The Diagnostic Utility of Contrast-Enhanced FLAIR Imaging in the Diagnosis of Pediatric Uveitis

TL;DR

This study shows that contrast-enhanced FLAIR imaging is more effective than T1-weighted imaging for diagnosing and assessing the severity of pediatric uveitis.

Contribution

The study demonstrates that CE-FLAIR-FS imaging has higher sensitivity and diagnostic value for pediatric uveitis compared to CE-T1WI.

Findings

CE-FLAIR-FS detected uveal tract enhancement in 50% of eyes, compared to 11.9% with CE-T1WI.

CE-FLAIR-FS showed significantly higher sensitivity and severity grading than CE-T1WI (p < 0.001).

Three patients had vitreous signal abnormalities on CE-FLAIR-FS but not on CE-T1WI.

Abstract

Objectives: Contrast-enhanced FLAIR fat-suppressed (CE-FLAIR-FS) imaging can potentially increase the diagnostic accuracy of uveal diseases and ultimately provide better patient management. This study aimed to determine the diagnostic value of CE-FLAIR-FS imaging versus contrast-enhanced T1-weighted imaging (CE-T1WI) in the assessment of pediatric patients with uveitis.

Material and methods: Twenty-one children with uveitis who underwent whole brain magnetic resonance imaging (MRI), including CE-FLAIR-FS and CE-T1WI, were retrospectively included in the study. We evaluated the presence of uveal tract contrast enhancement with thickening, vitreous humor signal abnormality, and accompanying brain abnormalities. The uveal enhancement intensity was assessed semiquantitatively as mild, moderate, and marked uveitis compared to CE-T1WI and CE-FLAIR-FS images.

Results: Panuveitis (61.9%) was the most frequent anatomic location, and most of them were idiopathic (47.6%). Of the 42 eyes with clinical uveitis, enhancement of the uveal tract was observed on CE-FLAIR-FS images in 21 eyes (50%), while in 5 eyes (11.9%) on CE-T1WI. The sensitivity of CE-FLAIR-FS in panuveitis was detected to be quite high (80.8%). The number of affected eyes and enhancement degree were found to be higher on CE-FLAIR-FS (p < 0.001). In assessing the severity of uveitis, CE-FLAIR-FS grades were significantly higher and more sensitive than CE-T1WI (p < 0.001, Z: −4.347). Three patients had vitreous abnormal signals on CE-FLAIR-FS images, but none on CE-T1WI.

Conclusion: CE-FLAIR-FS plays a significant role in the diagnosis of pediatric uveitis, identifying the involvement and severity of the uveal inflammation and guiding the appropriate management. It would be beneficial to add it as a standard sequence to the routine MRI protocol for uveal pathologies.

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