Perilymphatic enhancement is the signature of blood-perilymph barrier impairment

Axial delayed gadolinium-enhanced 3D FLAIR images at the level of the inner ear in a 77-year-old woman with unilateral left-sided definite Meniere disease. There is cochlear hydrops grade 1 (small arrowhead) and vestibular hydrops grade 2 according to a four-stage grading system (large arrowhead). Note increased vestibular (small arrow) and cochlear (large arrow) perilymphatic enhancement on the symptomatic side compared with the normal right labyrinth. This is the signature of blood-perilymph barrier impairment. (Source: Bernaerts A, Vanspauwen R, Blaivie C, et al. The value of four-stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Menière's disease on MRI. Neuroradiology 2019;61[4]:421-429. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)