Contrast-enhanced T2-FLAIR MR imaging in patients with uveitis

Abstract

To report MRI findings which reflect a pathological inflammatory condition of the uveal tract. This study includes single-center retrospective case series of five patients with clinical diagnosis of uveitis. There were 1 male (20 %) and 4 female patients (80 %). The average age was 29.6 years (range 25-38 years). Patients and 50 age-range-matched control subjects were scanned using a 1.5 T scanner. Ten additional control subjects scanned at 3 T were evaluated to have reference images at that high field. All patients (n = 5, 100 %) presented uveal tract enhancement on post-contrast T2-FLAIR fat-suppressed images and only 2 (40 %) had enhancement on T1-weighted images. The enhancement was anterior in 2 (40 %), pan-uveal in 2 (40 %), and posterior in 1 patient (20 %). Two patients (40 %) had unilateral increased vitreous signal on T2-FLAIR. One patient (20 %) had bilateral retrobulbar fat enhancement in both post-contrast T2-FLAIR and T1-weighted images. Post-contrast T2-FLAIR images can reveal abnormal enhancement of the uveal tract and retrobulbar fat as well as increased vitreous signal in patients with uveitis. In our small series, the sensitivity of post-contrast T2-FLAIR was higher than the conventional post-contrast T1-weighted images. Nonetheless, when bilateral uveal tract enhancement is present, there should be discretion before calling uveitis because the finding has been reported in different eye conditions as well as in a small percentage of healthy subjects at 1.5 T. In addition, it should be noted that post-contrast T2-FLAIR enhancement of the uveal tract is a normal finding at 3 T imaging.

Glymphatic System in Ocular Diseases: Evaluation of MRI Findings

“…In our study cohort, a significantly higher number of patients with an ophthalmologic disease had arterial hypertension than in the control group, indicating a vascular risk factor. We present similar findings to the reports of impairment of the blood-retina barrier in patients with uveitis 6 and optical neuritis 5 in a larger number of cases and furthermore in comparison with cases with diseases in the AEC.…”

“…This reversed enhancement pattern of the VB could be interpreted as a disruption of the blood-retinal barrier compared with the findings in cases with optic neuritis 5 and uveitis. 6 Previous studies did not report Gd diffusion through the bloodretinal barrier in healthy patients, 2,7,8,16 which is in accordance with our findings in eyes without PEC disease. GLOS has been related to patients with stroke 12 and patients with small-vessel disease, referring to age-related and vascular risk factor diseases.…”

“…2 In contrast, an increase in Gd in the vitreous body with retina (VB) has been described as gadolinium leakage in ocular structures (GLOS) in patients with acute ischemic stroke and small-vessel diseases caused by impairment of the blood-retinal barrier. 4,12 GLOS was observed in patients with uveitis 6 and optic neuritis. 5 Glymphatic dysfunction was also suggested as a possible pathomechanism for idiopathic intracranial hypertension.…”

“…2 The optic nerve and retina have similar paravascular clearance systems as parts of the CNS. 3 The diffusion of gadolinium (Gd) in the glymphatic pathway through the blood-brain barrier, the CSF barrier, and the bloodocular barrier has been demonstrated in several reports, 2,[4][5][6][7][8] especially in delayed imaging with a signal increase in different CSF compartments (anterior eye compartment [AEC], the Meckel cave, suprasellar cistern, internal auditory canal, and ambient cistern). 8 These findings reinforce the hypothesis that in the glymphatic pathway, Gd diffuses physiologically into the CSF through the choroid plexus and the aqueous chamber of the eye because there is a higher permeability for Gd in these compartments than in the blood-brain barrier and the blood-retina barrier.…”

Diagnostic Value of Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging for Multilocular Ameloblastoma

“…Fluid-attenuated inversion recovery (FLAIR) imaging is an inversion recovery technique that suppresses the signal of pure water by setting the inversion time to the time at which the magnetization of pure water equals zero. FLAIR, an MRI sequence, has important roles in brain imaging [10][11][12] and has recently been used to examine pathological areas in the eye 13) . There are few reports, however, of the potential use of FLAIR in the oral and maxillofacial region 14,15) .…”