Accuracy of Magnetic Resonance Imaging for Grading of Subglottic Stenosis in Patients With Granulomatosis With Polyangiitis: Correlation With Pulmonary Function Tests and Laryngoscopy

Henes, Frank Oliver; Laudien, Martin; Linsenhoff, Laura; Bremer, Jan Phillip; Oqueka, Tim; Adam, Gerhard; Schön, Gerhard; Bannas, Peter

doi:10.1002/acr.23332

Cited by 14 publications

(11 citation statements)

References 31 publications

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“…Biopsy findings of the trachea or bronchi are usually nonspecific [ 32 , 33 ]. Thin-section CT helps in the assessment of the depth of tissue spread [ 34 - 36 ]. MRI and laryngoscopy provide comparable results for grading of subglottic stenosis in GPA and correlate well with pulmonary function testing [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Granulomatous Polyangiitis With Renal Involvement: A Case Report and Review of Literature

Koritala¹,

Mene²,

Schaefer³

et al. 2021

Cureus

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Granulomatosis with polyangiitis (GPA), formerly named Wegner’s granulomatosis is an antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis of the small vessels. GPA can affect several organ systems even though predominantly affects respiratory and renal systems. Pathogenesis is initiated by activation of the immune system to produce ANCA, Cytoplasmic (C-ANCA) antibody, which thereby leads to widespread necrosis and granulomatous inflammation. Multisystem involvement with varied symptomatology makes GPA diagnosis more challenging. Early diagnosis and management are vital and can alter the prognosis of the disease. We present a literature review and a clinical scenario of a 26-year-old male with a history of chronic sinusitis, testicular carcinoma in remission, recent onset of worsening cough, epistaxis, hoarseness of voice, weight loss, and dark-colored urine. Workup revealed high titers of C-ANCA, C-reactive protein, procalcitonin, CT chest evidence of mass-like consolidation, and bronchoscopy findings of friable tissue that was not amenable for biopsy. Methylprednisolone and rituximab (RTX) were administered, which resulted in marked clinical improvement. Therefore, a keen eye for details is necessary to diagnose GPA early, which can improve disease outcomes dramatically.

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Section: Discussionmentioning

confidence: 99%

Granulomatous Polyangiitis With Renal Involvement: A Case Report and Review of Literature

Koritala¹,

Mene²,

Schaefer³

et al. 2021

Cureus

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“…Good correlations between spirometry outcomes and lumen areas suggest that MRI measurements could aid in understanding the anatomical substrate causing airflow obstruction, as indicated by a previous study. 14 A more affordable and widely available alternative method could be flexible nasal endoscopy, however, this method is unsuitable to evaluate anatomy below the vocal cords, is non- quantitative and can be challenging in case of arytenoid prolapse. Therefore, we consider flexible nasal endoscopy not a realistic alternative to laryngotracheoscopy nor to MRI.…”

Section: Discussionmentioning

confidence: 99%

MRI of the upper airways in children and young adults: the MUSIC study

Elders

Ciet

Tiddens

et al. 2020

Thorax

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RationalePaediatric laryngotracheal stenosis (LTS) is often successfully corrected with open airway surgery. However, respiratory and vocal sequelae frequently remain. Clinical care and surgical interventions could be improved with better understanding of these sequelae.ObjectiveThe objective of this cross-sectional study was to develop an upper airway MRI protocol to obtain information on anatomical and functional sequelae post-LTS repair.MethodsForty-eight patients (age 14.4 (range 7.5–30.7) years) and 11 healthy volunteers (15.9 (8.2–28.8) years) were included. Spirometry and static and dynamic upper airway MRI (3.0 T, 30 min protocol) were conducted. Analysis included assessment of postoperative anatomy and airway lumen measurements during static and dynamic (inspiration and phonation) acquisitions.Main resultsGood image quality without artefacts was achieved for static and dynamic images in the majority of MRIs. MRI showed vocal cord thickening in 80.9% of patients and compared with volunteers, a significant decrease in vocal cord lumen area (22.0 (IQR 17.7–30.3) mm2 vs 35.1 (21.2–54.7) mm2, p=0.03) but not cricoid lumen area (62.3±27.0 mm2 vs 66.2±34.8 mm2, p=0.70). Furthermore, 53.2% of patients had an A-frame deformation at site of previous tracheal cannula, showing lumen collapse during inspiration. Dynamic imaging showed incomplete vocal cord abduction during inspiration in 42.6% and incomplete adduction during phonation in 61.7% of patients.ConclusionsStatic and dynamic MRI is an excellent modality to non-invasively image anatomy, tissue characteristics and vocal cord dynamics of the upper airways. MRI-derived knowledge on postsurgical LTS sequelae might be used to improve surgery.

