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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
Author(s) -
Henes Frank O.,
Laudien Martin,
Linsenhoff Laura,
Bremer Jan P.,
Oqueka Tim,
Adam Gerhard,
Schön Gerhard,
Bannas Peter
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23332
Subject(s) - medicine , granulomatosis with polyangiitis , laryngoscopy , magnetic resonance imaging , subglottic stenosis , grading (engineering) , radiology , stenosis , pulmonary function testing , nuclear medicine , surgery , intubation , vasculitis , civil engineering , disease , engineering
Objective To compare magnetic resonance imaging (MRI)–based and laryngoscopy‐based subglottic stenosis (SGS) grading with pulmonary function testing (PFT) in patients with granulomatosis with polyangiitis (GPA). Methods In this retrospective study, we included 118 examinations of 44 patients with GPA and suspected SGS. All patients underwent MRI, laryngoscopy, and PFT. Stenosis was graded on a 4‐point scale by endoscopy and MRI using the Meyer‐Cotton (MC) score (score 1: ≤50%, 2: 51–70%, 3: 71–99%, and 4: 100%) and as percentage by MRI. Results were compared with peak expiratory flow (PEF) and maximum inspiratory flow (MIF) from PFT, serving as objective functional reference. Results In MRI, 112 of 118 examinations (95%) were rated positive for SGS (grade 1 [n = 82], grade 2 [n = 26], and grade 3 [n = 4]), whereas in laryngoscopy 105 of 118 examinations (89%) were rated positive for SGS (grade 1 [n = 73], grade 2 [n = 24], and grade 3 [n = 8]). MRI and laryngoscopy agreed in 75 of 118 examinations (64%). MRI determined higher scores in 20 examinations (17%) and lower scores in 23 examinations (19%) compared to laryngoscopy. MC scores as determined by both MRI and laryngoscopy showed comparable correlations with PEF (r = −0.363, P = 0.016, and r = −0.376, P = 0.012, respectively) and MIF (r = −0.340, P = 0.024, and r = −0.320, P = 0.034, respectively). The highest correlation was found between MRI‐based stenosis grading in percentage with PEF (r = −0.441, P = 0.003) and MIF (r = −0.413, P = 0.005). Conclusion 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.