University Hospital Hamburg-Eppendorf, Hamburg, Germany.
University of Kiel, Kiel, Germany.
Arthritis Care Res (Hoboken). 2018 May;70(5):777-784. doi: 10.1002/acr.23332. Epub 2018 Apr 2.
To compare magnetic resonance imaging (MRI)-based and laryngoscopy-based subglottic stenosis (SGS) grading with pulmonary function testing (PFT) in patients with granulomatosis with polyangiitis (GPA).
In this retrospective study, we included 118 examinations of 44 patients with GPA and suspected SGS. All patients underwent MRI, laryngoscopy, and PFT. Stenosis was graded on a 4-point scale by endoscopy and MRI using the Meyer-Cotton (MC) score (score 1: ≤50%, 2: 51-70%, 3: 71-99%, and 4: 100%) and as percentage by MRI. Results were compared with peak expiratory flow (PEF) and maximum inspiratory flow (MIF) from PFT, serving as objective functional reference.
In MRI, 112 of 118 examinations (95%) were rated positive for SGS (grade 1 [n = 82], grade 2 [n = 26], and grade 3 [n = 4]), whereas in laryngoscopy 105 of 118 examinations (89%) were rated positive for SGS (grade 1 [n = 73], grade 2 [n = 24], and grade 3 [n = 8]). MRI and laryngoscopy agreed in 75 of 118 examinations (64%). MRI determined higher scores in 20 examinations (17%) and lower scores in 23 examinations (19%) compared to laryngoscopy. MC scores as determined by both MRI and laryngoscopy showed comparable correlations with PEF (r = -0.363, P = 0.016, and r = -0.376, P = 0.012, respectively) and MIF (r = -0.340, P = 0.024, and r = -0.320, P = 0.034, respectively). The highest correlation was found between MRI-based stenosis grading in percentage with PEF (r = -0.441, P = 0.003) and MIF (r = -0.413, P = 0.005).
MRI and laryngoscopy provide comparable results for grading of SGS in GPA and correlate well with PFT. MRI is an attractive noninvasive and radiation-free alternative for monitoring the severity of SGS in patients with GPA.
比较磁共振成像（MRI）和喉镜下基于声门下狭窄（SGS）分级与肉芽肿性多血管炎（GPA）患者的肺功能测试（PFT）。
在这项回顾性研究中，我们纳入了 44 名 GPA 患者和疑似 SGS 的 118 次检查。所有患者均接受 MRI、喉镜和 PFT 检查。狭窄程度采用 4 分制内镜和 MRI 分级（Meyer-Cotton[MC]评分，评分 1：≤50%，2：51-70%，3：71-99%，4：100%）和 MRI 测量的百分比表示。结果与 PFT 的呼气峰流速（PEF）和最大吸气流量（MIF）进行比较，作为客观功能参考。
在 MRI 中，118 次检查中有 112 次（95%）被评估为 SGS 阳性（1 级[n=82]，2 级[n=26]，3 级[n=4]），而喉镜检查中有 105 次（89%）被评估为 SGS 阳性（1 级[n=73]，2 级[n=24]，3 级[n=8]）。MRI 和喉镜检查在 75 次检查中（64%）一致。MRI 比喉镜检查确定的评分高 20 次（17%），低 23 次（19%）。MRI 和喉镜检查确定的 MC 评分与 PEF（r=-0.363，P=0.016，r=-0.376，P=0.012）和 MIF（r=-0.340，P=0.024，r=-0.320，P=0.034）呈类似相关性。与 PFT 相关性最高的是 MRI 测量的百分比与 PEF（r=-0.441，P=0.003）和 MIF（r=-0.413，P=0.005）之间的相关性。
MRI 和喉镜检查对 GPA 患者的 SGS 分级提供了可比的结果，并与 PFT 密切相关。MRI 是一种有吸引力的非侵入性和无辐射替代方法，可用于监测 GPA 患者 SGS 的严重程度。
