Fujikawa Taro, Honda Keiji, Ito Taku, Kishino Mitsuhiro, Kimura Naoki, Umezawa Natsuka, Hirano Mana, Aoki Natsuki, Kawashima Yoshiyuki, Tsutsumi Takeshi
Department of Otolaryngology Tokyo Medical and Dental University Tokyo Japan.
Department of Radiology Tokyo Medical and Dental University Tokyo Japan.
Laryngoscope Investig Otolaryngol. 2020 Nov 4;5(6):1168-1175. doi: 10.1002/lio2.489. eCollection 2020 Dec.
This study aimed to test the hypothesis that contrast-enhanced 3D MRI with gradient-echo sequences (CE-3D-GRE) can detect signs of vasculitis in the fallopian canal, which may cause otologic involvement, in four patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).
CE-3D-GRE acquired at 3.0 Tesla was performed on four patients diagnosed with granulomatosis with polyangiitis or eosinophilic granulomatosis with polyangiitis, at onset or relapse of the disease, and in remission. Clinical correlations between otologic symptoms and radiological findings were examined for each patient. Furthermore, signal intensity of the mastoid segment of the fallopian canal was compared between the ears with active disease (n = 3) and those in remission or without vasculitis (n = 3).
Intense enhancement in the tympanic and mastoid segments of the fallopian canal was associated with development of external otitis, otitis media, and sensorineural hearing loss, and was unrelated to the presence of facial paresis. Maximal intensity projection images visualized the close relationship between the enhanced fallopian canal and middle ear inflammation. The findings were absent in remission. Signal intensity of the mastoid segment of the fallopian canal was higher in ears with active disease than in normal ears ( < .001) and decreased to normal levels during remission ( = .597).
CE-3D-GRE can demonstrate vasculitis in the temporal bone, reflecting disease activity and the severity of otologic manifestations, including cochlear involvement, in AAV patients. Intense enhancement of the fallopian canal on CE-3D-GRE can be a potential marker for vasculitis of the temporal bone.
本研究旨在验证以下假设，即对于4例抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者，采用梯度回波序列的对比增强三维磁共振成像（CE-3D-GRE）能够检测出可能导致耳部受累的输卵管管腔内血管炎迹象。
对4例诊断为肉芽肿性多血管炎或嗜酸性肉芽肿性多血管炎的患者，在疾病发作期、复发期及缓解期进行3.0特斯拉的CE-3D-GRE检查。检查每位患者耳部症状与影像学表现之间的临床相关性。此外，比较了3例有活动性疾病的耳朵与3例缓解期或无血管炎的耳朵的面神经管乳突段信号强度。
面神经管鼓室段和乳突段的强化与外耳道炎、中耳炎及感音神经性听力损失的发生相关，与面瘫的存在无关。最大强度投影图像显示了强化的面神经管与中耳炎症之间的密切关系。缓解期未见上述表现。有活动性疾病的耳朵的面神经管乳突段信号强度高于正常耳朵（<0.001），缓解期降至正常水平（=0.597）。
CE-3D-GRE能够显示颞骨血管炎，反映AAV患者的疾病活动度及耳部表现的严重程度，包括耳蜗受累情况。CE-3D-GRE上面神经管的强化可作为颞骨血管炎的潜在标志物。
5级。
