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Magnetic resonance imaging in patients with granulomatosis with polyangiitis (Wegener’s) and subglottic stenosis

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Abstract

Objective

To evaluate the ability of MRI to detect subglottic stenosis and to differentiate between active and inactive subglottic inflammation in patients with granulomatosis with polyangiitis (GPA).

Materials and methods

MRI studies of the larynx of 18 GPA patients with suspected SGS were included. The MRI protocol included T1- and T2-weighted and STIR-sequences, dynamic contrast enhancement (DCE) and diffusion weighted imaging (DWI). Two independent observers reviewed the MR images. SGS were identified and quantified, inflammatory activity was assessed using edema imaging, DCE and DWI. Final MRI diagnoses were compared to the clinical, laryngoscopic and histopathologic results.

Results

MRI confirmed SGS in all GPA patients with significant narrowing of the airway lumen and thickening of subglottic wall. Assessing the subglottic inflammatory activity, MRI showed a sensitivity of 87.5 % and a specificity of 60.0 %. Interrater agreement was κ = 0.769. Of the different MR technical approaches tested, edema imaging was most sensitive and specific. DWI led to significant differences in the apparent diffusion coefficient between active and inactive subglottic inflammation. No significant differences were found with DCE imaging.

Conclusion

MR imaging has shown the ability to detect and grade SGS in patients with GPA. It non-invasively assesses the status of inflammatory activity utilizing edema sensitive sequences and DWI.

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References

  1. Fienberg R (1955) Pathergic granulomatosis. Am J Med 19(6):829–831

    Article  PubMed  CAS  Google Scholar 

  2. Reinhold-Keller E, Beuge N, Latza U, de Groot K, Rudert H, Nolle B, Heller M, Gross WL (2000) An interdisciplinary approach to the care of patients with Wegener’s granulomatosis: long-term outcome in 155 patients. Arthritis Rheum 43(5):1021–1032

    Article  PubMed  CAS  Google Scholar 

  3. Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS (1992) Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med 116(6):488–498

    Article  PubMed  CAS  Google Scholar 

  4. Carrington CB, Liebow A (1966) Limited forms of angiitis and granulomatosis of Wegener’s type. Am J Med 41(4):497–527

    Article  PubMed  CAS  Google Scholar 

  5. Knoch DW, Lucarelli MJ, Dortzbach RK, Smith ME (2003) Limited Wegener granulomatosis with 40 years of follow-up. Arch Ophthalmol 121(11):1640–1642

    Article  PubMed  Google Scholar 

  6. Ahmad I, Lee WC, Nagendran V, Wilson F, Shortridge RT (2000) Localised Wegener’s granulomatosis in otolaryngology: a review of six cases. ORL J Otorhinolaryngol Relat Spec 62(3):149–155

    Article  PubMed  CAS  Google Scholar 

  7. Laudien M, Ambrosch P, Till A, Podschun R, Lamprecht P (2008) Diagnosis, therapy and current research aspects of selected chronic inflammatory diseases with head and neck involvement. Z Rheumatol 67(5):397–406

    PubMed  CAS  Google Scholar 

  8. Kutta H, Steven P, Paulsen F (2006) Anatomical definition of the subglottic region. Cells Tissues Organs (Print) 184(3–4):205–214

    Article  Google Scholar 

  9. Langford CA, Sneller MC, Hallahan CW, Hoffman GS, Kammerer WA, Talar-Williams C, Fauci AS, Lebovics RS (1996) Clinical features and therapeutic management of subglottic stenosis in patients with Wegener’s granulomatosis. Arthritis Rheum 39(10):1754–1760

    Article  PubMed  CAS  Google Scholar 

  10. Waxman J, Bose WJ (1986) Laryngeal manifestations of Wegener’s granulomatosis: case reports and review of the literature. J Rheumatol 13(2):408–411

    PubMed  CAS  Google Scholar 

  11. Lebovics RS, Hoffman GS, Leavitt RY, Kerr GS, Travis WD, Kammerer W, Hallahan C, Rottem M, Fauci AS (1992) The management of subglottic stenosis in patients with Wegener’s granulomatosis. Laryngoscope 102(12 Pt 1):1341–1345

    Article  PubMed  CAS  Google Scholar 

  12. Holle JU, Gross WL, Holl-Ulrich K, Ambrosch P, Noelle B, Both M, Csernok E, Moosig F, Schinke S, Reinhold-Keller E (2010) Prospective long-term follow-up of patients with localised Wegener’s granulomatosis: does it occur as persistent disease stage? Ann Rheum Dis 69(11):1934–1939

    Article  PubMed  Google Scholar 

  13. Shvero J, Shitrit D, Koren R, Shalomi D, Kramer MR (2007) Endoscopic laser surgery for subglottic stenosis in Wegener’s granulomatosis. Yonsei Med J 48(5):748–753

    Article  PubMed  Google Scholar 

  14. Gluth MB, Shinners PA, Kasperbauer JL (2003) Subglottic stenosis associated with Wegener’s granulomatosis. Laryngoscope 113(8):1304–1307

    Article  PubMed  Google Scholar 

  15. Schokkenbroek AA, Franssen CFM, Dikkers FG (2008) Dilatation tracheoscopy for laryngeal and tracheal stenosis in patients with Wegener’s granulomatosis. Eur Arch Otorhinolaryngol 265(5):549–555

    Article  PubMed  Google Scholar 

  16. Solans-Laqué R, Bosch-Gil J, Canela M, Lorente J, Pallisa E, Vilardell-Tarrés M (2008) Clinical features and therapeutic management of subglottic stenosis in patients with Wegener’s granulomatosis. Lupus 17(9):832–836

