizo","family":"Koizumi","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Nippon Life Hospital  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9598-6287","authenticated-orcid":false,"given":"Toru","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology St. Marianna University Yokohama Seibu Hospital  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuya","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Izumi City General Hospital  Izumi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroto","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck 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