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“…This is particularly important for laryngeal diseases with complex anatomy, such as laryngotracheal stenosis, laryngoceles, and haemangioma which are easily identified on MRI . Most selected studies compared the anatomy as shown on MRI to CT. No pediatric studies comparing MRI to laryngoscopy were found, but a comparative study in the adult population shows promising results in favor of MRI …”

Section: Discussionmentioning

confidence: 99%

“…In the pediatric population, the choice of the right modality should be carefully considered according to the wide variety of pathologies and the patient's age. Direct laryngoscopy is the gold standard for early diagnostics of the pediatric larynx and vocal cords, but its disadvantages are the operator‐dependant diagnostic accuracy, the absence of objective measurements, limited detailed imaging, and the need for anesthetics to get a clear view of the subglottis . Computed Tomography (CT) is used for extensive imaging of the larynx after surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging of the larynx in the pediatric population: A systematic review

Elders

Hermelijn

Tiddens

et al. 2019

Pediatric Pulmonology

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Background Magnetic Resonance Imaging (MRI) techniques to image the larynx have evolved rapidly into a promising and safe imaging modality, without need for sedation or ionizing radiation. MRI is therefore of great interest to image pediatric laryngeal diseases. Our aim was to review MRI developments relevant for the pediatric larynx and to discuss future imaging options. Methods A systematic search was conducted to identify all morphological and diagnostic studies in which MRI was used to image the pediatric larynx, laryngeal disease, or vocal cords. Results Fourteen articles were included: three studies on anatomical imaging of the larynx, two studies on Diffusion Weighted Imaging, four studies on vocal cord imaging and five studies on the effect of anaesthesiology on the pediatric larynx. MRI has been used for pediatric laryngeal imaging since 1991. MRI provides excellent soft tissue contrast and good visualization of vascular diseases such as haemangiomas. However, visualization of cartilaginous structures, with varying ossification during childhood, and tissue differentiation remain challenging. The latter has been partly overcome with diffusion weighted imaging (DWI), differentiating between benign and malignant masses with excellent sensitivity (94‐94.4%) and specificity (91.2‐100%). Vocal cord imaging evolved from static images focused on vocal tract growth to dynamic images able to detect abnormal vocal cord movement. Conclusion MRI is promising to evaluate the pediatric larynx, but studies using MRI as diagnostic imaging modality are scarce. New static and dynamic MR imaging techniques could be implemented in the pediatric population. Further research on imaging of pediatric laryngeal diseases should be conducted.

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Accuracy of Magnetic Resonance Imaging for Grading of Subglottic Stenosis in Patients With Granulomatosis With Polyangiitis: Correlation With Pulmonary Function Tests and Laryngoscopy

Abstract: 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.

Cited by 14 publications

References 31 publications

Granulomatous Polyangiitis With Renal Involvement: A Case Report and Review of Literature

Granulomatous Polyangiitis With Renal Involvement: A Case Report and Review of Literature

MRI of the upper airways in children and young adults: the MUSIC study

Magnetic resonance imaging of the larynx in the pediatric population: A systematic review

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