목적: Diagnosis of Meniere’s disease (MD) has been made based on the clinical history and audiometry, and histopathologic confirmation of endolymphatic hydrops (EH) is necessary to make a diagnosis of certain MD in 1995 AAO guideline. Since nonspecific ear symptoms such as dizziness and ear fullness are frequently accompanied in many other diagnoses as well as MD, and EH is the main pathophysiologic mechanism of MD, recently developed MR protocol to document EH can be very useful tool to understand the status of inner ear. We took MRI using HYDROPS (HYbriD of Reversed image Of Positive endolymph signal and native image of positive perilymph Signal) protocol in MD patients and analyzed the role of MRI visualizing the endolymphatic space in the diagnosis of MD. 방법:Total 123 MD patients were recruited for this study. There were 80 definite MD, 11 probable MD, 32 possible MD patients based on 1995 AAO guideline. The grade of endolymphatic hydrops on MRI was separately measured by two authors (SCH and YSK). The grade of EH was compared with several clinical parameters including the duration of MD, diagnostic scale, pure tone audiometry, and caloric test. The comparison was conducted between affected ear and unaffected ear. The degree of EH was also correlated with parameters in affected ears. Kruskal-Wallis test and Pearson’s chi square test were conducted using RStudio (version 3.5.2.). 결과:Mean hearing threshold was significantly higher depending on the grade of EH (p<0.05). However, averages of low tone threshold were significantly different between EH grade 0 and 1. Unilateral weakness on caloric test showed significant difference depending on the grade of vestibular hydrops, but not on the cochlear hydrops. The grade of EH was not associated with the duration of MD. 결론:Severity of EH showed significant correlation with the diagnostic scale and clinical parameters. Radiological evaluation of MD using HYDROPS protocol seems a valuable tool to evaluated the extent and the severity of EH in the diagnosis of MD based on its pathophysiologic mechanism.