[The magnetic resonance tomographic signs of Wegener's granulomatosis in the head area]. / Magnetresonanztomographische Kennzeichen der Wegenerschen Granulomatose im Kopfbereich.

MRI of the head was performed in 25 patients suffering from Wegener's granuloma. 23 patients showed evidence of mucosal thickening in the paranasal sinuses, the middle and inner ears and in the mastoid cells; these were characterised by low signal intensity of T1-weighted and high signal intensity of T2-weighted images. In 10 patients there were granulomas in the paranasal sinuses and in the orbits which showed low signal intensity of both T1-weighted and T2-weighted images. In 4 patients, additional images were obtained after the intravenous injection of Gd-DTPA. In 2 patients this resulted in non-homogeneous contrast accumulation in the granuloma. In 7 patients there were signal changes in the brain which were typical of infarcts. The complete extent of bone destruction in the facial skeleton was visible only by CT.

Orbital involvement in Wegener's granulomatosis.

Orbital granulomas may complicate the course of Wegener's granulomatosis (WG). Granulomas that grow and compress the optic nerve may lead to blindness. Careful magnetic resonance imaging (MRI) is recommended for early detection and follow-up of intraorbital granulomas. Sufficient systemic immunosuppressive treatment should be given as usual for Wegener's granulomatosis. In order to preserve vision orbital decompression may be necessary in rapidly progressive pseudotumor of the orbit.

MRI of the head in Wegener's granulomatosis.

MRI of the head was performed in 25 patients suffering from Wegener's granulomatosis. 23 patients showed mucosal inflammation in the nasal cavity and in the paranasal sinuses, 10 patients had granulomas in the paranasal sinuses and in the orbits, 7 patients had cerebral lesions, 3 patients had submucosal hemorrhages in the paranasal sinuses and 3 patients showed bone erosions or destructions in the facial skeleton, which was visible only by CT.

[Orbital involvement in Wegener's granulomatosis]. / Orbitale Beteiligung bei Wegenerscher Granulomatose.

BACKGROUND: Granulomas of the orbit can complicate Wegener's granulomatosis (WG). If they compress the optic nerve, blindness of one or both eyes may result. Therefore, early detection and sufficient treatment are important. MATERIAL AND METHODS: Computed tomography (CT) and magnetic resonance imaging (MRI) of the orbit and CNS were performed in patients suffering from WG and orbital granulomas (n = 6). The patients were seen interdisciplinary by internists, ENT-specialists, radiologists and ophthalmologists. RESULTS: 12 out of 121 biopsy proven WG-patients showed orbital granulomas during their disease process. Granulomas of the orbit could be best visualized by MRI. However, MRI and CT taken together were most informative. 6 patients with orbital granulomas are presented as case reports, in four of them WG lead to blindness of one eye. The course of orbital granulomas may be chronic progressive or acutely fulminant. Therapy of first choice is a high dosage, long-term immunosuppression with cyclophosphamide and prednisolone. CONCLUSIONS: The detection of orbital granulomas in WG is most successful using CT and MRI. In addition to that, the analysis of visual acuity and visual field are the most important parameters in the detection and follow-up of orbital granulomas. A high dosage, long-term immunosuppression is the treatment of first choice, but in rapidly progressive cases an early decompression of the orbit has to be discussed additionally.