CT and MR Imaging in the Diagnosis of Scleritis

Fellows’ Journal Club

Scleritis is a rare vision-threatening condition that can occur isolated or in association with other orbital abnormalities and whose etiology is typically inflammatory/noninfectious, either idiopathic or in the context of systemic disease. The authors analyzed 11 cases of scleritis in which CT and/or MR imaging were performed during the active phase of disease and assessed the diagnostic utility of these techniques. The most important imaging findings of scleritis were scleral enhancement, scleral thickening, and focal periscleral cellulitis. MR imaging is the recommended imaging technique.

Summary

Figure 1 from paper
Asynchronous IOID with scleritis. A, CECT depicts outward, eccentric thickening and enhancement of the right globe wall with focal periscleral cellulitis (black arrow), compatible with posterior scleritis. There is associated pre- and postseptal cellulitis (white arrow) and proptosis. B, CECT 18 months after examination (A) shows almost identical findings in the left orbit. Black and white arrows point to the scleritis and cellulitis, respectively. Notice the complete resolution of the alterations of the right orbit. Also, notice involvement of the tendon of the lateral rectus anteriorly (dashed arrow).

Scleritis is a rare, underdiagnosed vision-threatening condition that can occur isolated or in association with other orbital abnormalities. The etiology of scleritis is mainly inflammatory noninfectious, either idiopathic or in the context of systemic disease. Ultrasonography remains the criterion standard in diagnostic imaging of this condition but might prove insufficient, and studies on the diagnostic value of CT and MR imaging are lacking. We retrospectively analyzed 11 cases of scleritis in which CT and/or MR imaging were performed during the active phase of disease and assessed the diagnostic utility of these techniques. The most important imaging findings of scleritis were scleral enhancement, scleral thickening, and focal periscleral cellulitis. MR imaging is the recommended imaging technique, though posterior scleritis also can be accurately diagnosed on CT. It is important for the radiologist to be acquainted with these findings because being able to diagnose scleritis is of clinical significance and might be vision-saving.

 

Read this article: http://bit.ly/2h7DYeo

CT and MR Imaging in the Diagnosis of Scleritis
jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.