Enhanced fallopian canal as a potential marker for temporal bone vasculitis

Area of Science:

• Radiology and Imaging
• Otolaryngology
• Rheumatology

Background:

• Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) can affect the temporal bone, leading to otologic symptoms.
• Diagnosing vasculitis in the fallopian canal is crucial for managing AAV-related hearing loss and other ear conditions.

Purpose of the Study:

• To evaluate the efficacy of contrast-enhanced 3D MRI with gradient-echo sequences (CE-3D-GRE) in detecting signs of vasculitis within the fallopian canal in patients with AAV.
• To correlate radiological findings with otologic symptoms and disease activity in AAV patients.

Main Methods:

• CE-3D-GRE MRI at 3.0 Tesla was performed on four AAV patients during disease onset, relapse, and remission.
• Clinical data on otologic symptoms were collected and correlated with MRI findings.
• Signal intensity in the mastoid segment of the fallopian canal was compared between active disease and remission/non-vasculitic states.

Main Results:

• Intense enhancement of the tympanic and mastoid segments of the fallopian canal was observed in active disease, correlating with external otitis, otitis media, and sensorineural hearing loss.
• Maximal intensity projection images revealed a link between fallopian canal enhancement and middle ear inflammation.
• Signal intensity was significantly higher in active disease (P < .001) and normalized during remission (P = .597).

Conclusions:

• CE-3D-GRE MRI is effective in visualizing temporal bone vasculitis in AAV patients, reflecting disease activity and the severity of otologic manifestations.
• Intense enhancement of the fallopian canal on CE-3D-GRE serves as a potential imaging biomarker for temporal bone vasculitis in AAV.