Objective To analyze the proportion of endolymphatic hydrops (EH) in patients with Meniere’s disease (MD) verified by 3D-FLAIR magnetic resonance imaging (MRI) through intravenous gadolinium (IV-Gd) and to explore its clinical diagnostic value for MD.Methods A total of 86 patients with suspected MD according to clinical symptoms were selected from March 2016 to Oct 2021. All the patients underwent inner ear 3D -FLAIR MRI scan through IV-Gd, the clinical characteristics and EH results were analyzed.Results Among all the 86 patients, 32 were male and 54 female, aged from 28 to 72 years old with an average of 51.7±11.2 years, and medical history of one month to 18 years with an average of 2.9±2.6 years. Of the 61 patients with EH in inner ear (EH-positive), MD was confirmed in 56, and 7 of the remaining 25 patients without obvious EH in inner ear (EH-negative) were diagnosed with MD. Among the 61 EH-positive cases, 23 (37.7%) had both ears EH, and among the 84 EH-positive ears, 29 ears (34.5%) had vestibular EH, 15 (17.9%) had cochlear EH, and 33 (75%) had both vestibular and cochlear EH. The sensitivity, specificity, accuracy, the positive and negative predictive values of IV-Gd MRI for the diagnosis of MD were 88.9%, 78.3%, 86.1%, 91.8%, and 78.3%, respectively, and the area under the ROC curve was 0.836. The IV-Gd MRI had a good consistency with the clinical diagnosis result (Kappa=0.653，P<0.001). Comparison between the MD patients of EH-positive and EH-negative groups showed no statistically significant differences in patients’ age and gender, concomitant migraine and MD stage (P>0.05). Their differences in clinical course of MD and average pure tone threshold audiometry (PTA) were statistically significant (P<0.05).Conclusions With the help of the EH results detected by IV-Gd, inner ear MRI can effectively improve the diagnostic accuracy rate of MD. The course of MD and hearing loss may be related to EH. If possible, IV-Gd MRI should be used for further corroboration in patients with suspected MD.