Muhle C, Reinhold-Keller E, Richter C, Duncker G, Beigel A, Brinkmann G, Gross W L, Heller M
Department of Diagnostic Radiology, University of Kiel, Germany.
Eur Radiol. 1997;7(4):566-70. doi: 10.1007/s003300050206.
The purpose of this study was to evaluate diagnostic MRI criteria in Wegener's granulomatosis of the nasal cavity, the paranasal sinuses and orbits. Between March 1991 and January 1996, 62 patients with biopsy-proven Wegener's granulomatosis were studied with T1- and T2-weighted spin-echo (SE) sequences. In 32 patients coronal postcontrast T1-weighted images were obtained. Mucosal thickening of the nasal cavity and paranasal sinuses was demonstrated as high-intensity lesions on T2-weighted SE sequences in 57 patients (92%). Of this group, inflammatory granulomatous tissue was found on biopsy in 30 patients (48%) in the nasal cavity and in 4 patients (6%) in the paranasal sinuses. In 23 patients (37%) biopsy revealed unspecific inflammatory changes without evidence of granulomatous tissue. In 14 patients (23%) granulomas were depicted as low-signal intensity lesions on T1- and T2-weighted SE sequences in the paranasal sinuses and orbits. In 5 patients (8%) osseous destruction was found. After gadolinium injection, 12 of 14 granulomas showed inhomogeneous signal enhancement. In two granulomas no enhancement was found. The MRI technique is helpful in the diagnosis of patients with Wegener's granulomatosis. In the initial inflammatory process of Wegener's granulomatosis, it is not possible to differentiate between mucosal inflammation and granulomatous tissue in MRI. In the later stage of granulomatous transformation, granulomas can be depicted as low-signal-intensity lesions. Therefore, Wegener's granulomatosis should be included in the differential diagnosis of patients with low-signal-intensity lesions on T1- and T2-weighted SE sequences of the nasal cavity, paranasal sinuses and orbits.
本研究的目的是评估鼻腔、鼻窦和眼眶韦格纳肉芽肿的诊断性MRI标准。1991年3月至1996年1月期间，对62例经活检证实为韦格纳肉芽肿的患者采用T1加权和T2加权自旋回波（SE）序列进行研究。32例患者获得了冠状位增强T1加权图像。57例患者（92%）在T2加权SE序列上显示鼻腔和鼻窦黏膜增厚为高强度病变。在该组中，30例患者（48%）鼻腔活检发现炎性肉芽肿组织，4例患者（6%）鼻窦活检发现炎性肉芽肿组织。23例患者（37%）活检显示非特异性炎症改变，无肉芽肿组织证据。14例患者（23%）在鼻窦和眼眶的T1加权和T2加权SE序列上肉芽肿表现为低信号强度病变。5例患者（8%）发现骨质破坏。注射钆后，14个肉芽肿中有12个显示不均匀信号增强。2个肉芽肿未发现增强。MRI技术有助于韦格纳肉芽肿患者的诊断。在韦格纳肉芽肿的初始炎症过程中，MRI无法区分黏膜炎症和肉芽肿组织。在肉芽肿转变的后期，肉芽肿可表现为低信号强度病变。因此，韦格纳肉芽肿应纳入鼻腔、鼻窦和眼眶T1加权和T2加权SE序列上低信号强度病变患者的鉴别诊断。
