Imaging characteristics of hypertrophic pachymeningitis due to ANCA-associated vasculitis

Takagi, Toshiharu; Okada, Masahiro; Nakamura, Masashi; Hanari, Takahiro; Nakata, Takashi; Teraoka, Masato; Hato, Naohito

doi:10.1016/j.anl.2022.01.009

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Accordingly, our study also suggested that inflammatory lesions adjacent to the CNS, notably including eye and middle ear involvement, may be robustly implicated in HP development in AAV. In fact, it was demonstrated that HP, which was related to otitis media with AAV (OMAAV), was the most commonly localized in a cranial fossa [31]. This study also demonstrated that headache and cranial neuropathies were common neurological symptoms associated with HP in both newly diagnosed and relapsed AAV, consistent with previous reports [8,10,[15][16][17][18][19][20].…”

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confidence: 90%

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Hypertrophic pachymeningitis in ANCA-associated vasculitis: a cross-sectional and multi-institutional study in Japan (J-CANVAS)

et al. 2022

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Background This study investigated the characteristics of hypertrophic pachymeningitis (HP) in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), using information from a multicenter study in Japan. Methods We analyzed the clinical information of 663 Asian patients with AAV (total AAV), including 558 patients with newly diagnosed AAV and 105 with relapsed AAV. Clinical findings were compared between patients with and without HP. To elucidate the relevant manifestations for HP development, multivariable logistic regression analyses were additionally performed. Results Of the patients with AAV (mean age, 70.2 ± 13.5 years), HP was noted in 30 (4.52%), including 20 (3.58%) with newly diagnosed AAV and 10 (9.52%) with relapsed AAV. Granulomatosis with polyangiitis (GPA) was classified in 50% of patients with HP. A higher prevalence of GPA was significantly observed in patients with HP than in those without HP in total AAV and newly diagnosed AAV (p < 0.001). In newly diagnosed AAV, serum proteinase 3 (PR3)-ANCA positivity was significantly higher in patients with HP than in those without HP (p = 0.030). Patients with HP significantly had ear, nose, and throat (ENT) (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.03–2.14, p = 0.033) and mucous membrane/eye manifestations (OR 5.99, 95% CI 2.59–13.86, p < 0.0001) in total AAV. Moreover, they significantly had conductive hearing loss (OR 11.6, 95% CI 4.51–29.57, p < 0.0001) and sudden visual loss (OR 20.9, 95% CI 5.24–85.03, p < 0.0001). Conclusion GPA was predominantly observed in patients with HP. Furthermore, in newly diagnosed AAV, patients with HP showed significantly higher PR3-ANCA positivity than those without HP. The ear and eye manifestations may be implicated in HP development.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Hypertrophic pachymeningitis in ANCA-associated vasculitis: a cross-sectional and multi-institutional study in Japan (J-CANVAS)

et al. 2022

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“…The internal auditory meatus is not an ordinary site of AAV-related HP, and previous reports of AAV have not mentioned the dura mater of the internal auditory meatus as a possible site affected by HP. (2)(3)(4)(5)(6)11,12) Recently, it has been reported that HP involving the internal auditory meatus may be a characteristic finding in AAV/OMAAV (13), which is consistent with our results. As shown in Figure 2B, dural thickening of the internal auditory meatus may easily be overlooked when reviewing images without caution.…”

Section: Discussionsupporting

confidence: 93%

Locations and Predictive Factors of Hypertrophic Pachymeningitis in Otitis Media With Antineutrophil Cytoplasmic Antigen-Associated Vasculitis

Morita¹,

Kitazawa²,

Yagi³

et al. 2022

Otol Neurotol

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Objective: To determine the locations and predictive factors of hypertrophic pachymeningitis (HP), a serious central complication of otitis media with antineutrophil cytoplasmic antigen-associated vasculitis (OMAAV). Study Design: Retrospective study. Setting: University hospital. Patients: Thirty-six patients with OMAAVunderwent contrast-enhanced magnetic resonance imaging (CE-MRI) of the brain, of whom 18 and 18 had or did not have HP, respectively. Main Outcome Measures: The location of HP lesions, which were detected as dural thickening on CE-MRI, was reviewed. Clinical characteristics, laboratory data, and audiometric data before treatment were correlated with the occurrence of HP. Results: HP lesions were most frequently observed in the middle cranial fossa, followed by the internal auditory meatus, tentorium cerebelli, and posterior cranial fossa, which were adjacent to the middle ear primary lesion. Headache was more frequently observed in patients with HP than without HP. The neutrophil-to-lymphocyte ratio (NLR) of the HP (+) group (median, 3.91; interquartile range, 2.50-6.06) was higher than that of the HP (−) group (median, 2.40; interquartile range, 2.01-3.03). The area under the receiver operating characteristic curve for the NLR was 0.741. An NLR of 3.46 had the highest sensitivity (61.1%) and specificity (94.4%) for predicting HP. Other markers of systemic inflammation and comorbidities of systemic diseases were not different between the groups. Conclusions: HP may not be a systemic manifestation of OMAAV but may be related to local lesions in the adjacent brain. A high NLR may be a predictive factor for comorbid HP. Therefore, CE-MRI should be considered for patients with a high NLR.

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Hypertrophic pachymeningitis in ANCA-associated vasculitis: Clinical and immunopathological features and insights

Shimojima

Sekijima

2023

Autoimmunity Reviews

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Imaging characteristics of hypertrophic pachymeningitis due to ANCA-associated vasculitis

Cited by 5 publications

References 21 publications

Hypertrophic pachymeningitis in ANCA-associated vasculitis: a cross-sectional and multi-institutional study in Japan (J-CANVAS)

Hypertrophic pachymeningitis in ANCA-associated vasculitis: a cross-sectional and multi-institutional study in Japan (J-CANVAS)

Locations and Predictive Factors of Hypertrophic Pachymeningitis in Otitis Media With Antineutrophil Cytoplasmic Antigen-Associated Vasculitis

Hypertrophic pachymeningitis in ANCA-associated vasculitis: Clinical and immunopathological features and insights

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