    Article  PubMed  Google Scholar 

  17. Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, Hagen EC, Hoffman GS, Hunder GG, Kallenberg CG (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37(2):187–192

    Article  PubMed  CAS  Google Scholar 

  18. Fries JF, Hunder GG, Bloch DA, Michel BA, Arend WP, Calabrese LH, Fauci AS, Leavitt RY, Lie JT, Lightfoot RW Jr et al (1990) The American College of Rheumatology 1990 criteria for the classification of vasculitis. Summary. Arthritis Rheum 33(8):1135–1136

    Article  PubMed  CAS  Google Scholar 

  19. Luqmani RA, Bacon PA, Moots RJ, Janssen BA, Pall A, Emery P, Savage C, Adu D (1994) Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. QJM 87(11):671–678

    PubMed  CAS  Google Scholar 

  20. Exley AR, Bacon PA, Luqmani RA, Kitas GD, Gordon C, Savage CO, Adu D (1997) Development and initial validation of the Vasculitis Damage Index for the standardized clinical assessment of damage in the systemic vasculitides. Arthritis Rheum 40(2):371–380

    Article  PubMed  CAS  Google Scholar 

  21. Garske U, Haack A, Beltran O, Flores-Suarez LF, Bremer JP, Lamprecht P, Hedderich J, Quetz J, Gross WL, Ambrosch P, Laudien M (2012) Intra- and inter-rater reliability of endonasal activity estimation in granulomatosis with polyangiitis (Wegener s). Clin Exp Rheumatol 30(1 Suppl 70):S22–S28

    PubMed  Google Scholar 

  22. Lakhal K, Delplace X, Cottier JP, Tranquart F, Sauvagnac X, Mercier C, Fusciardi J, Laffon M (2007) The feasibility of ultrasound to assess subglottic diameter. Anesth Analg 104(3):611–614

    Article  PubMed  Google Scholar 

  23. Malattia C, Damasio MB, Basso C, Verri A, Magnaguagno F, Viola S, Gattorno M, Ravelli A, Tomà P, Martini A (2010) Dynamic contrast-enhanced magnetic resonance imaging in the assessment of disease activity in patients with juvenile idiopathic arthritis. Rheumatology 49(1):178–185

    Article  PubMed  Google Scholar 

  24. Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33(2):363–374

    Article  PubMed  CAS  Google Scholar 

  25. Wolter NE, Ooi EH, Witterick IJ (2010) Intralesional corticosteroid injection and dilatation provides effective management of subglottic stenosis in Wegener’s granulomatosis. Laryngoscope 120(12):2452–2455

    Article  PubMed  Google Scholar 

  26. Eustaquio ME, Chan KH, Deterding RR, Hollister RJ (2011) Multilevel airway involvement in children with Wegener’s granulomatosis: clinical course and the utility of a multidisciplinary approach. Arch Otolaryngol Head Neck Surg 137(5):480–485

    Article  PubMed  Google Scholar 

  27. Althoff CE, Feist E, Burova E, Eshed I, Bollow M, Hamm B, Hermann KG (2009) Magnetic resonance imaging of active sacroiliitis: do we really need gadolinium? Eur J Radiol 71(2):232–236

    Article  PubMed  Google Scholar 

  28. Bozgeyik Z, Ozgocmen S, Kocakoc E (2008) Role of diffusion-weighted MRI in the detection of early active sacroiliitis. AJR Am J Roentgenol 191(4):980–986

    Article  PubMed  Google Scholar 

  29. Hodgson RJ, Barnes T, Connolly S, Eyes B, Campbell RS, Moots R (2008) Changes underlying the dynamic contrast-enhanced MRI response to treatment in rheumatoid arthritis. Skeletal Radiol 37(3):201–207

    Article  PubMed  Google Scholar 

  30. Huang J, Stewart N, Crabbe J, Robinson E, McLean L, Yeoman S, Tan PL, McQueen FM (2000) A 1-year follow-up study of dynamic magnetic resonance imaging in early rheumatoid arthritis reveals synovitis to be increased in shared epitope-positive patients and predictive of erosions at 1 year. Rheumatology 39(4):407–416

    Article  PubMed  CAS  Google Scholar 

  31. Watts RA, Mooney J, Skinner J, Scott DGI, Macgregor AJ (2012) The contrasting epidemiology of granulomatosis with polyangiitis (Wegener’s) and microscopic polyangiitis. Rheumatology 51(5):926–931

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Dr. Martin Lorenzen and Renate Himstedt (Department of Radiology, Klinikum Bad Bramstedt GmbH), Joachim Graessner (Siemens, Hamburg), Dr. Philipp Simon, Dr. Azien Laqmani (UKE, Hamburg), Dr. Hannes Petersen (Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig–Holstein), and Dr. David Evans (UKE, Hamburg) for their helpful support of our work.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Thorsten Klink, Frank Oliver Henes, Gerhard Adam & Thorsten Alexander Bley

  2. Department of Rheumatology and Clinical Immunology, Klinikum Bad Bramstedt GmbH, University of Luebeck, Oskar-Alexander-Str. 26, 24576, Bad Bramstedt, Germany

    Julia Holle, Frank Moosig, Corinna Platzek & Wolfgang-Ludwig Gross

  3. Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Arnold-Heller-Str. 14, 24105, Kiel, Germany

    Martin Laudien

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  1. Julia Holle
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Correspondence to Thorsten Klink.

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Klink, T., Holle, J., Laudien, M. et al. Magnetic resonance imaging in patients with granulomatosis with polyangiitis (Wegener’s) and subglottic stenosis. Magn Reson Mater Phy 26, 281–290 (2013). https://doi.org/10.1007/s10334-012-0351-6

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  • DOI: https://doi.org/10.1007/s10334-012-0351-6

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